King Kathryn M, King Philip J, Nayar Rahul, Wilkes Scott
University of Sunderland, Sunderland, Tyne and Wear, UK.
Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK.
Diabetes Spectr. 2017 Feb;30(1):23-35. doi: 10.2337/ds15-0041.
The care and management of adolescents with type 1 diabetes presents numerous challenges that are inherent to the fears, attitudes, and perceptions of their illness. This qualitative study aimed to explore the "lived experience" of individuals with type 1 diabetes. In-depth interviews were conducted with 20 patients diagnosed with type 1 diabetes in their adolescent years to elicit their views, perceptions, and concerns regarding living with diabetes. All interviews were conducted and analyzed using the principles of grounded theory. Five categories defining the patients' lived experience were elicited: Barriers, Develop Skills, Manage Emotion, Social World, and Health Care Professionals. The problems experienced by adolescents with type 1 diabetes are multifactorial. Existentially, type 1 diabetes affects their daily activities and impinges on their academic achievement and personal aspirations. They have great difficulty coping with their health status and highlight a lack of empathy from health care professionals (HCPs). Their major fear is of hypoglycemia, resulting in their subsequent focus of preventing hypoglycemic episodes. Indeed, regardless of consequence, blood glucose levels are often deliberately kept above recommended levels, which serves to decrease the effectiveness of their health care management. This study shows that the quality of care provided for adolescent patients with type 1 diabetes is failing to meet their expectations and falls short of the essential standards commensurate with current health care policy. Improvements in long-term care management for these patients require changes in both patients' and professionals' understanding of the disease and of the ways it is managed.
对 1 型糖尿病青少年患者的护理和管理面临着诸多挑战,这些挑战源于他们对疾病的恐惧、态度和认知。这项定性研究旨在探索 1 型糖尿病患者的“生活体验”。对 20 名在青少年时期被诊断为 1 型糖尿病的患者进行了深入访谈,以了解他们对糖尿病生活的看法、认知和担忧。所有访谈均按照扎根理论的原则进行并分析。得出了定义患者生活体验的五个类别:障碍、培养技能、管理情绪、社交世界和医护人员。1 型糖尿病青少年患者所经历的问题是多因素的。从生存角度来看,1 型糖尿病影响他们的日常活动,影响他们的学业成绩和个人抱负。他们在应对自身健康状况方面存在很大困难,并强调医护人员缺乏同理心。他们最主要的恐惧是低血糖,这导致他们随后将重点放在预防低血糖发作上。事实上,无论后果如何,血糖水平往往被故意维持在推荐水平之上,这降低了他们医疗管理的效果。这项研究表明,为 1 型糖尿病青少年患者提供的护理质量未能达到他们的期望,也未达到与当前医疗政策相称的基本标准。改善这些患者的长期护理管理需要患者和专业人员在对疾病及其管理方式的理解上都做出改变。