Hiratsuka Katsuhiro, Nakamura Nobue
Department of Nursing, School of Nursing and Rehabilitation Sciences, Showa Medical University, 1865, Tokaichibacho, Yokohama Midori-ku, Yokohama 226-8555, Japan.
Department of Nursing Science, Uekusa Gakuen University, 1639-3, Oguracho, Chiba Wakaba-ku, Chiba 264-0007, Japan.
Nurs Rep. 2025 Aug 21;15(8):308. doi: 10.3390/nursrep15080308.
This study conducted a secondary and integrative analysis of qualitative data on adolescents and young adults (AYAs) with biliary atresia who survive with their native livers. These individuals struggle with independence and self-care due to prolonged parental involvement. Prior studies have insufficiently clarified how AYAs and parents jointly navigate daily responsibility transitions during this period. Therefore, we aimed to elucidate this process and develop a practical model to support nursing care. Semi-structured interview data from eight adolescent-parent dyads (one male and seven females, aged 17-25; one father and seven mothers, aged 40-60) were reanalyzed using the modified grounded theory approach. By reframing the analytical focus on dyadic interactions, four transition phases were identified, which were then integrated with the findings of two prior studies to construct an integrative process model. The transition comprised four phases: (1) parent-led recuperation, (2) a vicious cycle of control and rebellion, (3) passing the axis of responsibility, and (4) aligning the parent-child rhythm to create a patient-centered life. The transition processes were shaped by changes in cognition and behavior. The model illustrates mutual adaptation through communication, negotiation, and reflection, identifying opportunities for nursing intervention. This process model offers a practical framework for nurses to assess readiness for care transitions, support transitional role shifts, and co-develop care strategies. The model provides insights into relationship-based communication and shared decision-making in transitional care by capturing the relational dynamics between AYAs and their parents.
本研究对患有胆道闭锁且肝脏未移植而存活下来的青少年和青年（AYAs）的定性数据进行了二次综合分析。由于父母长期的参与，这些个体在独立和自我护理方面存在困难。先前的研究尚未充分阐明AYAs及其父母在此期间如何共同应对日常责任的转变。因此，我们旨在阐明这一过程，并开发一个实用模型来支持护理工作。我们使用改良的扎根理论方法，对来自八个青少年-父母二元组（一名男性和七名女性，年龄在17 - 25岁；一名父亲和七名母亲，年龄在40 - 60岁）的半结构化访谈数据进行了重新分析。通过将分析重点重新聚焦于二元互动，确定了四个过渡阶段，然后将其与之前两项研究的结果相结合，构建了一个综合过程模型。该过渡包括四个阶段：（1）父母主导的康复阶段，（2）控制与叛逆的恶性循环阶段，（3）责任轴心的转移阶段，以及（4）调整亲子节奏以创造以患者为中心的生活阶段。过渡过程受到认知和行为变化的影响。该模型通过沟通、协商和反思说明了相互适应的过程，并确定了护理干预的机会。这个过程模型为护士评估护理过渡的准备情况、支持过渡角色转变以及共同制定护理策略提供了一个实用框架。该模型通过捕捉AYAs与其父母之间的关系动态，为过渡护理中基于关系的沟通和共同决策提供了见解。
