PubMed Health⌕ Search

Biomedical subjects

Kathleen A Knafl

Publications and source records attributed to Kathleen A Knafl.

13 recordsLinked to original sources
PubMed2006

Changing patterns of self-management in youth with type I diabetes.

Self-management of type I diabetes is key to good physical and psychosocial outcomes of the disease, yet little is known about how youth and their parents share responsibility for illness management. This study describes the division of labor between youth and their parents, self-management conflict, and three patterns of self-management in youth across four developmental stages: preadolescence, early adolescence, mid-adolescence, and late adolescence. Twenty-two youth (8-19 years) with type I diabetes and one of their parents were interviewed using semistructured interviews. Data were analyzed using qualitative content analysis. Results indicated that parents of preadolescents (8-11 years) performed much of their children's diabetes care. Dyads reported some conflicts, particularly over food, amount of bolus, and blood glucose testing. The dyads demonstrated a self-management pattern that we identified as parent-dominant. Most early adolescents (11-15 years) performed much of their own daily care, but parents actively participated in their self-management and oversaw it. The majority of dyads reported conflict over food and blood glucose testing. Most early adolescents demonstrated a transitional self-management pattern whereby they managed their own daily care, with varying amounts of parental oversight. In mid-adolescence (15-17 years), youth managed nearly all of their diabetes care; however, some dyads reported that parental oversight of illness care was still considerable. Exercise was conflictual for the majority of these dyads. Over half of the youth and, by late adolescence (17-19 years), all youth demonstrated a pattern of adolescent-dominant self-management. In adolescent-dominant self-management, youth independently managed their diabetes. Half of the dyads reported that there were sometimes conflicts over food and blood glucose testing. Understanding the nature of sharing self-management responsibilities, the nature of conflict in carrying out such responsibilities, and the pattern of self-management may help nurses provide more targeted assistance to youth with diabetes and to their parents.

Adaptation, Psychological↗
PubMed2006

Dimensional analysis of the concept of obesity.

AIM: The aim of this paper is to explore the evolution of the concept of obesity and to identify variations in its meaning and use from the perspectives of healthcare professionals and Black Americans, Caucasian Americans, and Latino Americans. BACKGROUND: Obesity constitutes an emerging global healthcare epidemic. Little convergence is found between the meaning and use of the concept of obesity by healthcare professionals and those they are trying to serve. This lack of convergence points to the need for exploration of the assumptions, use and various meanings associated with this important concept. METHOD: The analysis included 20 papers from 18 research studies from the fields of nursing, psychology, epidemiology, medicine, and sociology. Caron and Bowers' dimensional analysis method guided the analysis. RESULTS: Eight dimensions were identified: objective measure, attractiveness, sexual desirability, health, body image, strength or goodness, self-esteem, and social acceptability. Substantial differences in assumptions, use, and meanings of this concept were found within and between the perspectives studied. However, there were insufficient data to fully assess use and meaning of the concept of obesity from the Latino American perspective. CONCLUSION: This analysis contributes to the development of an understanding of the meaning and use of the concept of obesity within varied socio-cultural contexts as well as from a healthcare perspective. Culture was found to play a significant role in how obesity is understood by the individual.

Attitude of Health Personnel↗
PubMed2005

Mixed models incorporating intra-familial correlation through spatial autoregression.

Family researchers are challenged by the need to account for the special forms of statistical dependence that can exist in family data. To address this issue, mixed modeling methods were adapted to account for dependence of continuous outcomes measured across multiple family members. This was accomplished using a spatial autoregressive approach that accounts for dependence on direction as well as on distance apart. For family data, the dimensions underlying direction can correspond to different family members, thereby accounting for different correlations between family members. When the data are also longitudinal, a dimension representing distance apart in time also can be included to account for temporal correlation. Fixed effects involving general linear models can be included as well. Example analyses were conducted to demonstrate the use of the spatial autoregressive approach for modeling intra-familial correlation.

Clinical Nursing Research↗
PubMed2003

Older women's response to residential relocation: description of transition styles.

Older women relocating to institutional facilities are at risk for negative outcomes such as poorer health, decreased self-esteem, increased sense of social isolation and loneliness, loss of social support, and depression. However, little is known about relocation to congregate living facilities (CLF), the relocation transition process, or factors that contribute to outcomes. The perspectives of 31 women on their relocation experiences to CLF were elicited using a naturalistic approach. The Schumacher & Meleis nursing model of transitions was used to focus the study. Three distinct relocation transition styles emerged: Full Integration (45%), Partial Integration (42%), and Minimal Integration (13%). By understanding the characteristics and risk factors of relocation, unhealthy outcomes can be minimized and healthy outcomes promoted.

Adaptation, Psychological↗
PubMed2003

Within-case and across-case approaches to qualitative data analysis.

The generalizations developed by qualitative researchers are embedded in the contextual richness of individual experience. Qualitative data management strategies that depend solely on coding and sorting of texts into units of like meaning can strip much of this contextual richness away. To prevent this, some authors have recommended treating individual accounts as whole cases or stories, but whole cases are difficult to compare with one another when the goal of the research is to develop generalizations that represent multiple accounts. In this article, the authors describe the ways in which three different qualitative researchers combined across-case coding and sorting with a variety of within-case data management and analysis techniques to produce contextually grounded, generalizable findings.

Caregivers↗
PubMed2002

The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis.

AIM: An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents. BACKGROUND: Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults. METHODS: Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts. RESULTS: The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested. CONCLUSIONS: It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.

Adolescent↗
PubMedDate not supplied

Parents sharing information with their children about genetic conditions.

INTRODUCTION: Nurses are in an ideal situation to help families share information with their children about genetic conditions. While many factors contribute to this decision making, little is known about how parents decide when and how to convey this information to their children. The purpose of this qualitative analysis was to examine parents' beliefs and strategies related to sharing information about a genetic condition with their affected and unaffected children. METHOD: One hundred thirty-nine parents participated in this study. Narrative analysis and fundamental qualitative description were employed to identify approaches and strategies that parents used to share information with their children. RESULTS: Parents' information sharing approaches and strategies were grounded in the goal of promoting the child's adaptation to the genetic condition. Parents shared information based on their assessment of the child's developmental readiness and interest and described information sharing as an unfolding process that continued throughout childhood. DISCUSSION: The approaches and strategies contribute to understanding the processes associated with information sharing between parents and their children and between health care professionals and parents.

Adaptation, Psychological↗
PubMedDate not supplied

A review of measures of self-management of type 1 diabetes by youth and their parents.

PURPOSE: The purpose of this paper was to identify and critique relevant existing instruments designed to measure self-management of type 1 diabetes in children and adolescents. METHODS: Literature on the self-management of type 1 diabetes in children and adolescents was systematically searched to identify instruments measuring self-management. After eliminating instruments that measured only one aspect of self-management, those published prior to DCCT findings, and those for which little information was available, 6 instruments were identified for review. Each instrument is discussed in terms of history and description of the instrument, definitions, psychometrics, findings from studies using the instrument, availability of the instrument, and evaluation. RESULTS: All of the instruments measure some of the activities of self-management; 1 expressly measures self-management; 1 measures the frequency of various self-care activities, and 4 measure adherence to prescribed diabetes regimens. Only 1 instrument comprehensively assesses the process of self-management. None measure the goals of self-management. CONCLUSIONS: Instrument development has been hindered by the lack of clarity concerning the concept of self-management of type 1 diabetes in children and adolescents. Existing measures need to be further developed and new measures need to be designed.

Adolescent↗
PubMedDate not supplied

Family management style and the challenge of moving from conceptualization to measurement.

This article describes the process of translating the Family Management Style (FMS) Framework into a measure of FMS Survey. The conceptual underpinnings of the FMS Survey are briefly described as are the steps for translating the FMS major components and dimensions into a questionnaire to assess the family response to a childhood chronic illness. Content validity testing has been completed on the FMS Survey. Future plans include full-scale field testing of remaining psychometric properties.

Adaptation, Psychological↗
PubMedDate not supplied

Great expectations: a position description for parents as caregivers: Part I.

Parents caring for a child with a chronic condition must attend to a myriad of day-to-day management responsibilities and activities. This two-part series examines parental roles and responsibilities in detail. Part I will review both the adult and pediatric family caregiving literature. It will also describe four major caregiving responsibilities with associated tasks in both direct and indirect illness-related care, which parents are expected to perform when caring for a child with a chronic condition. These are: (a) managing the illness; (b) identifying, accessing, and coordinating resources; (c) maintaining the family unit; and (d) maintaining self. Part II (to be published in the next issue of Pediatric Nursing) will present a multifaceted list of parent caregiving management responsibilities and associated activities drawn from the literature. Clinical nursing implications associated with caregiver responsibilities and tasks will also be addressed.

Adaptation, Psychological↗
PubMedDate not supplied

Great expectations: a position description for parents as caregivers: Part II.

Parents caring for a child with a chronic condition must attend to a myriad of day-to-day management responsibilities and activities. Part I of this two-part series (in the previous issue of Pediatric Nursing) reviewed both the adult and pediatric family caregiving literature within the context of four major categories of responsibilities: (a) managing the illness, which includes hands-on care, monitoring and interpreting signs and symptoms, as well as problem-solving and decision-making processes; (b) identifying, accessing, and coordinating resources, which involves assessing and negotiating community resources including health care providers; (c) maintaining the family unit, including balancing illness and family demands while at the same time attempting to meet the health and developmental needs of each family member; and (d) maintaining self, including physical, emotional, and spiritual health.. Part II presents a multifaceted list of parent caregiving management responsibilities and associated activities, and discusses nursing implications. The list was developed to facilitate "caregiving" dialogue between health care providers and families of children with chronic conditions. It is hoped that through such partnerships creative ways of educating, preparing, and supporting caregivers will be generated.

Adult↗