The School-Based Lived Experiences of Adolescents with Type 1 Diabetes

第一型糖尿病青少年校園生活經驗

王月伶(Yueh-Ling Wang) ； Sharon A. Brown ； Sharon D. Horner

《The Journal of Nursing Research》 21卷4期 (2013/12) Pp. 235-243

https://doi.org/10.1097/JNR.0000000000000003

摘要

背景　學校在第一型糖尿病青少年的健康、安全、發展與安適上扮演重要角色，然而至今探討糖尿病青少年校園生活經驗的研究卻極少。目的　本研究目的在於探討台灣第一型糖尿病青少年之校園生活經驗。方法　海德格詮釋現象學為本研究之研究方法與哲學基礎，以滾雪球方式目標取樣14位罹有第一型糖尿病的青少年，以半結構訪談指引為工具，進行錄音深度訪談直到資料達到飽和為止。資料分析乃透過詮釋循環，並佐以質性分析軟體NVivo協助。過程中利用反思日誌、同儕驗證、摘要記錄、與個案檢視增加研究可信度。結果　研究發現，第一型糖尿病青少年校園生活經驗中的主要要素有：（1）相同卻也不同、（2）隱瞞及公開、（3）限制及自由、（4）獨立及依賴、（5）守序及脫軌、以及（6）疾病認同及否定。許多因素諸如：疾病認同、社交焦慮與壓力、學校工作人員及同學的無知、獨立自我照顧的過渡等，皆威脅著糖尿病青少年在校時的健康與安適。結論／實務應用　要協助糖尿病青少年擁有正向校園生活經驗尚有極大發展空間，未來研究宜針對提升這些青少年疾病照護的自主性與自我效能、糖尿病知識、疾病認同、以及情境障礙的因應繼續努力。此外，提升學校老師與同學對於第一型糖尿病的認識，以及學校護理人員的主動參與，也是未來有待加強之處。

關鍵字

青少年 ； 現象學 ； 學校 ； 第一型糖尿病

並列摘要

Background: School plays a critical role in influencing the health, safety, development, and well-being of adolescents with type 1 diabetes mellitus (T1DM). However, scant research has been conducted to understand the lived experiences of these adolescents in school settings.Purpose: This study investigates the school-based lived experiences of Taiwanese adolescents with T1DM.Method: A Heidegger's hermeneutic phenomenological approach was used, and 14 Taiwanese adolescents with T1DM were enrolled through purposive snowball sampling until data saturation was reached. Data were collected using audio-recorded, semistructured interviews and analyzed using the hermeneutic circle supported by qualitative analysis software NVivo 9.0. Reflective journaling, peer debriefing, memo writing, and member checking were performed to enhance the trustworthiness of the findings.Results: Six interrelated themes were identified: (a) the same yet different, (b) covert and overt, (c) limitations and freedom, (d) independent and dependent, (e) derailing and being on track, and (f) disease identity and denial. Multiple factors, including disease identity, social anxiety and pressure, ignorance of school personnel and classmates, and transition to independent self-management threatened the at-school health and well-being of participants.Conclusions/Implications for Practice: Much work remains to be done to adequately improve the school-life experiences of adolescents with T1DM. Interventions to facilitate their autonomy, self-efficacy, diabetes knowledge, disease identity, and handling of situational obstacles are suggested as well as improving the understanding of T1DM for teachers and classmates and facilitating more proactive care by school nurses.

並列關鍵字

adolescent ； phenomenology ； school ； type 1 diabetes mellitus

參考文獻

American Diabetes Association(2012).Standards of medical care in diabetes-2012.Diabetes Care.35(1, Suppl.),S11-S63.

Bobo, N.,Kaup, T.,McCarty, P.,Carlson, J. P.(2011).Diabetes management at school: Application of the Healthy Learner Model.The Journal of School Nursing.27(3),171-184.

Brandt, C. M.(2002).Enhancing school nurse visibility.The Journal of School Nursing.18(1),5-10.

Broussard, L.(2004).School nursing: Not just band-aids anymore!.Journal for Specialists in Pediatric Nursing.9(3),77-83.

Broussard, L.(2007).Empowerment in school nursing practice: A grounded theory approach.Journal of School Nursing.23(6),322-328.