Academic journal article Research and Theory for Nursing Practice

Theoretical Perspective: Resilience in Medically Fragile Adolescents

Academic journal article Research and Theory for Nursing Practice

Theoretical Perspective: Resilience in Medically Fragile Adolescents

Article excerpt

Medically fragile adolescents require medical technology and skilled care from parents and nurses in daily life. These adolescents may be ventilator dependent, require intravenous nutrition or medications, depend on nutritional or respiratory support, and depend on nursing care or other medical devices for daily living. Much of the extant research on medically fragile children and adolescents has lacked an overarching theoretical perspective. Findings suggest that peer relationships, family support, technology dependence, school attendance, and self-esteem are concepts of relevance for these adolescents. Thus, a theoretical framework derived from the risk and resilience literature was developed to identify the nature of their interrelationships using theory derivation techniques. The resilience in medically fragile adolescents framework was derived using concepts described by these adolescents. Further study is needed to test this model in medically fragile adolescents with hopes to foster positive outcomes for these adolescents.

Keywords: resilience; theory derivation; medically fragile; technology dependence

Medically fragile adolescents require medical technology and skilled care from parents and nurses in daily life. These adolescents may be ventilator dependent, require intravenous nutrition or medications, depend on nutritional or respiratory support, and depend on nursing care or other medical devices for daily living (Office of Technology Assessment [OTA], 1987). These adolescents have a wide range of illnesses, typically chronic in nature, and require varying levels and types of technology. Studies with pediatric medically fragile populations include children and adolescents ranging from minimal technology needs to advanced technology needs with nurse dependent care (Earle, Rennick, Carnevale, & Davis, 2006; Haley & Ratliffe, 2006; Heaton, Noyes, Sloper, & Shah, 2005; Rehm & Bradley, 2005; Rehm & Rohr, 2002). Medically fragile adolescents are a unique population with challenges in their daily lives, yet much of the extant research on medically fragile children and adolescents has lacked an overarching theoretical perspective.

The current state of the scholarly research on medically fragile adolescents consists primarily of qualitative studies. From this limited body of research on medically fragile adolescents, researchers have gained insight into the importance of friends, family, and school in the development of self-esteem for these adolescents (Earle et al., 2006; Heaton et al., 2005; Noyes, 2000). Findings also suggest that peer relationships, family support, technology dependence, school attendance, and self-esteem are concepts of relevance for these adolescents. However, of the few studies including medically fragile adolescents, none has been found that used a theoretical framework from which to frame the research questions or interpret the results. There may be great utility in adopting and adapting existing theoretical frameworks for use in the study of medically fragile adolescents. Resilience was chosen as the basis for a theory for medically fragile adolescents as the literature suggests that these adolescents do well despite the need for technology in their daily lives. In addition, the concepts of relevance for these adolescents have been described in the resilience literature. Thus, a theory derived from the risk and resilience literature was developed to identify the salient constructs and nature of their interrelationships for guiding further research of medically fragile adolescents. This article develops a theoretical framework for medically fragile adolescents based on concepts found in the literature using theory derivation techniques by Walker and Avant (2005). From this framework, a theoretical perspective guides future research on medically fragile adolescents.

THEORY DERIVATION USING RESILIENCE AS A FRAMEWORK

Resilience was chosen as the basis for theory derivation for medically fragile adolescents because these adolescents do well in their lives in light of their daily need for technology (Carnevale, Alexander, Davis, Rennick, & Troini, 2006; Earle et al. …

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