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A transition of care (TOC) process from pediatric to adult medicine ensures that adolescents receive ongoing care into young adulthood, a time of high risk for preventable morbidity and mortality. We explored patient, caregiver, and physician perspectives on ways to improve TOC communication with healthy adolescents. Two researchers conducted key informant interviews with healthy 12- to 18-year-old adolescents, their caregivers, and primary care physicians working in pediatric, internal, and family medicine. Data saturation was reached after interviewing 12 adolescents, 10 caregivers, and 36 physicians. Three themes were identified: perceptions of TOC; effective communication among the triad of adolescents, caregivers, and providers; and early communication about TOC preparation. From these themes, a model of communication was identified and adapted, outlining the communication skills and responsibilities for physicians and patients during TOC. Physicians must understand how to use strong, consistent, adolescent-centered communication to execute effective TOC. [ABSTRACT FROM AUTHOR]

This qualitative study describes the temporal patterns of fatigue found as part of a larger study designed to elicit a description of the experience and self-management of fatigue for patients on hemodialysis. Two patterns of fatigue were identified. The first pattern, continuous fatigue, was characterized by participants who experienced fatigue at all times, which was their normal, baseline feeling. Within this group, two subgroups were identified The second pattern of fatigue, post-dialysis fatigue only, was characterized by participants who experienced fatigue only after their hemodialysis session. This study is unique because it expands our knowledge about hemodialysis and fatigue by describing the patterns that fatigue follows over time from one hemodialysis session to the next. Insight into these phenomena could help ameliorate fatigue and allow nurses to tailor interventions for patients on hemodialysis. [ABSTRACT FROM AUTHOR]

Objective: One of the most common, yet most difficult to detect injuries sustained by U.S. soldiers in Iraq and Afghanistan is mild traumatic brain injury (mTBI). Left untreated, mTBI can negatively impact soldiers' postdeployment adjustment. This research describes the rehabilitation experiences of soldiers with a history of mTBI and their spouses.Method: Nine soldiers with mTBI and their spouses participated in the study. A total of 27 interviews were conducted exploring couples' post-mTBI rehabilitation experiences. Participants consisted of active duty soldiers with mTBI who had returned from deployment within 2 years, and their civilian spouses. Strauss and Corbin's grounded theory methodology was used to collect and analyze the data.Findings: The majority of the soldiers and spouses who participated (16/18) indicated that uncertain prognosis and symptom management were the greatest challenges of post-mTBI. Other challenges, such as delayed diagnosis, limited access to mental health care, and difficulty navigating an unfamiliar military health care system was also reported.Conclusions: Because of mTBI's lack of visible manifestation, soldiers may confuse their mTBI symptoms with those of other deployment-related injuries and this leads to a delay in treatment. Future research should explore the standardization of post-mTBI rehabilitation programs and the effectiveness of soldier education to promote early detection and treatment. [ABSTRACT FROM AUTHOR]

Fatigue is a common and debilitating symptom for adult patients with end stage renal disease on hemodialysis, and has been associated with decreased survival and quality of life. Patients on hemodialysis must find ways to manage their fatigue and mitigate its effects on their lives. The purpose of this qualitative descriptive work was to describe the experience and self-management of fatigue in patients on incenter hemodialysis. Several themes were identified, which included the nature of fatigue, management of fatigue, consequences of fatigue, and factors associated with fatigue. This information will be valuable to nephrology nurses as they continue to care for and educate patients on hemodialysis. [ABSTRACT FROM AUTHOR]