TREATMENT

The transition from child health care services to adult health care services should be managed carefully to ensure that the individual adapts (Fleming et al., 2002). The changes involved in the transitions can be very difficult for it encourages the individual to be independent. However, if the transition is planned and coordinated then the changes may not seem unmanageable (Fleming et al., 2002). As a nurse it is very important to include the client in decisions regarding change. This will provide the nurse with valuable information regarding the clients feelings in relation to change (Wolpert & Anderson, 2001). Research has shown that one�s ability to manage blood glucose levels is associated with receiving support from a diabetes treatment team. �The Diabetes Control and Complications Trial (DCCT), demonstrated that by working closely with a diabetes treatment team, adolescents randomized to receive intensive therapy could improve their blood glucose control and sustain the improvement over a mean period of 7.4 years� (Wolfsdorf, 1999, p. 1767). The intensive therapy is aimed at providing adolescents with problem solving skills. This would enable the client to make decisions regarding blood glucose levels, insulin dosages and food intake (Wolfdorf, 1999). However, before the health provider can develop a treatment plan the adolescent�s expectations and receptiveness to change needs to be assessed (Wolpert & Anderson, 2001).

Kyngas and Rissanen (2001) found that adolescents who were encouraged to participate in decisions regarding their treatment plan were more likely to adhere to regular self-care. Also, discussions between the adolescent and the health care provider help to �establish a two-way flow of information that aims at the negotiation of a contract of management between physician and teenager� (Kyngas & Rissanaen, 2001, p. 772). The teenager must genuinely believe that the treatment plan will have short and long term benefits in order to seem worthwhile (Wichowski & Kubsch, 1997). Furthermore, they need to believe that they are capable of adhering to the regimen. Research conducted by Kyngas and Hentinen (1995) found that �patients need to feel that compliance and its aims are achievable and meaningful within their lifestyle� (p. 734).

Kyngas, H., & Hentinen, M. (1995). Meaning attached to compliance with self-care, and coalitions for compliance among young diabetics. Journal of Advanced Nursing, 21, 729-736.

Kyngas, H., & Rissanen, M. (2001). Support as a crucial predictor of good compliance of adolescents with a chronic disease. Journal of Clinical Nursing, 10, 767- 775.

Fleming, E., Bernie, C., & Warren, G. (2002). The transition of adolescents with diabetes from the children�s health care service into the adult health service. Journal of Clinical Nursing, 11, 560-568.

Wolfdorf, J.I. (1999). Improving diabetes control in adolescents. Diabetes Care, 22, 1767- 1778.

Wolpert, H.A., & Anderson, B.J. (2001). Young adults with diabetes: Need for a new treatment paradigm. Diabetes Care, 24, 1513-1514.