Date of Award

12-5-2014

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.) Nursing

Department

Nursing

Abstract

Transitioning to adulthood is not without challenges. The move away from family influence towards independence and self-determination is filled with uncertainty. As emerging adults (18-29) transition to adulthood they will encounter various challenges related to their new adult roles (Arnett & Tanner, 2005; Jensen & Arnett, 2012). Increased challenges and vulnerabilities in transitioning are evident among emerging adults with disabilities because they face additional challenges related to their disability over and above what all others of this developmental stage experience (Betz & Redcay, 2002; Blomquist, 2007; Faux & Nehring, 2010; King, Baldwin, Currie & Evans, 2005; Murray, 2003; National Research Council & Institute of Medicine, 2009; Urbano, 2010).

The purpose of this mixed methods convergent parallel study was to understand resilience in a select group of emerging adults with disabilities as they are transitioning to adulthood by combining both quantitative and qualitative data. In this approach, quantitative instruments were used to measure the relationship between the independent variable of resilience and the dependent variables of physical health, mental health, satisfaction with life, and future orientation. At the same time, the central phenomenon of resilience was explored using qualitative methods of a focus group and interview with a subset of the participants.

The aims of this study were twofold: (1)To gain a better understanding of resilience from the emerging adults' perspective as it relates to managing adversities while transitioning to adulthood; and (2)To characterize the relationship of resilience with indicators of healthy transitioning. This study describes a select group of transitioning emerging adults with disabilities who have been recognized by others for their accomplishments. It explored their level of resilience and resilience attributes; and identified key attributes of resilience, transitioning goals and values, and challenges encountered while transitioning.

Given the complexity of the topic and uniqueness of the population, this study has combined quantitative and qualitative methods for data gathering purposes. Variables were measured using survey questionnaires to quantify resilience, physical and mental health, life satisfaction, future orientation and social support resources. In addition to the survey questionnaires, a subset of the sample was invited to participate in a focus group or individual interview to supplement the quantitative data. A purposeful sample of 31 participants was recruited and completed the quantitative phase of the study. Ten of the 31 participants also participated in the qualitative phase; five participated in a focus group and five participated in individual interviews. Following a mixed method convergent parallel design, quantitative and qualitative data were collected simultaneously and analyzed independently. The data were then merged to create a matrix reflecting quantitative variables and qualitative themes.

Quantitative analyses of instrument measures conclude that participants in this select group of emerging adults with disabilities (n=31) have a moderate resilience level (M=79.1), expensive average disease burden on physical health (M=49.7), experience less than average disease burden on mental health (M=54.1), feel things are going well in their lives (M=24.9), are future orientated (M=3.43), and have a social support resources (M=3.9); independently the participants in the qualitative sample (n=10) have a moderately high resilience level (M=82.3), experience more than average disease burden on physical health (M=43.9), experience an average disease burden on mental health (M=50.1), are generally satisfied with their lives (M=23.6), are future orientated (M=3.7), and have social support resources (M=2.9). No correlation was noted between the variables resilience and physical health (r=-.277), n=31, p=n.s. two tailed). Regression analysis indicated that resilience is not a good predictor of physical health (β=-.277; t=-1.555;p=n.s.). A moderate positive correlation was noted between the variables of resilience and mental health (r=.502, n=31, p

Qualitative analyses of focus group and interview data revealed the following themes: standing on my own, longing to create own meaning, altruistic sense of duty towards others with disabilities, challenges specific to me vs. challenges we all face, I am a person with abilities, butterfly's story...our struggles make us stronger, life is a journey, traits that keep me going, patience is a virtue, and it takes a village. These themes demonstrate transitioning goals and values, challenges encountered while transitioning, and attributes of resilience that have aided in mitigating adversity for these emerging adults with disabilities as they are transitioning to adulthood. Collectively, the these represent resilience. Purposeful life, self-reliance, perseverance, equanimity and existential aloneness represent individual attributes; and social support resources represent environmental attributes.

The mixed method analysis was comprised of combining the data for meaningful interpretation. Findings from the quantitative analyses were concurrent with the findings from the qualitative analyses. Overall the instrument measures for quantitative variables uphold the prominent themes discovered in the qualitative data. A frequency analysis identified the number of times a particular resilient attribute emerged from the qualitative data. The attribute purposeful life emerged most frequently (f=16), followed by equanimity (f=14), self-resilience (f=11), perseverance (f=9), and existential aloneness (f=6). A cross-tabulation analysis of instrument measures and themes contributed to an enhanced interpretation and understanding of the relationships among the data. Analyses showed that those who contributed to the qualitative theme I am a person with abilities (n=5) scored the highest on mental health (M=54.6) indicating they are emotionally bothered less than most experiencing a less than average disease burden on mental health.

Although these participants reported a physical impairment and a more than average disease burden on physical health (M = 44.2), other measures indicate a moderately high resilience level (M = 86.8), a high level of satisfaction with life (M = 28.4), that they are future orientated (M = 3.8), and have social support resources (M = 3.2). Participants who contributed to the qualitative theme altruistic sense of duty towards others with disabilities (n = 4) scored the lowest physical health score (M = 37.2) indicating that they are physically impaired and experiencing much more than average disease burden on physical health. These participants also reported having more than average disease burden on mental health (M= 43), and a slightly below average satisfaction with life (M = 18). However, other measures for these qualitative participants indicate a moderate resilience level (M = 80), that they are future orientated (M = 3.5), and have social support resources (M = 3). A hierarchical categorization of resilience attributes was created to achieve a deeper understanding of the resilient attributes expressed by the participants. This hierarchical categorization demonstrates that resilience for these individuals comes from both within themselves and from their environment.

Nurses care for individuals, particularly those with disabilities. They are uniquely present to intervene throughout all stages of the transitioning process. Identifying resilient attributes can play a vital role in facilitating transitions. Nurses can work as moderators, fostering resilient growth and nurturing the process by incorporating intervention strategies that focus on developing resilient attributes both within individuals and in their environment. Knowing which resilient attributes are most effective in facilitating transitioning would be especially useful in the development of preventative holistic patient-centered nursing vi interventions. The research and practice implications of this study may suggest that resilience is a viable concept for the development of strength-based, patient-centered nursing interventions that facilitate transitioning.

This study employed a positive psychological approach aimed at identifying resilient attributes in individuals with disabilities who have been identified for their accomplishments and are transitioning to adulthood. Rather than focusing on problems, this study focused on answers. The findings of this study provide a basis for recommending intervention programs on building resilience among emerging adults with disabilities. This exploratory study may lead to suggestions as to how education, policy, practice, and research can be used to fit the needs of emerging adults with disabilities so that they achieve a successful transition to adulthood.

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