Keeping up with friends: A grounded theory of friendship and well-being in children with juvenile rheumatoid arthritis

Abstract

Children with Juvenile Rheumatoid Arthritis (JRA) often describe themselves as lonely. This grounded theory investigation documented ways that friends aid children with JRA. In depth, open ended interviews with three children with JRA, their best friends, and mothers of each were done. Observations at Arthritis Camp supplemented the interview data. In this document only the data from the children with JRA were reported. A substantive range nursing theory was generated to specify the process by which friendships influence the child with JRA's well-being. The basic social psychological process of Keeping Up, the child with JRA's ability to maintain acceptable play interactions, was identified as the core category in the grounded theory Keeping Up With Friends. Three stages of friendships were identified: Making Friends, Being Friends, and Losing Friends. The process of Keeping Up took place in the stage of Being Friends. Categories that positively related to the child with JRA's sense of well-being were: Keeping Up, Maintaining Acceptable Play Interactions, Companionship, Help from Friends, and Strategies to Manage Denigrating Social Responses. Categories that decreased the child's well-being included Problems with Having JRA and Missing Out. Well-being was defined by the children with JRA as feeling good, happy, strong, and as normal as possible. Being Visibly Different from friends and Barriers to Friendships were found to negatively affect the child with JRA's ability to Keep Up. Among several implications for nursing practice and research was the importance of the children learning to pace themselves as they participated in social activities as well as their sensitivity to unwanted attention in social situations. Clinically this model could be used "as is" when working with girls with JRA who are lonely, being teased or left out of social activities.