title: A Qualitative Study of Confusing Experiences among Japanese Adult Patients with Type 1 Diabetes.
abstract: BACKGROUND
  In this study, we investigated the powerlessness of patients with type 1 diabetes (T1D), and described the structure of powerlessness that these individuals experienced. In order for patients to recover from this state, we recommend that they take steps to regain their power.
  
  
  METHODS
  Fifteen Japanese adults with T1D participated in this study. Data were collected from all subjects between July 2013 and March 2014 via in-depth semi-structured interviews. Qualitative data analysis was conducted according to a grounded theory approach. Finally, the core category was identified, which allowed us to build a new powerlessness structure for T1D.
  
  
  RESULTS
  The results suggested a core category, 'Wandering a tangled path,' comprising four categories, eight subcategories, and twenty-six concepts. These four categories were as follows: 'being burdened by T1D,' 'suffering from insulin-related troubles,' 'being unable to cope with difficulties in self-management,' and 'facing social prejudice.' In the state of powerlessness, negative emotional experiences snowballed, with patients feeling more and more depressed until they ultimately reached 'rock bottom.'
  
  
  CONCLUSIONS
  We found that as negative emotional experiences related to powerlessness increased, negative feelings intensified until the patients reached rock bottom. Powerlessness is like 'wandering a tangled path,' a state in which T1D patients struggle to cope with reality on their own when faced with both internal and external events. 'Wandering a tangled path' is at the core of powerlessness. A primary characteristic of the structure of powerlessness is suffering from confusing experiences. To help patients cope with T1D without being crushed by powerlessness, nurses must pay attention to signs of powerlessness. Powerlessness is not just an emotional state, but a combination of feelings, perceptions, and thoughts; therefore, it is important to comprehensively understand patients' narratives.
authors.affiliation: Department of Adult and Elderly Nursing, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Nishio
authors.affiliation: Department of Adult and Elderly Nursing, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Chujo
authors.affiliation: Department of Adult and Elderly Nursing, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kataoka
keywords: confusion; experience; powerlessness; type 1 diabetes