Can’t even make friends with my brain. I’m too young to be where I’m going. But I’m too old to go back again. 1. Identify the developmental tasks of adolescence. 2. Describe the biological view of adolescence. 3. Discuss the major areas that should be included when assessing adolescents. 4. Examine maladaptive responses evident in adolescence. 5. Analyze nursing interventions useful in working with adolescents. TABLE 36-1 THEORETICAL VIEWS OF ADOLESCENCE • Achieving more mature relationships with peers of both genders • Achieving masculine or feminine social roles • Accepting physical build and using the body effectively • Achieving emotional independence from parents and other adults • Preparing for marriage and family life • Acquiring a set of values and an ethical system as a guide to behavior Nursing care of adolescents begins with a thorough assessment of their health status. Data collection by the nurse is based on current and previous functioning in all aspects of an adolescent’s life (American Academy of Child and Adolescent Psychiatry, 2005). A variety of approaches and tools may be used, but data collection should include the information listed in Box 36-1. These data are collected from adolescents and significant others through interviews, examinations, observations, and reports. The nurse also may ask the following questions of the adolescent’s family: • What concerns you about your adolescent? • When did these problems start? • What changes have you noticed? • Have the problems been noticed in school as well as at home? • What makes the behavior better or worse? • How have these problems affected your adolescent’s relationship with you, siblings, peers, and teachers? One outcome of the nursing assessment should be the identification of teenagers at high risk for problems. Nurses need to understand the difference between constructive and age-appropriate exploration and engagement in activities that are potentially dangerous and threaten the adolescent’s physical and emotional well-being. Focus should be on how the teenager is functioning in all areas of their lives. The Youth Risk Behavior Surveillance System (Centers for Disease Control and Prevention, 2010) conducted a national school-based survey of students in grades 9 to 12. The data reveal many threats to the health and well-being of teenagers, as seen in Box 36-2. A profile of the high-risk adolescent is presented in Figure 36-1. Teenage behaviors that contribute to death and injury include smoking, poor diet, lack of physical activities, alcohol and drug abuse, unprotected sex, violence, suicide, homicide, and automobile crashes. Several high-risk behaviors, including substance use, delinquency, risky sexual behavior, and self-injury among adolescents, have been linked to victimization involving interpersonal violence. This includes experiencing sexual or physical assault and witnessing domestic or community violence (Danielson et al, 2006). • Traditional parents tend to value a sense of continuity and order. They accept the value judgments that come from previous generations. Adolescents from these families tend to be more attached to their parents, conforming, and achievement oriented. Often they avoid major conflicts in their teenage years. • Authoritarian parents are oriented toward shaping, controlling, and restricting the adolescent to fixed standards. Obedience is seen as a virtue. Power and responsibility are not shared with the adolescent. Harsh discipline is used to curb autonomous strivings that are viewed as willfulness. The approach here is often punitive, and it can result in problems with the adolescent’s development of autonomy. • Democratic parents do not believe that their standards are always right. They tend to be supportive and respond to the specific situation with solutions that promote the adolescent’s autonomy. They foster stimulation and challenge. This parenting style combines limit setting with negotiation, encouraging the teenager’s participation in the disciplinary process. It is shown to predict greater independent functioning in adolescents. • Not all homosexual adolescents are sexually active. • Many homosexual adolescents are heterosexually active. • Many heterosexual adolescents are homosexually active. • The relationship between sexual identity and sexual behavior is variable during adolescence. • Sexual issues produce stress and anxiety for adolescents of all sexual orientations. Adolescents are diagnosed with the various Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) psychiatric illnesses described in Chapters 15 through 25 of this text. The nursing interventions described in these chapters can be implemented with adolescents, along with the various treatment modalities described in Chapters 26 through 32. Evidence-based treatment strategies for adolescents have been identified that take into account the particular developmental issues and the unique challenges of establishing a therapeutic alliance with an adolescent (Evans et al, 2005). Sexual behaviors can be the cause of many teenage problems. Some of the negative outcomes as a result are described in Box 36-3 (Centers for Disease Control and Prevention, 2009). Sexual activity is often not as much an outlet for sexual passion as an attempt to achieve closeness with another person. Adolescents tend to use their sexuality to sublimate other needs, such as those for love and security and personal anxiety about sexual adequacy. Peer group pressure also may lead to the adolescent to inappropriate sexual relations. Adolescent depression is the most common mental health disorder, and it can be fatal (Box 36-4). The symptoms of depression in adolescence listed in Box 36-5 differ somewhat from those seen in adults (American Academy of Child and Adolescent Psychiatry, 2008). Adolescents have difficulty describing their emotional or mood states. Young teenagers often do not complain about the way they feel and instead act moody and irritable. Youth who develop depression between ages 14 and 16 years are at greater risk for major depression later in life. Interventions for depression in adolescence are similar to those for adults. Cognitive behavioral therapy (CBT) is an effective intervention for adolescents who are depressed. It identifies and modifies negative cognitions or thoughts that underlie depression (see Chapter 27). It also focuses on coping strategies to deal with situations that trigger emotional problems (Nelson and Tusaie, 2011).
Adolescent Psychiatric Nursing
Developmental Stage
THEORY
DESCRIPTION
Biological
Emphasis is on physical growth, behavior, and the environment, which influence feelings, thoughts and actions.
Psychoanalytical
Puberty is called the genital stage, in which sexual interest is awakened. Biological changes upset the balance between the ego and id, and new solutions must be negotiated.
Psychosocial
Adolescents attempt to establish an identity within the social environment. They try to coordinate self-security, intimacy, and sexual satisfaction in their relationships.
Cognitive
Adolescence is an advanced stage of cognition in which the ability to reason goes beyond the concrete to more abstract thinking, described as formal operational thought.
Cultural
Views adolescence as a time when a person believes that adult privileges are deserved but withheld. This stage ends when society gives the adolescent the full power and status of an adult.
Moral
Adolescents’ moral development is how teens approach moral conflicts. Boys generally seek direct resolution and girls avoid conflicts to maintain a relationship.
Assessing the Adolescent
Independence
Sexual Behavior
Maladaptive Responses
Inappropriate Sexual Activity
Mood Disorders
Depression
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Adolescent Psychiatric Nursing
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