The young person lives through an exciting period of life that is characterised by transitions. Through these transitions, from one developmental achievement to the next, emerge challenges that the young person needs to address successfully so they emerge as a young adult established for a successful life journey. These transitions are all about potential—potential of what the young person may achieve and become. The bioecological theory of human development (Bronfenbrenner 2001) argues that inherent potential is not static. Rather, potential increases for the young person who is well supported by their family, school, church, community and all levels of government. For many young people, peers are also an important aspect of their life. Benefits from stable peer relationships can significantly increase developmental outcomes. However, these same peer relationships can create tension for the young person and their family.

Developing the young person’s potential helps to establish a good pathway that will assist to maximise achievements as an adult. Nurses have a significant role during these transitions, especially within the community, where most nursing and healthcare for this group occurs. The foundational support structure for the young person is the family, a source of strength and protection. A family-focused approach to nursing enhances the outcomes of healthcare for the young person. This chapter will address three keys strategies for promoting health and wellbeing and providing best nursing care to the young person:

As an adolescent health nurse working in a rural community health centre, you receive a referral from the local high school. Becky, a 14-year-old female, is legally competent to give consent for her own healthcare and has accepted the referral (see Ch 4 for further information about informed consent and young people). Becky has been referred following noticeable behavioural changes that are negatively affecting her relationships with the teachers and other students. Her appearance has become increasingly ‘scruffy’ and her language has become nonchalant and at times offensive.

Becky’s family and relationship losses and stress are affecting her. You ask Becky to draw a genogram, a diagram that depicts family relationships (Harris et al. 2006), and then you use this to identify important relationships in her life. Using the Australian Family Strengths Nursing Assessment Guide (see Table 1.2 in Ch 1), you start to explore with Becky her family’s strengths. Since Becky is autonomous in seeking healthcare in this situation, you ask her how she would like your relationship to progress. You let Becky know that she is free to direct what her needs are and when she would like to meet with you. Becky decides that she would like to get together next week, and says she really liked talking to you about her life without being told what to do.

At your next visit, you further explore her family and personal strengths, and together you identify where Becky would like to be in 2 months time. Becky identifies that she wants to continue with her schooling and to make some new friends. She also wants to find some time to talk to her mum more—like she used to. Her brother’s wellbeing is also a major concern, but just now she does not think she can deal too much with it, so you leave this for another day. A visit to her dad also seems a nice idea to her, perhaps in the summer holidays.

Young childhood is often experienced as a period of delight and joy. This delight however can be interrupted with the onset of developmental changes that create challenges for the upper primary child and adolescent. The joys of childhood can be quickly forgotten when the tumultuous years of change appear. Despite community concerns over increasingly negative outcomes of late childhood and adolescence, statistics indicate that young people generally experience good health and succeed in their transition into young adulthood. Most young people in Australia are faring well. Mortality rates for all the major causes of death in children aged 1–14 in Australia continue to fall. The major cause of death in this age group remains injury and poisoning (Australian Institute of Health and Welfare 2005). Death rates for young people aged 12–24 also continue to fall, with the major cause in this age group also being injury and poisoning (Australian Institute of Health and Welfare 2003).

Yet, not every young person is doing so well. Too many young people experience traumatic periods in their adolescent years. Despite improvements in health statistics, in Australia, Aboriginal and Torres Straight Islander children and children from poorer socioeconomic backgrounds continue to experience higher mortality and morbidity rates, poorer developmental outcomes and generally reduced wellbeing when compared to other Australian children (Australian Institute of Health and Welfare 2005). Likewise, Maori and Pasifika children suffer from inequalities and injustices, which result in higher preventable mortality and morbidity rates than for non-Maori and non-Pasifika children (New Zealand Children’s Commissioner 2006).

Statistics indicate that the intact family (where the child is the biological, adopted or foster child of both parents) remains the place where most young people live (Australian Institute of Health and Welfare 2005). Chapter 1 presented a detailed description of family characteristics in New Zealand and Australia. From data of families with children aged 4–12 years, the majority reported high levels of family cohesion, with cohesion higher generally in intact families than in lone-parent or blended families (Australian Institute of Health and Welfare 2005 p. 79). The resilience of the family to remain and to function well serves a protective function for children and young people. However, family and social changes (e.g. parental separation, divorce and relocation) can be impediments to the formation of secure relationships, and this may increase the risks to the health, wellbeing and actualisation of potential of the young person (Bronfenbrenner & Morris 1998, Eckersley 2001).

Some morbidity statistics continue to increase or remain high across a wide range of key indicators of health, development and wellbeing in young people in both Australia and New Zealand. Childhood obesity and type 2 diabetes are on the rise in both countries (Australian Institute of Health and Welfare 2005, New Zealand Children’s Commissioner 2006). Adolescent alcohol abuse rates continue to increase (Hayes et al. 2004). Young people are responsible for more offences (judicial) than any other age group (Smart et al. 2003). Approximately 28% of young Australians are depressed, anxious, involved in antisocial behaviour and/or high alcohol consumption (Smart & Sanson 2005). Persistent struggles by Australian and New Zealand young people with abuse, homelessness, violence, teenage pregnancy, illicit drug usage, alcohol abuse, poor education outcomes, psychosocial disorders, depression and mental health are all problems facing young people and youth in recent years (McMurray 2007, Vimpani et al. 2002, New Zealand Children’s Commissioner 2006). See Box 9.1 for the research basis of information about antisocial behaviour. These struggles may result in future trends of morbidity and mortality that we do not currently see. However, these recent patterns have significant bioecological factors that can be mediated with increased investment in primary healthcare and health promotion.

Illustrating the benefits of concerted health promotion to address issues confronting young people is the trend in young male suicide rates. In the early 1980s, the suicide rate for young Australian males aged 15–24 (19 per 100,000) was considerably lower than most other groups, yet by the late 1980s it had increased to the same rate as older males. The rate then peaked in 1997 at 31 per 100,000. Following public concerns and intensive injection of funds into prevention strategies, interventions and support for young men, the suicide rate has fallen dramatically back to 19 per 100,000 in 2001–02 (de Vass 2004).

Likewise, in New Zealand, youth suicide rates peaked in 1998 and have declined since (New Zealand Children’s Commissioner 2006). Although the cause of the decline cannot be solely attributed to any one intervention, this illustrates the benefits gained through sound investment in health promotion and the huge cost we carry in loss of life and grief when primary healthcare strategies are neglected, especially for the young and vulnerable.

Effective health promotion that promotes youth resilience should have a bioecological focus. The greatest achievements in promoting health for the young person, especially the adolescent, can be gained through strengthening family cohesion and wellbeing. Other health promoting activities need to address broader bioecological factors. McMurray (2007 p. 199) identifies six major health issues affecting adolescents as:

Recent developmental research discoveries have indicated that genetic makeup does not solely determine human traits; rather, genetic messages interacting with environmental experiences determine developmental outcomes. Ecological factors affecting biological developments (such as parental interactions with their child impacting on early and young brain development) demonstrate how genetic endowment and environmental experiences interact to determine outcomes and human functioning (Vimpani 2001, Neill & Bowden 2004).

Genetic material contains blueprints for potential. However, they do not contain the processes. These processes of actualising genetic potential are found externally. Thus, development occurs through interactions between the individual and the environment (Rutter 2006). These interactions, which become effective if occurring regularly over time, are bi-directional. The ecology changes the person and the person changes the ecology. Therefore, the individual is active in their own development through selective patterns of attention, action and responses with people, objects and symbols.

Human interactions are the primary mechanism through which human genetic potential is actualised (Bronfenbrenner 2001). The bioecological theory of human development proposes that, by enhancing human interactions and environments, it is possible to increase the extent of genetic potential realised into development (Bronfenbrenner 2001, Bronfenbrenner & Ceci 1994 p. 568). The bioecological theory focuses on the mechanisms of development alongside the ecological context as equal determinants of development. This establishes the basis for understanding the young person within their environment as an active participant in their own development. It also establishes that in human development, the influential environment is not merely the immediate context in which the developing young person resides; rather, it also includes the interactions between people in various settings and the influences from larger surroundings. These are the bioecological determinants of development, health and wellbeing.

Understanding bioecological determinants assists nurses to promote optimal outcomes for the young person. Developing connections and relationships in partnership between the nurse, the young person and their family is a key strategy for nursing care of the young person. These connections are particularly important in promoting adolescent health and wellbeing, as they recognise the autonomy of the adolescent and promote partnerships between the adolescent and their nurse. Across all stages of life, nurses provide an important human input into the life, wellbeing, health and development of others. Understanding your role in the life of a young person and their family is necessary to enhance connectedness, facilitate communication and maximise empowerment.