Adolescence and Nursing Education What Is Adolescence
Adolescence, spanning from approximately 12 to 19 years of age, represents a critical transitional phase from childhood to adulthood. This period is characterized by profound changes and often considerable turmoil for adolescents and their families. Adolescents undergo significant physical, emotional, and cognitive transformations, which can impact various aspects of their health and well-being. This stage influences many healthcare issues, from eating disorders like anorexia to obesity, and understanding adolescent thought processes is crucial for addressing these challenges effectively (Elkind, 1984).
Adolescents are identified as one of the most at-risk populations in healthcare (Ares, Kuhns, Dogra, & Karmik, 2015). The Healthy People 2020 initiative, recognizing the unique needs of this demographic, introduced “Adolescent Health” as a new focus area. This initiative emphasizes interventions aimed at promoting health and mitigating risks associated with adolescence (USDHHS, 2014).
For effective patient education, it is essential to comprehend the developmental characteristics of adolescents (Ackard & Neumark Sztainer, 2001; Ormrod, 2012). Today’s adolescents belong to Generation Z (Gen Z), who excel in self-directed learning and are highly engaged with technology (Shatto & Erwin, 2016).
Aspects of Development in Adolescence
Adolescents exhibit considerable variation in their biological, psychological, social, and cognitive development. Physically, they experience rapid and dramatic bodily changes, which can temporarily result in clumsiness and uncoordinated movements. Changes in physical size, shape, and secondary sex characteristics lead to heightened concern with appearance and a strong desire to express sexual urges (Crandell et al., 2012; Santrock, 2017).
Neuroscience research highlights that adolescent brains process information differently from adult brains. This can explain behaviors such as impulsiveness, rebelliousness, and social anxiety, which may have biological underpinnings rather than purely environmental causes (Packard, 2007).
Piaget (1951, 1952, 1976) described this stage as the period of formal operations. Adolescents reach a higher order of reasoning compared to earlier childhood stages. They develop the capacity for abstract thought and complex logical thinking, termed propositional reasoning, in contrast to syllogistic reasoning. Adolescents can reason inductively and deductively, hypothesize, and apply logical principles to novel situations.
Adolescents can conceptualize and internalize ideas, debate different viewpoints, understand cause and effect, comprehend complex explanations, imagine possibilities, and discern relationships among objects and events (Aronowitz, 2006; Crandell et al., 2012). Formal operational thought allows them to grasp invisible processes and evaluate others’ statements and behaviors.
Adolescents may become preoccupied with their thoughts and perceptions of others, a phenomenon known as adolescent egocentrism. They believe that everyone is focused on them and their activities, a belief referred to as the imaginary audience. This social thinking profoundly affects adolescent behavior (Elkind, 1984).
The imaginary audience leads to heightened self-consciousness. Adolescents may feel embarrassed, believing that everyone is scrutinizing them, yet simultaneously crave attention to affirm their sense of being special and unique (Crandell et al., 2012; Oswalt, 2010; Santrock, 2017; Snowman & McCown, 2015).
Adolescents develop an understanding of health and illness, including disease causation, health status influences, and health promotion and disease prevention concepts. Sources of health-related information include parents, healthcare providers, and the Internet. At this stage, adolescents recognize illness and disability as results of dysfunction within the body and can understand prognosis and outcomes (Ormrod, 2012).
They can identify health behaviors but may reject them or engage in risk-taking behaviors due to peer pressure and a sense of invincibility. This sense of invulnerability, termed the personal fable, leads adolescents to believe that they are exempt from risks affecting others (Elkind, 1984). This belief can result in risky behaviors, as they may perceive themselves as shielded from harm (Alberts, Elkind, & Ginsberg, 2007; Jack, 1989; Oswalt, 2010).
Recent research indicates that adolescents aged 15 and older might be less susceptible to the personal fable than previously thought. Despite recognizing risks, they still require support and guidance (Cauffman & Steinberg, 2000; Brown, Teufel, & Birch, 2007).
Erikson (1968) identified the psychosocial challenge of adolescence as the conflict between identity and role confusion. Adolescents strive to develop their identity, align their skills with career choices, and achieve autonomy from their parents. They seek belonging to groups, peer acceptance, and support while often rebelling against perceived authoritarian figures.
Adolescents place significant emphasis on personal appearance and peer conformity, often leading to conflicts with parents and other authority figures. Their relationships with authority figures are frequently marked by conflict, tolerance, stereotyping, or alienation (Hines & Paulson, 2006). While they seek new, trusting relationships outside the home, they remain susceptible to peer influence (Santrock, 2017).
Adolescents demand personal space, control, privacy, and confidentiality. For them, illness, injury, disability, and hospitalization signify dependency, loss of identity, body image changes, bodily embarrassment, confinement, separation from peers, and potential death. Providing knowledge alone is insufficient for this population (Grey, Kanner, & Lacey, 1999; Hoffman, 2016; Williams & McGillicuddy-De Lisi, 1999; Zimmer-Gembeck & Skinner, 2008). Some developmentalists extend the upper limit of adolescence to 24 years, acknowledging that many young individuals reach psychosocial milestones later (Newman & Newman, 2015).
Adolescent and Teaching Strategies in Nursing Education
Despite the relative health of most adolescents, approximately 20% face serious health issues such as asthma, learning disabilities, eating disorders (e.g., obesity, anorexia, bulimia), diabetes, injury-related disabilities, or psychological problems from depression or maltreatment. Additionally, adolescents are at high risk for teen pregnancy, poverty effects, substance abuse, and sexually transmitted diseases, including venereal disease and AIDS. The leading causes of death in this age group are accidents, homicide, and suicide, with over 50% of adolescent deaths resulting from accidents, primarily involving motor vehicles (Kochanek, Xu, Murphy, Minino, & Kung, 2011; London et al., 2017).
Adolescents use medical services less frequently than other age groups. Historically, adolescent health has been a lower priority, and global healthcare systems have largely neglected this population (Patton et al., 2016). Consequently, their educational needs are diverse and extensive.
Teaching topics may include sexual adjustment, contraception, venereal disease, accident prevention, nutrition, substance abuse, and mental health. Healthy adolescents struggle to envision themselves as sick or injured, and those with illnesses or disabilities often resist medical regimens and continue risky behaviors. Their focus on body image, peer acceptance, and autonomy makes health recommendations seem like threats to their independence and control. Developing a respectful, trusting relationship is a significant challenge for nurses working with adolescents, whether healthy or ill (Brown et al., 2007).
Adolescents’ advanced cognitive and language abilities allow them to engage fully in learning. However, they require privacy, understanding, an honest approach, and unconditional acceptance to address fears of embarrassment, loss of independence, identity, and self-control (Ackard & Neumark-Sztainer, 2001). The American Academy of Pediatrics Committee on Adolescence (2016) highlights factors such as availability, visibility, quality, confidentiality, affordability, flexibility, and coordination as crucial for effective education.
The imaginary audience and personal fable can exacerbate existing issues or create new ones. Adolescents with visible disabilities may experience depression and altered self-perception as they view themselves from others’ perspectives. Teenagers might forego contraceptives due to a belief in their own invincibility or stop medications to prove their wellness (Alberts, Elkind, & Ginsberg, 2007; Jack, 1989; Oswalt, 2010).
The language skills and abstract thinking abilities of adolescents offer a wide range of teaching methods and tools. Recommended teaching strategies include:
For Short-Term Learning
- Use One-to-One Instruction: Ensure confidentiality of sensitive information. Peer-group discussions are effective for topics like smoking, alcohol, drug use, safety, obesity, and teenage sexuality. Adolescents benefit from interacting with peers who share similar concerns or experiences.
- Engage in Group Discussions: Utilize face-to-face or computer-based group discussions, role-playing, and gaming to clarify values and solve problems. Adolescents’ need for belonging and involvement is addressed through these methods, which can be conducted in person or online (e.g., blogs, social networking, podcasts, online videos).
- Employ Adjunct Instructional Tools: Use complex models, diagrams, and detailed written materials. Adolescents are generally comfortable with technology, which facilitates learning.
- Clarify Terminology: Explain scientific terms and medical jargon. Share decision-making to enhance adolescents’ sense of control.
- Include Adolescents in Planning: Involve them in creating teaching plans, setting goals, and determining learning needs. Offering choices and rationales helps them feel in control.
- Approach with Respect: Maintain tact, openness, and flexibility to engage adolescents effectively. Expect resistance due to threats to their self-image and self-integrity.
- Avoid Confrontation: Instead of direct contradiction, acknowledge their opinions and suggest alternatives gently.
For Long-Term Learning
- Respect Personal Fable and Imaginary Audience: Acknowledge their feelings of uniqueness and invincibility without challenging them directly.
- Allow Testing of Convictions: Permit adolescents to test their beliefs, such as managing medication regimens, and suggest feasible trial periods for adjustments.
- Include Families: While respecting adolescents’ privacy and individuality, involve families when appropriate to enhance teaching effectiveness and provide support. Guide families in understanding adolescent behavior and setting realistic limits while fostering independence (Brown et al., 2007; Hines & Paulson, 2006).
Healthcare teaching must address both the adolescent’s and the family’s learning needs to be effective during this transitional stage (Ackard & Neumark-Sztainer, 2001; Falvo, 2011).