The Wonder Years: Working with Adolescents

When working with adolescents, it is important to communicate clearly, interpret their need accurately and to provide education on topics that are sometimes overwhelming.

Adolescents pose a challenge to health care professionals. Whether it be stubbornness or unwillingness to accept that their actions have consequences, or difficulty to communicate clear and factual information, working with adolescents often creates unique obstacles.

Know your audience:

Adolescents are at that challenging age, not quite adults and no longer a child. Therefore, our communication with them as patients requires care and consideration, since their mindset will most likely shift as a conversation regarding their medical needs progresses.

Awareness of specific personality characteristics that are prominent during the adolescent period will aid nurses in their relationship with the adolescent. Present a positive approach to this relationship but be aware of possible problem areas, such as:

Over-identification with the adolescents problems
Responding based on surface behaviors being demonstrated by the adolescent
Attempts of manipulation by the adolescent.

The Office of Disease Prevention and Health Promotion stated in their “Adolescent Health” article “Although adolescence and young adulthood are generally healthy times of life, some important health and social problems either start or peak during these years.” Examples include:

Mental disorders
Substance use
Smoking/nicotine use
Nutrition and weight conditions
Sexually transmitted infections, including human immunodeficiency virus (HIV)
Teen and unintended pregnancies
Homelessness
Academic problems and dropping out of school
Homicide
Suicide
Motor vehicle collisions

In the article “Adolescents: health risks and solutions” by the World Health Organization, an “estimated 1.2 million adolescents died in 2015, over 3000 every day, mostly from preventable or treatable causes.”

Mental Health Issues with Adolescents:

The concept of trust, conflict management, learning to deal with others and stress management are developed during the childhood and adolescent years. This is the age in which identities are being formed. During this time of identity development, if an adolescent struggles with mental health issues, there is a “concern these issues may manifest themselves into high-risk behavior, violence, dangerous activities with other teens, and self-destructive acts”, as noted by Judith Herman PhD, RN, ANEF in her 2014 article.

Being aware of risk factors that may affect an adolescents mental health, will allow greater understanding of their physical health needs and assist in honest dialog with health care professionals.

Possible factors affecting the mental health of an adolescent:

Desire for greater autonomy
Pressure to conform with peers
Exploration of sexual identity
Increased access to and use of technology
Media influences
Gender norms
Quality of home life
Relationship with peers
Violence:Harsh parenting, Bullying
Sexual Violence
Socio-economic problems
Discrimination
Chronic illness
Intellectual disability or other neurological conditions
Pregnancy
Adolescent parents

Per the World Health Organization, “it is estimated that 10-20% of adolescents experience mental health conditions”. Additionally, “depression is the ninth leading cause of illness and disability among all adolescents; anxiety is the eighth leading cause”.

Emotional disorders can be disabling to an adolescent. Emotional disorders affect schoolwork, attendance, family and peer relationships and can increase depression, which can lead to suicide.

Possible results of poor mental health in adolescents:

Depression
Anxiety
Eating disorders
Psychosis (hallucinations, delusions)
Suicide or Self-harm
Risk-taking behaviors
Violence
Substance Abuse

It is important to promote strong mental health to adolescents. It will help build resilience so they can cope in difficult situations and adversities. Strong mental health will enable the adolescent to constructively and openly discuss their overall health concerns with medical professionals.

Topics that most teens worried about:

In a September 2018, verywellfamily.com released an article listing the top 10 social issues teens struggle with today.

Depression
Bullying
Sexual Activity
Drug Use
Alcohol Use
Obesity
Academic Problems
Peer Pressure
Social Media
On-Screen Violence

By understanding the topics that are most concerning to adolescent patients, we will be able to have a more diverse and open dialog to engage adolescents in caring for their physical and mental health.

What we can do:

By knowing that each adolescent is transitioning towards adulthood, in their own unique way and timeframe, we should keep in mind that their physical changes may be occuring on a much quicker timeline than are their mental maturities. By creating a relaxed, open environment, where the adolescent feels free to truly express concerning issues, we can gain a better understanding of where their mental status currently resides. Which in turn, provides insight to the “unsaid” or possibly embarrassing health issue they are actually inquiring about. It will provide the caregiver the opportunity to present education on health topics and to provide understanding to the adolescent, encouraging them to take an active part in their physical and mental well being.

In a 2017 article published on Taylor & Francis Online, they reviewed how “health care professionals’ interpersonal communication skills with adolescents and young adults play a vital role in early identification of issues, provision of emotional support, effective illness management and health education”. They discovered three areas needing to be addressed or improved:

Communication barriers between adolescents and health care providers. Specifically with sensitive and personal aspects of life. “Strategies and tools could moderate these barriers for better psychosocial care and preventative health.”
Open and engaging communication between health care providers and adolescents requires trust and emotional safety.
Adolescents need to feel included and autonomous during health communication. “Health care providers required specific skills to balance these needs with the influence of parents.”

Though the situation which has lead the adolescent to visit the healthcare facility may vary, the importance of clear communication between the caregiver and adolescent is crucial. Often adolescents may feel more comfortable discussing issues with the attending nurse than the doctor, so being prepared to aid the adolescent and the doctor with effective communication skills, will be of benefit to all involved.

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