Programming for adolescent health and development. Report of a WHO/UNFPA/UNICEF Study Group on Programming for Adolescent Health

One in every five persons is an adolescent (10-19 years of age). What happens, or does not happen, during the second decade of life has implications that last throughout a lifetime and affect both individual and public health. What sets adolescents apart from children is the increasing autonomy they demonstrate. Their own decisions, behaviours and relationships increasingly determine their health and development. Moreover, adolescence brings with it expanded capacities--for abstract thought and contemplating the future, for empathy and idealism, for critical thought including the questioning of self and others, and for reproduction. Yet the use of these new capacities is dependent on the environment in which adolescents live. So while adolescents display more self-reliance than children, they lack the status and resources of adults. Indeed, they are often dependent on adults to meet many of their basic needs. The consolidation of knowledge and experience acquired through the WHO/UNFPA/UNICEF Study Group on Programming for Adolescent Health is presented in this report. Verified by research, the report describes the guiding concepts and major interventions that are necessary components for country programming for adolescent health and development. The report asserts the value of addressing the health and development of adolescents simultaneously. It indicates the emerging evidence that actions to meet adolescents' needs for development also discourage them from adopting high-risk behaviours and protect them from the situations that lead to the major health problems. The report is illustrated by examples of programming efforts from around the world.

An exploratory study of developmental growth in adults with heart failure

Persons with heart failure face a myriad of challenges due to the physical limitations imposed by the chronic illness. Despite these changes, each person must continue to face the developmental challenges of adulthood. This exploratory study was conducted to examine the impact that this chronic illness has on the developmental processes of adults. Methods triangulation was used to examine the content of unprompted, written goals and the results of surveys of life satisfaction and mood states of 138 persons with heart failure. Younger adults had higher anger, depression, and anxiety scores than older or middle-aged adults and had lower scores of life satisfaction. This may reflect the emotional reaction to the realization that their lives may be shortened by this chronic illness. Analysis of their goals reflected the developmental challenges described by Erikson. Despite severe physical limitations, these individuals demonstrated growth and achievement of developmental tasks by transcending usual time lines.

Furthering caring through nursing education

The nursing students' main quest is for self actualization by attributing meaning to life through caring. To assist student nurses in this quest, the nurse educator needs to plan educational interventions according to an anthropological model that posits care and caring as innate human attributes. Further, the structural essence of what professional nursing caring entails should also be posited as a point of departure for curriculum planning. The author proposes such models. The main implications include that the nursing curriculum must increasingly attend to the emotional needs of nursing students. Curricular content and teaching strategies toward this goal are suggested.

Sexual health. 1: Sexuality and nurses' role in sexual health

This article, the first of two, looks at the issue of sexuality in health care. Sexuality underpins much of what a person is and has significance in everyone's life. Through sexuality, people express their most intimate feelings of individuality and their need for emotional closeness with other human beings. Sexuality is not just about sexual intercourse, it is about the concept of people as men and women--about their manliness or femininity. Sexuality also affects the way people see themselves or would like to be seen, their appearance and behaviour, and their desire to attract those who matter to them. It is about the fears and fantasies people have about themselves and others. Nurses need to have an understanding of sexuality as they may have a crucial part to play in its dynamic progress.

Weathering the storm: persevering through a difficult time

Parse's human becoming theory of nursing and research methodology were used to uncover the structure of the lived experience of persevering through a difficult time for eight women with ovarian cancer. Three core concepts surfaced: deliberately persisting, significant engagements, and shifting life patterns. Through conceptual integration these emerged as powering valuing in the connecting-separating of originating. Deliberately persisting, an active forging onward, was supported in the perseverance literature. The concept significant engagements, a variety of encounters uniquely important to an individual, was further clarified. Shifting life patterns, the changing ways of living as the difficult time emerged, was not addressed in the perseverance literature and represents new knowledge to the discipline of nursing.

The lived experience of serenity: using Parse's research method

Parse's research method was used to investigate the meaning of serenity for survivors of a life-threatening illness or traumatic event. Ten survivors of cancer told their stories of the meaning of serenity as they had lived it in their lives. Descriptions were aided by photographs chosen by each participant to represent the meaning of serenity for them. The structure of serenity was generated through the extraction-synthesis process. Four main concepts--steering-yielding with the flow, savoring remembered visions of engaging surroundings, abiding with aloneness-togetherness, and attesting to a loving presence--emerged and led to a theoretical structure of serenity from the human becoming perspective. Findings confirm serenity as a multidimensional process.

Nursing to care or caring to nurse: a qualitative investigation of perceptions of new recruits

This article discusses the perceptions of nine student nurses at the commencement of a 3-year diploma programme in nursing. In particular, it focuses on new recruits' perceptions of nursing. As part of a larger longitudinal study which examines the impact of the nursing curriculum on perceptions of health, data were collected from a sample of students concerning their perceptions of nursing, health, illness and the course. Content analysis of indepth interviews identified four themes concerning perceptions of nursing. These were caring, nurture, healing and self-development. These themes are discussed in relation to the student nurses life experiences and in the context of a notion of health as a central goal for nurse education. The students' perceptions of nursing at the commencement of the course suggest that nursing may be a moral choice as an occupation underpinned by the desire to do something worthwhile, whilst the relationship between nursing and health was not explicit.

Reducing risks and building developmental assets: essential actions for promoting adolescent health

Developmental assets provide the positive building blocks young people need for success. In this article, based on a keynote address to attendees at the 1998 American School Health Association annual conference, research is discussed that suggests building specific developmental assets relates to lowered risk behavior patterns and increased patterns of thriving behavior among an aggregate sample of nearly 100,000, 6th-12th grade youth in 213 US communities. Issues related to the scientific foundations, reliability, and validity of the development assets framework are discussed. The contribution that building youth's developmental assets makes toward their well-being is presented as both a unique component of a healthy community and a necessary complement to risk reduction and treatment strategies.

Some implications of chaos theory for the genetic analysis of human development and variation

Non-linear epigenetic processes are a potential underlying source of phenotypic differences in development. Simulation studies of twin pairs using simple non-linear development models characterised by chaotic or near-chaotic behavior are presented. The effect of chaotic processes on correlations is to lower them from their initial values, but high initial correlations are affected much less by chaotic and near-chaotic processes than intermediate correlations. Therefore, we would predict that traits affected by chaotic processes would have high MZ and low DZ twin correlations and this is reminiscent of certain traits such as EEG spectra. However the much more frequent observation of MZ correlations close to twice their DZ counterparts would suggest that the role of chaos in development is quite limited.

Considering tomorrow: Parse's theory-guided research

The purpose of this nursing study, guided by Parse's human becoming theory and research methodology, was to investigate the meaning of considering tomorrow for women who are homeless. This is the first study to explore the newly conceptualized health phenomenon of considering tomorrow; thus, this research provides new knowledge for nursing and expands Parse's theory in relation to considering tomorrow, health, and quality of life. Through dialogical engagements with 10 women who were homeless and the process of extraction-synthesis, the researcher generated the structure of considering tomorrow as contemplating desired endeavors in longing for the cherished, while intimate alliances with isolating distance emerge, as resilient endurance surfaces amid disturbing unsureness. Conceptual integration led to a theoretical structure in which considering tomorrow is imaging the valuing in the connecting-separating of originating.

Developmental task achievement and learned resourcefulness in healthy older adults

Although resourcefulness has been found to promote healthy functioning and is believed to be learned throughout life, studies have not examined relationships between developmental variables and resourcefulness. This study examined Erikson's eight developmental tasks as predictors of learned resourcefulness in 60 healthy elders. Hierarchical regression based on Erikson's theory revealed that 37% of the variance in learned resourcefulness was explained by trust, autonomy, initiative, industry, and identity whereas intimacy, generativity, and integrity were not significant. The results suggest that mastery of developmental tasks through adolescence play a key role in determining how resourceful healthy elders are in their daily activities.

Korean adolescents' experiences of smoking cessation: a prelude to research with the human becoming perspective

Smoking cessation has been identified as an important factor for health and quality of life in Korean society. This article explicates Korean adolescents' experiences of smoking cessation from the perspective of Parse's human becoming theory, as a prelude to conducting research. A nurse was truly present with individual students as they shared their experiences of trying to stop smoking. Interpreted through the principles and concepts of Parse's theory, the experience of quitting smoking is elucidated as a struggle of choosing one's value priorities amid the opportunities and limitations inherent in this decision, while moving with unique patterns of relating. Staying with the commitment to stop smoking is changing one's health and quality of life. The authors briefly discuss the implications of this perspective for nursing practice, and identify struggling to change as a phenomenon for future research.