Nursing competence in adolescent health: anticipating the future needs of youth.

The health problems of youth have dramatically shifted in the last 30 years from biological to social causes of morbidity and mortality. To assess the adequacy of nurses' knowledge and skills in adolescent health, a national survey of 445 nurses, including members of the American Public Health Association, the American School Health Association, and the National Association of Pediatric Nurse Associates and Practitioners, was undertaken in 1985. Results indicated that even among nurses who work with young people the most, areas of greatest knowledge and skill deficiencies included common social morbidities of adolescents. In addition to self-assessed inadequacies in knowledge and skills, nurses identified excessive time demands as a primary obstacle to the provision of health services to adolescents. To assure adequate preparation of nurses, it is recommended that accreditation criteria for baccalaureate and graduate programs specify essential adolescent health content for curricula compared to current accreditation criteria that generalizes "across the life span." Focusing on the enhancement of educational opportunities in adolescent health, nurses identified strategies for further education that would bridge the gap between the health needs of youth and nurse's self-perceived competencies in providing these services.

Complications of cervical cryotherapy in adolescents.

Cervical dysplasia and human papillomavirus (HPV) infections in sexually active adolescents appear to be increasing. Cervical cryotherapy offers the advantages of inexpensive outpatient therapy that is well tolerated without anesthesia. Previous series have focused on women beyond adolescence and have concluded that the risks and complications are rare. Sixty-seven adolescents underwent cervical cryotherapy for cervical intraepithelial neoplasia (CIN) or HPV infection. Pelvic inflammatory disease developed in 9% within one month of treatment. Two patients developed cervical stenosis and hematometra. Cervical cultures performed prior to cryotherapy were documented to be negative, but the interval from negative cultures to treatment exceeded four weeks in 54% of the patients because of problems with patient compliance with appointments. The risk of infectious complication in our adolescent population prompted a recommendation for aggressive preventive measures, including documentation of recent negative cultures for Neisseria gonorrhoeae and Chlamydia. The use of prophylactic antibiotics should be investigated for adolescents undergoing cervical cryotherapy.

Self-reported health concerns and sexual behaviors in adolescents with cervical dysplasia. A pilot study.

A group of 46 women attending an adolescent dysplasia clinic were surveyed regarding the reported impact of cervical dysplasia on sexual beliefs and behaviors. The adolescents reported being concerned about their future health and having changed their sexual practices. There were no clear relationships between demographic variables or sexual attitudes and changes. The adolescents' self-reports of their behavior were not consistent; those adolescents who reported safer sex practices did not have lower rates of sexually transmitted diseases postbiopsy. The results of this study indicate the important but complex impact of sexually transmitted disease on adolescents and suggests that this impact on adolescents may be different from that on adults.

Acute and long-term consequences of adolescents who choose abortions.

PIP: An estimated 40% of US females now 14 years of age can be expected to experience pregnancy by age 19 years, and the majority of these pregnancies will be unintended. In 1981, there were 1,343,200 pregnancies among US females under 20 years of age and 448,570 abortions in this same age group. The abortion ratio is highest for adolescents under 15 years of age (1379 abortions/1000 live births), while the abortion rate is highest for 18-19 year olds (61.8/1000). When compared to adult women, adolescents obtain abortions at a later gestational age--a factor that increases both the psychological and medical risks of the procedure. Adolescents are also more likely than adults to base their decision regarding the pregnancy on the opinions of significant others. Comparative studies have shown teenagers who continue a pregnancy to have underdeveloped conceptualizations of the future, high levels of anxiety, and an external locus of control. Adolescents at greatest risk of psychological sequelae of abortion are those with pre-existing mental illness, strong religious beliefs, limited coping skills, a narrow support network, and abortion at later gestational stages. If the teenager feels pressured by her family to terminate the pregnancy, she is also at high risk for adverse psychological sequelae and a repeat pregnancy soon after abortion. Thus, counselors should maintain a neutral position while helping teens to examine the positive and negative aspects of their options. In terms of medical effects, teenagers have been shown to have the lowest risk of all age groups for abortion-related mortality. However, because of the later gestational age at which adolescents seek abortion, there is a higher risk of complications such as endometritis. Emphasis should be placed on expediting the abortion decision making process among adolescents to reduce delays and the potential risks.^ieng