Adolescent research recruitment issues and strategies: application in a rural school setting.

This report discusses adolescent research recruitment strategies in general and specifically, those developed by a research team for a rural school setting. Recruitment of adolescent subjects involves the consideration of several complex issues. These issues include adolescent development, ethical and legal guidelines, and access to school settings. Specific strategies are discussed regarding access and culture of the rural setting, collaboration, and recruitment procedures in relation to their use to recruit adolescent subjects from rural schools.

Optimism and its relationship to depression, coping, anger, and life events in rural adolescents.

Optimism is a stable personality trait that has important implications for behavior, yet little attention has been given to examining optimism in adolescents. This article describes levels of optimism in rural adolescents and the relationship of optimism with depression, coping, anger, and life events. The identification of optimism may be a vulnerability factor when screening adolescent mental health and, as such, has implications for the psychiatric nurse clinician.

Health concerns and risk behaviors of rural adolescents.

Although much has been written about the health status of adolescents, little is known about adolescents' perception of their own health. The purpose of this article is to describe the health concerns of rural adolescents. Two national studies, the Youth Risk Behavior Survey and the National Longitudinal Study of Adolescent Health (Add Health Project), are used as comparisons. Data from the rural survey represent 624 community adolescents attending 4 rural Pennsylvania schools. The students were in the 9th, 10th, and 11th grades. The Adolescent Health Inventory was used to report concerns related to general health, psychosocial issues, and risk behaviors. Overall, rural adolescents in the study reported an average of 6.5 (SD = 3.2) health concerns with frequencies of occurrence being always or often and reported an average involvement in 1 (SD = 1.3) risk behavior. Psychosocial issues were reported by 28%, and 23% worried about their general health. Frequently reported risk behaviors included alcohol use, drug use, and a lack of exercise. There was minimal concern expressed regarding venereal disease or AIDS, whereas 12% expressed concern about the possibility of pregnancy. These results suggest the likelihood that adolescents perceive health from a holistic perspective and that health promotion programs should consider involving adolescents in planning, both (a) to ensure congruence of the plan of care with adolescents' concerns and (b) to clarify the interpretation and meaning of their concerns. We present implications for the community health nurse.

School relocation and stress in teens.

Geographical relocation, with transfer to a new school, is a life transition experienced by many adolescents. The normal developmental tasks of adolescence may complicate the transition for relocated teens, particularly those with inadequate coping skills. This 2-year study, conducted in an upper-middle-income suburban community in the Northeast, with highly mobile students, compared the effects of relocation on 43 teens with matched non-relocated controls. While statistical significance was found in differences between the relocated and non-relocated groups, the relocated teens were only mildly anxious. There were no significant differences between the groups for depression, hostility, life events, or coping. Implications for schools and school nursing regarding health promotion interventions with relocated adolescents are discussed.

Screening and predicting adolescent depressive symptoms in rural settings.

Adolescent depression with related suicidal behavior is a serious health problem. This article describes depressive symptoms, reported life events, and demographic risk factors in 846 rural adolescents. The results indicate that self-reported depressive symptoms in rural adolescents is significantly (p < .05) related to gender, death in the family, and the perceived positive and negative impact of life events, as well as the specific events of losing a close friend, an increase in number of arguments with parents, trouble with classmates, and trouble with police. The type of school program and trouble with siblings was marginally significant (p < .10). These demographic factors and life events may assist health-care professionals in identifying adolescents at risk for depressive symptoms.

School-based intervention to promote coping in rural teens.

PURPOSE: To evaluate a program designed to help high school students with depressive symptomology to effectively cope. DESIGN: Two-phase experimental study. METHODS: Rural high school students (N = 222), ages 14 through 19 years, were surveyed to identify teens with depressive symptomatology, identify stressful life events and coping styles of at-risk subjects, and evaluate a cognitive-behavioral group intervention to enhance students' coping and affect levels of depression. Students with depressive symptomatology were randomized into control (n = 18) or intervention (n = 23) groups. Intervention subjects were treated with a nurse-led, 8-week cognitive skills group, conducted at school. RESULTS: On posttesting, the intervention groups demonstrated reduced depressive symptoms in females and a wider range of coping compared with controls. CLINICAL IMPLICATIONS: School-based nurses are in an ideal position to provide assessment, referral, and intervention programs in the natural setting of the school. Results of this study indicate that such programs can be implemented successfully in schools and have the potential to promote mental health in teenagers.

Teaching kids to cope: a preventive mental health nursing strategy for adolescents.

TOPIC: The theoretical base, implementation, and effectiveness of Teaching Kids to Cope (TKC). PURPOSE: To inform clinicians about the benefits and uses of TKC, a 10-week psychoeducational group intervention designed to enhance the coping repertoire of adolescents. SOURCE: Authors' clinical experience. CONCLUSIONS: Following the TKC intervention, students demonstrated less depressive symptomatology and improved coping behaviors. Further research is needed to test the intervention on a larger group and to determine its effectiveness.

High touch meets high tech. Distance mental health screening for rural youth using Teleform.

This article presents an overview of distance mental health screening using Teleform. This technology provides nurses with the ability to have questionnaires administered in one location then processed and scored rapidly at a location some distance away by using a facsimile system and Teleform. The authors examine the process of using Teleform, cite its advantages and disadvantages, discuss its application with rural youth, and suggest implications for school personnel and health-care providers. Technology has facilitated many changes in health-care delivery and increasingly will be instrumental in creating changes. Computer technology can help nursing deliver services swiftly to larger populations.

Nursing research in a school setting.

As more nurses are expanding their role and moving beyond traditional staff nursing, it is becoming increasingly common to find nurses conducting research. The utilization of schools as research sites is on the rise. Life events in families, such as divorce, unemployment, and geographic relocation, predispose school-aged children to high levels of stress, and nurse researchers are in a position to examine students' responses to these stressors. The purpose of this article is to discuss four issues inherent to research in schools, and to share some strategies which were effective. The issues include recruitment of subjects, informed consent, interviewing subjects, and coping with the unpredictable.

Adolescent geographic relocation: theoretical perspective.

This article analyzes the literature related to adolescent geographic relocation. A model of transitions developed by Chick & Meleis (1986) is the basis for the analysis. This analysis suggests that adolescent relocation is a type of life transition, and the relocated adolescents constitute an at-risk population for health status alterations. The relocation transition is defined and its dimensions delineated through the literature review. Preventive nursing intervention for future research and theory development related to adolescent geographic relocation are proposed.

Adolescent suicide: behaviors, risk factors, and psychiatric nursing interventions.

Current statistics show a marked increase in suicides among adolescents 15 to 19 years of age. The literature suggests an increase in the use of lethal methods such as firearms by young suicide attempters. Studies show that most adolescent suicide completers have never received mental health treatment, although the majority had exhibited psychiatric symptoms previous to their deaths. This review of the literature identifies the characteristics and precipitants of suicidal behavior among adolescents. The literature clearly indicates a need for suicide awareness and prevention programs and for the early identification of teenagers at risk for suicidal behaviors. The most logical location for suicide prevention programs and activities is in the schools where the greatest number of adolescents can be reached. The master's-prepared psychiatric mental health nurse in a consultive and collaborative role can be instrumental in the successful formation and execution of these programs. In a joint effort, school personnel and the psychiatric mental health nurse specialist may be able to decrease significantly the number of suicidal behaviors among adolescents.

Psychiatric mental health nursing in a biopsychosocial era.

Clients in long-term facilities carry a wide array of psychiatric diagnoses, often with equally diverse medical problems. This "back ward" population requires a specialized area of psychiatric mental health nursing practice. The need for comprehensive assessment and adequate interventions, and the various frustrations of nursing staff, are discussed using a case example.

Examining the common stressors and coping methods of rural adolescents.

The major objective of this study was to explore and examine common stressors and coping strategies of rural adolescents. Coping was defined as a cognitive and transactional process between a person and the person's environment. A survey of 222 normal adolescents attending a rural southwestern Pennsylvania high school reported experiencing stressful events related to school, family, friendship, health, and transportation. The coping strategy reported as being the most commonly used was optimistic. However, the coping strategy reported to be most effective in dealing with stressful events was supportant. The results of this study contribute to the limited information on adolescent coping in rural areas. This study should help health care providers further their understanding of this vulnerable population. Clinicians can enhance the effective coping and overall health of the rural adolescent by screening for and discussing coping strategies.

Tots and teens: similarities in behavior and interventions for pediatric and psychiatric nurses.

The separation-individuation process is played out in similar ways by toddlers and teenagers. Child and adolescent psychiatric nurses may have a better appreciation of the subtleties and complexities in dealing with behaviors of these patients with a comparison of the two groups. This paper discusses similarities in behaviors of toddlers and teens and presents theory-based guidelines for interventions with clients in these age groups.

Difficulties with teens: can nursing consultation help?

Child/youth problems and psychiatric hospitalizations are increasing. A literature review suggests that there is an increased need for more nurses with the knowledge and skills necessary to work in this specialty area. The review also suggests that providing psychiatric nursing consultation services is one way to help direct care staff to strengthen or develop these skills. The authors describe a consultation project that took place on a newly developed 15-bed adolescent program in a 30-bed private psychiatric hospital. They examine the effectiveness of consultation sessions, ascertained through both verbal and written evaluations of staff members. The outcome suggests that psychiatric nursing consultation services can be an important contribution in expanding the knowledge base of direct care staff (child care specialists and nurses) who work with the hospitalized adolescent psychiatric patient.

Relocation stress in adolescents: helping teenagers cope with a moving dilemma.

Relocation affects approximately 20% of the people in the United States. The review of literature indicates that adolescents, already in a vulnerable developmental stage, are particularly susceptible to many stressors related to relocation. These stressors impact on the adolescents' physical welfare, social/peer relationships, school performance, emotionality, and coping behaviors. School professionals can collaborate with psychiatric mental health nurse consultants to help facilitate the adolescents' positive coping with relocation. A health-promotion model to use when working with these adolescents is illustrated.

The role of the psychiatric/mental health nurse clinical specialist in an adolescent coping skills group.

The psychiatric/mental health nurse clinical specialist is a professional who brings unique skills to the area of mental health prevention. Adolescents are an at-risk population in need of preventive mental health services. This article describes the unique features of a nurse-led adolescent prevention program. A specific Adolescent Coping Skills Group format, which uses the skills of the master's prepared psychiatric nurse, is presented.

Psychiatric nursing management of medication-free psychotic patients.

This article discusses how a team of psychiatric nurses manages acutely psychotic patients on a clinical research unit without the use of psychotropic medications. The article describes a schizophrenia research unit, identifies the behaviors of acutely psychotic patients, and provides examples of effective nursing interventions used on the unit. These interventions are grounded in principles of interpersonal psychiatric nursing practice and milieu therapy. The discussion is directed to psychiatric nurses and other health care professionals who are employed on research units.

International relocation: womens' coping methods.

This article focuses on how corporate and military wives cope with international relocation. Specifically, the coping behaviors of women who exhibited signs of depression and anxiety and those women who did not in a convenience sample of 28 military and corporate women were studied. Six instruments were used: (a) the Relocation Survey, (b) the Beck Depression Inventory, (c) the Multiple Affect Adjective Check List, (d) the CAGE Questionnaire, (e) the Sarason Life Experience Survey, and (f) the Coping Questionnaire. Coping and adaptation formed the conceptual framework. The findings revealed that women who coped well used active coping behaviors and women who coped poorly used more passive coping behaviors. This study offers some direction for health care providers who may use anticipatory guidance and counseling for women prior to international moves.

Relocation support groups for corporate wives.

Nurses can provide relocation support groups to focus on coping skills, stress management, and peer support for relocated women. Support groups can promote a healthier adjustment to relocation. Although depression and anxiety scores were not statistically decreased by participating in support groups, verbal responses from respondents indicated that the support groups were a valuable intervention.