Creating a conducive environment for adolescent-nurse interaction

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Managing negative peer pressure vulnerability

The second sub-category is about managing negative peer pressure vulnerability. Risk behaviour tends to happen in peer group settings and is driven by peer pressure (Dumas, Ellis & Wolfe, 2012:918). Negative peer pressure vulnerability refers to the level of exposure to the susceptibility of individuals regarding what others expect from them and in this case, the expectation has a negative connotation. Adolescents tend to be very prone to peer pressure and risk behaviour vulnerability (Dumas et al., 2012:917). They need anticipatory guidance to develop the means to take responsibility for their own decisions and ultimately for their own lives. Nurses can support adolescents to resist peer pressure to risk behaviour in general and specifically to becoming sexually active due to the pressure of others. The pressures that they experience are diverse and interlinked and innovative measures must be found to address it. They should be enabled to resist the pressures although it may have a detrimental effect on their acceptance in friendship groups. One of the theoretically sampled participants described the process as follows:
“…how do you assist them to resist…peer pressure…and how to stick to that…this will be very difficult to do.” (TP1)
Adolescents need to be encouraged to accept that all people can make mistakes, that it sometimes happens due to peer pressure and that they can learn from their own mistakes. Peer pressure related to negative outcomes happens, and adolescents must develop mechanisms to resist it when it could have negative consequences. The youth specialist remarked that adolescents should look beyond their mistakes and downfalls in life, and find ways of change that so that they can move on with their lives: “While we should acknowledge that there is something like peer pressure…even if one got the best of the intention I may make a mistake; I may start using drugs for instance…work around what has happened in my life and not see this as a pit in which I have fallen and now am trapped there.”
Adolescents were perceived as not being hopeful for their future and they were seen as not engaging to prepare for their future prospects. Therefore, the nurse participants insisted that adolescents must be supported to look beyond their mistakes and focus on their future and ways to prepare them for their future. Adolescents should be helped to appreciate themselves and their potential to be responsible adults. The adolescents were perceived to be vulnerable to negative peer pressure and to engage in risk behaviour due to their poor self-esteem. It made them vulnerable to the influences of others. They require anticipatory guidance to develop their own self-esteem and to resist pressure from others. One theoretically sampled participant advised that adolescents should be guided as follows when they experience downfalls in life:
“…in terms of this peer pressure…a big issue in South Africa is that our young people lack a real future orientation…they don’t see a future for themselves…So we need to start looking, not only at the peer pressure…why is this problem (no future orientation) occurring? And try and address some of the root causes of those problems…equipping our children with ways…should you experience a problem how do you work around the problem to get your life back on track again.” (TP1)
Anticipatory guidance to manage peer pressure vulnerability cannot be limited to healthcare settings. All venues where adolescents gather and thus all adult people, namely professional and laypersons, should play a role in helping them to resist peer pressure that may lead to activities that may have negative consequences. At schools and places where they meet with their friends, the adults involved at these places can be encouraged and trained by nurses to support adolescents to resist taking part in behaviour that they may regret. Schools and recreation venues are the places where adolescents interact with their peers. These are thus also the places where they experience peer pressure that may have negative consequences. These are also the places where they should be empowered to reject peer pressure. Empowerment cannot be limited to healthcare settings. It should be done where peer interaction takes place and where adolescents should learn to make informed decisions instead of giving in to pressure from others. The environment outside healthcare settings may be more ideal and appropriate for the empowerment of adolescents. It does not mean that empowerment should not be done at healthcare settings also. In such settings, formal programmes can be launched, while on-the-spot empowerment and formal anticipatory guidance programmes can be done at schools and recreation centres. Nurses should not wait for adolescents to access healthcare settings for primary care in order to find an opportunity to intervene.

Building capacity of adolescents

In this study, the researcher wanted to understand the adolescents’ perspective of how they would like to be supported and to explore how the nurses could support adolescents to resist peer pressure and coercion to sexual activity. The sub-category on building the capacity of adolescents emerged from in-vivo quotes. Building the capacity of adolescents is related to a process of helping them to gain knowledge on adolescent-related challenges and having to cope with peer pressure to become sexually active in order to meet the requirements of peer groups. It revolves around empowering them with life skills in order to become self-confident. Building adolescents’ skills can be done in different ways, namely through on-the-spot teaching as well as through formal programmes. When it is done in the latter manner, the learning opportunities are planned. The facilitator of learning determines the existing knowledge of the adolescents, and their readiness to take part in learning is determined. Interactive teaching and learning methodologies are preferred and adolescents want to participate in processes rather than to be passively listening to others. Learning should be reinforced by doing. Once-off teaching and learning is not recommended:
“So, it again requires time so that you can give them the practical experience of really doing the role play…practising the skills and not only theoretically learning…it is different to apply negotiation skills and just know about it and we know that if you have done it once or twice…when the real situation comes…they will be able to apply that.” (TP1)
The adolescents need skills and information to gain knowledge that will assist them to make informed decisions in order to avoid risk behaviour. When adolescents are adequately educated on how to promote their health, physical, social and psychological well-being, they will be cognisant of risks and the consequences thereof. Nurses should use all available platforms to offer customised education and provide dedicated spaces in healthcare services to build the capacity of adolescents to resist peer pressure and coercion through learning. In such spaces, adolescents can interact without fear that others may overhear them. Entertainment can also be mixed with health education:
“…today we still have kids who will talk about their journeys (of edutainment) and how they were moulded by such community centres…where there is…life skills training and dealing with issues in a real way…the activities were meant to entertain and educate at the same time.” (TP2)
Educating adolescents on the peer pressure and coercion to sexual activity provides nurses with opportunities to address their risk behaviour vulnerability. Adolescents need significant others to clarify the myths and misconceptions about their vulnerability. Should they agree that their parents can be involved in their education to resist peer pressure when it is aimed at encouraging them to take part in risk behaviour, nurses should encourage them to talk to their parents. They should, however, always be assured that the nurses are available to educate and to support them. One of the nurse participants responded as follows:
“It is best talking to your parent…or the professional somebody who can help both the parent and the child; because firstly the child can go to the father or mother asking for any advice or telling them whatever challenges…if the mother cannot answer appropriately…they can go for outside help…”

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Creating a conducive environment for adolescent-nurse interaction

This sub-category emerged from two initial codes, namely ‘strengthening positive adolescent-nurse interaction prospects’ and ‘providing alternative strategies to attract adolescents’. In this study, creating a conducive environment is defined as a process of creating an environment in which nurses and adolescents can build relationships in which the pressure of peers regarding risk behaviour in general and specifically in sexual behaviour, can be addressed. In such an environment, nurses can use anticipatory guidance in assisting adolescents to resist peer pressure that is aimed at risk behaviour.
It is the responsibility of nurses to create conducive environments. They should reach out to adolescents, invite them to visit healthcare facilities, make sure that they feel welcome in the facilities, treat them with respect, and be willing to listen in a non-judgmental way to their health-related challenges.
The adolescent and nurse participants acknowledged that most adolescents, and particularly males, do not utilise health facilities as they should do. If adolescents do not come to healthcare services, it poses a challenge to interact with them and to provide the necessary guidance they require for resisting peer pressure and coercion to sexual activity. One reason for poor utilisation of health services is that some of the adolescents (both male and female) only visit the services when they are very ill. They do not feel confident to visit services for health education and other illness preventative care:
“I think for us boys, the first thing about us, we don’t like going to the clinic.”

Male adolescents also try to prove their masculinity by pretending that they do not get ill and when they are ill, that they do not need healthcare. They believe that they will get better without healthcare as they are strong. This perception influenced male adolescents to become ignorant about healthy lifestyles. Such a situation makes it difficult for nurses to interact with them to provide anticipatory guidance. From the researcher’s point of view, such incidences are missed opportunities for interacting with adolescents for education and guidance. Therefore, for nurses to reach out to them through adolescent health services, information and guidance to address risk behaviour, they should find innovative ways to attract adolescents to the healthcare services. They should also be willing to reach out to adolescents and to go to them where they congregate. Adolescent participants cited that they are found in numbers out at playgrounds.

CHAPTER 1
1.1 INTRODUCTION
1.2 BACKGROUND TO THE PROBLEM STATEMENT
1.3 RATIONALE OF THE STUDY
1.4 PROBLEM STATEMENT
1.5 SIGNIFICANCE OF THE STUDY
1.6 RESEARCH QUESTIONS
1.7 AIMS AND OBJECTIVES OF THE STUDY
1.8 CONCEPT CLARIFICATION
1.9 THE META-PARADIGM OF NURSING
1.10 CONCEPTUAL FRAMEWORK FOR THIS STUDY
1.11 DELINEATION OF THE STUDY
1.12 METHODOLOGY OF THE RESEARCH
1.13 ETHICAL CONSIDERATIONS
1.14 SUMMARY
1.15 ORGANISATION OF THE STUDY
CHAPTER 2
2.1. INTRODUCTION
2.2 DESCRIPTION OF PEER PRESSURE AND COERCION
2.3. DYNAMICS OF PEER PRESSURE AND COERCION
2.4 VULNERABILITY OF ADOLESCENTS TO PEER PRESSURE AND COERCION
2.5. GENERAL PICTURE OF ADOLESCENT SEXUAL ACTIVITY IN SUB- SAHARAN AFRICA
2.6 INTERVENTIONS IN SUB-SAHARAN AFRICA AND SOUTH AFRICA TO SUPPORT ADOLESCENTS TO IMPROVE SEXUAL AND REPRODUCTIVE HEALTH
2.7 ANTICIPATORY GUIDANCE OF ADOLESCENTS
2.8 SUMMARY
CHAPTER 3
3.1 INTRODUCTION
3.2 PARADIGMATIC ASSUMPTIONS
3.3 RESEARCH METHODOLOGY
3.4 RIGOUR OF THE STUDY
3.5 SUMMARY
CHAPTER 4 
4.1 INTRODUCTION
4.2 CATEGORY AND SUB-CATEGORIES
4.3 DESCRIPTION OF THE EMERGENT THEORY
4.4 SUMMARY
CHAPTER 5
5.1 INTRODUCTION
5.2 SUBSTITUTING FOR PARENTAL SHORTCOMINGS
5.3 ADDRESSING NEGATIVE PEER PRESSURE VULNERABILITY OF ADOLESCENTS
5.4 ADDRESSING RISK BEHAVIOUR VULNERABILITY
5.5 OPTIMISING ADOLESCENT-NURSE INTERACTION
5.6 ENABLING RESPONSIBLE DECISION MAKING
5.7 SUMMARY
CHAPTER 6
6.1 INTRODUCTION
6.2 THE PROCESS OF THEORY SYNTHESIS
6.3 PRESENTATION OF THE THEORY
6.4 RELEVANCE AND CONTRIBUTION OF THE THEORY TO THE KNOWLEDGE BASE
6.5 POTENTIAL AREA FOR FURTHER STUDY
6.6 CONCLUSION
6.7 SUMMARY
REFERENCES

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