Teenage Sexual Health - Essay Example

TEENAGE SEXUAL HEALTH INTRODUCTION: An overwhelming public health problem is the risk for adverse health outcomes in adolescents, particularly female adolescents due to their sexual behaviour. Sexual risk behaviour including early sexual initiation, unprotected intercourse, and sex with multiple partners place female adolescents at risk for unintended pregnancy and sexually transmitted diseases (STDs). These include infection with the human immunodeficiency virus (HIV), state Wingood & DiClemente (2002: 113). This paper proposes to identify the various aspects of teenage sexual health and unintended pregnancy, related policies and legislation of the United Kingdom government towards child and adolescent protection, and a critical analysis of John’s Model of Reflection 1995, towards improved nursing practice in the field of teenage sexual health. DISCUSSION: Teenage Sexual Health: Sexual Health is defined by the Family Planning Association as “the capacity and freedom to enjoy and express sexuality without exploitation, oppression, physical or emotional harm”. Sexual health is stated to be an important part of physical and mental health. Together with other fundamental rights, it is a key part of our identity as human beings. According to Bekaert (2005: 86), the essential elements of good sexual health include access to information and services to avoid the risk of unintended pregnancy, illness or disease. Sexual intercourse at a younger age and poor condom use have led to increased rates of sexually transmitted infections (STIs) in the teenage group, states Bekaert (2005: 14). The government has responded to the general increase in STIs with the national strategy for sexual health and HIV. It recommends the promotion of sexual health and of mainstream sexual health services to decrease the incidence of STIs. 20% to 30% of teenage females diagnosed with a sexually transmitted infection acquire another disease within eighteen months. The consequences of infection with an STI vary according to the infection. They can include increased risk of cervical cancer, pelvic inflammatory disease (PID), ectopic pregnancy and infertility. With acquired immunodeficiency syndrome (AIDS), the individual is susceptible to opportunistic infections and will ultimately die. The consequences of STIs can be worse for teenagers as they tend to present late for treatment, have a poor knowledge of STIs and have unrealistic perceptions of their risks. The risk factors for contracting sexually transmitted diseases are: male sex, young age, early age at first intercourse, number of partners, ethnic group (high rates among Afro-Caribbeans, low amongst Asians), failure to use barrier method of contraception, low knowledge levels leading to poor perception of risk, previous STI, male homosexuality and attendance at a sexual health clinic, states Bekaert (2005: 85-86). Teenage Pregnancy: The United Kingdom (UK) has the highest teenage pregnancy rates in Western Europe. The government has recognized the problem and set up a specific working group called the Teenage Pregnancy Unit to formulate strategies to tackle teen pregnancy. The resultant Teenage Pregnancy Strategy targets the reduction in teen pregnancy by a rate of 40% to 60% by 2010. Teenage pregnancy can result in what the government calls “social exclusion” which is a reduced opportunity to socialise, carry on with education, find work, and a resulting poverty cycle for young parents. There is also an increased incidence of childhood illness and accidents in children born to teenage parents (Bekaert, 2005: 14). Contraception and pregnancy are particular focus areas for professionals working with young people. Wilson and MacAndrew (2000: 99) state that school-based sex education can be effective in reducing teenage pregnancy rates, especially when linked to access to family planning services. There is no evidence that it increases either sexual activity or pregnancy rates. The main reasons for high rates of teenage pregnancy are as follows: 1) Low expectations: Young people who were disadvantaged in childhood have poor expectations of education or the job market. Young women see no reason not to get pregnant. 2) Ignorance: Lack of accurate knowledge about contraception, sexually transmitted infections, relationships and being a parent. 3) Mixed messages: Young people are surrounded by sexually explicit material, yet adults do not generally talk openly about sex and about protection, resulting in unprotected sex (pp.49-50). With the coverage and publicity that teenage pregnancy receives, it is commonly believed that statistically the worst situation is in England and Wales. While U.K. does not compare favourably with neighbouring European countries, the statistics have been steadily improving since the 1970s. Teenagers are in fact less likely to get pregnant today than they were in the early 1970s. Per one thousand 15 to 19 year olds, the conception rate in 1970 was 82.4% as compared to 43.8 % in 2000. Since 1998 the teenage conception rate has declined. The decline in teenage motherhood is even more striking, reducing by half the rate by 2000. Bekaert (2005: 47) ascribes this improvement to increased availability of contraception, introduction of the Abortion Act in 1967 that increased the availability of legal abortion, and heightened awareness of sexual health and contraceptive issues amongst the population as a whole. Statistics: Bekaert (2005: 48) observes that there is great regional variations in statistics. In deprived areas of the country, for example in the poorer localities of London teenage conception rate is considerably higher than in the affluent areas or in other parts of the country. These areas are characterized by lower levels of education and poor job prospects. The probability of a pregnant teenager having an abortion decreases with age. In 2000, in England and Wales, 59 % of those aged under fourteen had an abortion, for fifteen-year-olds the figure is 52 %, at seventeen 40 %, and at nineteen 35%. As a result of legalized abortion, fewer children have been given for adoption in recent years. In 1975 more than 20, 000 children were given for adoption; in 1985 the figure was 7,000; and in 1995, 6000. Teens from higher socio-economic groups and with economic and educational aspirations would be the most likely to give a child for adoption, states Bekaert (2005: 48). The Teenage Pregnancy Strategy: The working group Teenage Pregnancy Unit set up by the government has formulated an Action Plan in which it takes a preventative and educative approach to help young people avoid becoming young parents; and helps to promote strategies by which teenage parents can improve their options in life. The two main goals of the action plan are: Halve the rate of conceptions among the under-18s by 2010, and getting more teenage parents into education, training or employment to reduce their risk of long-term social exclusion, . The Action Plan is a strategy consisting of four types of interventions (Bekaert, 2005: 50): 1. National campaign: Target young people and parents with the facts about teenage pregnancy and parenthood, advice on how to deal with pressures to have sex, importance of using contraception if required. 2. Joined-up action: Appointment of local co-ordinators to pull together all the services that have a role in preventing teenage pregnancy, or supporting those that become parents. 3. Better prevention: Better education in school, at home and outside, access to contraception, working with parents and targeting at-risk groups, especially young men. 4. Better support: For pregnant teenagers and teenage parents to return to education. Sexual Health Education Programmes: Young people need to be engaged in positive health behaviours so that beneficial health foundations can be laid for future years. It is essential that young people receive health and sexual health information from a reliable source such as the professionals who work with them. This will equip them with the correct knowledge to help them in making informed decisions (Bekaert, 2005: 14). The issues related to the sexual and reproductive health risks of adolescent females are complex and multi-faceted, hence the prevention messages provided to adolescents need to be clearly defined, non-judgmental, and specifically tailored to the unique needs of the target audience. The specific characteristics to be taken into account, according to Wingood & DiClemente (2002: 113) are: age, gender, race/ ethnicity, sexual orientation, developmental status and sexual experience. The sexual health education programs should be responsive to the needs of adolescents, and delivered in a timely manner, to avoid redundancy by giving too little too late. It is crucial to teach the implications of contraception and reproductive health services for the teenager, including questions of availability, accessibility, usage, and their effects on behaviour, health and well-being (p.231). The discussion should be interactive and include practical information on risk-reduction skills, besides focusing on the facts and risks. Teenagers should also be taught that protection from harm is their constitutional right, and various governmental policies have been formulated to safeguard them. In knowledge lies power, and children should be made aware of injustice and how to seek help if necessary. United Kingdom Government Policies on Child Protection: The Safeguarding Vulnerable Groups Act 2006: This government policy will introduce a new vetting and barring scheme for all those working with children and young people from 2008. Ahead of the new scheme, the Secretary of State for Education and Skills announced in June 2006 that regulations would be tightened and new guidance introduced to clarify responsibilities for safer recruitment, (TeacherNet, Child Protection). The guidance Working Together to Safeguard Children published in April 2006 sets out how individuals and organisations should work together to safeguard and promote the welfare of children. To help Local Safeguarding Children Boards implement the guidance, a set of outcomes for safeguarding training and an example of a local protocol for working with sexually active under 18-year-olds are being provided (TeacherNet, Child Protection). Child Protection Legislation: Sections 27 and 47 of the Children Act 1989 place duties on a number of agencies, including Local Education Authorities (LEAs, and therefore indirectly LEA maintained schools) to provide assistance to social services departments acting on behalf of children in need (s27) or investigating allegations of abuse (s47), (TeacherNet). Teenage Pregnancy Next Steps: Guidance for Local Authorities and Primary Care Trusts on Effective Delivery of Local Strategies: This Department of Health guidance provides information on good practice, to enable each local area to take action to meet the existing commitment to accelerate progress towards the joint target to halve the under-18 conception rate by 2010. Reducing teenage pregnancy rates is an important part of the government’s agenda to tackle poverty and reduce inequality. The guidance sets out what works, describes what needs to happen in each area, what support the centre will provide to local areas to help delivery, and how the centre will intervene in areas that fail to deliver (Department of Health, 2006). Reflective Practice in Nursing: For clinical effectiveness and best practice in nursing, reflective practice is known to be significantly useful. John’s model of structured reflection is frequently used for enhancing effectiveness in practice. Johns (2004) states that reflection is to confront and resolve the contradiction between what the practitioner wants to be and do (the ‘vision’) and what they actually do (the ‘lived reality’). The attempt (or desire) for the practitioner resolve this contradiction is a sort of tension which is creative because it can be resolved in a way that can move the practitioner forward in their practice. John’s Model of Structured Reflection Reflection on action is defined as “The retrospective contemplation of practice undertaken in order to uncover the knowledge used in practical situations, by analysing and interpreting the information recalled” (Fitzgerald, 1994: 67). On the other hand, reflection in action is defined as “To think about what one is doing whilst one is doing it; it is typically stimulated by surprise, by something which puzzled the practitioner concerned”(Greenwood, 1993). These views about reflection and action do not take into account the importance of reflection before action. Hence, it would be best to see the correlation between reflection and action as an integration of : reflection before action, reflection in action, and reflection on action (Lifelong Learning Project Team). Chris John’s (1994; 1995) model arose from his work in the Burford Nursing Development Unit in the early 1990’s. He envisaged this model as being used within a process of guided reflection. His focus was about uncovering and making explicit the knowledge that we use in our practice. He adopted some earlier work by Carper (1978) who looked at ways of knowing in nursing (Lifelong Learning Project Team). Ways of knowing Cues Aesthetics – the art of what we do, our own experiences What was I trying to achieve? Why did I respond as I did? What were the consequences of that for the patient? Others? Myself? How was this person (people) feeling? How did I know this? Personal – self awareness How did I feel in this situation? What internal factors were influencing me? Ethics – moral knowledge How did my actions match my beliefs? What factors made me act in an incongruent way? The framework uses five cue questions which are then divided into more focuses to promote detailed reflection. Cue Questions: I Description of the experience: 1. Phenomenon – describe the here and now experience 2. Casual – what essential factors contributed to this experience? 3.Context - what are the significant background factors to this experience? 4.Clarifying – what are the key processes for reflection in this experience? II Reflection: What was I trying to achieve? Why did I intervene as I did? What were the consequences of my actions for: Myself? The patient / family? The people I work with? How did I feel about this experience when it was happening? How did the patient feel about it? How do I know how the patient felt about it? III Influencing factors: What internal factors influenced my decision – making? What external factors influenced my decision – making? What sources of knowledge did / should have influenced my decision – making? IV Could I have dealt with the situation better? What other choices did I have? What would be the consequences of these choices? V. Learning: How do I now feel about this experience? How have I made sense of this experience in light of past experiences and future practice? How has this experience changed my ways of knowing Empirics – scientific Ethics – moral knowledge Personal – self awareness Aesthetics – the art of what we do, our own experiences (Lifelong Learning Project Team). Critical Analysis of John’s Model of Reflection (1995): When using the series of questions posed by a model of reflection, any real reflection may be difficult for the nurse to undertake, since her experience will get reduced to the questions in the model. Therefore, researchers prefer to use John’s Model of Structured Reflection (1995), which has a series of cues or signposts rather than a succession of questions to be answered religiously in order (mentalhealthnursing web site). The most important aspect of engaging in reflective writing for work-based learning is that a change in conceptual perspective is brought about. More than just a gain in knowledge, the process of reflective writing also challenges the concepts and theories by which one makes sense of knowledge. Reflection makes one see the situation differently. The structural progression in John’s (1995) model of Structured Reflection, guides the nurse’s reflective thinking by giving cues and signals as prompts by which reflection is inspired. The different way of viewing the situation is defined by statements denoting a commitment to action. Action is the final stage of reflection. The nurse will gain new perspectives when she shares her reflective writing with her mentor/ educational adviser (Learning Unit). Two of the most important questions in John’s Model of Structured Reflection are: “How do I feel about what happened?” and “How can I do this differently next time?” These questions help to reduce traumatic feelings, thereby, benefiting the nurse and helping in the improvement of practice. The first step of thinking through the description of the experience, the key processes, helps in focusing clearly on the work that had been done. The second question considers the consequences of the action for each person involved, and the feelings invoked during the particular work that had been done. Studying the influencing factors is also an important step. However, bias should be avoided, in guaging the factors which played a part in the decision making. The model encourages creative thinking by asking the nurse to think through the consequences of any alternative methods that could have been applied. By considering various other options and questioning oneself whether the situation could have been handled in a different way, reflection, far-sightedness and learning enhancement take place. Thus it is observed that John’s (1995) model is comprehensive, convenient to use, and valuable as a learning tool. CONCLUSION: In this paper, the various aspects of teenage sexual health, unexpected pregnancy and related factors have been studied. The prevalence of sexual activity starting from a very young age, and the occurrence of unplanned pregnancy among girls from thirteen to sixteen years of age, is a cause of great concern to the U.K. government. Strategic steps are being taken by the government to reduce the rate of unexpected pregnancy among young girls, and to control the escalating incidence of infectious diseases such as acquired immunodeficiency syndrome and sexually transmitted diseases. If drastic measures with the help of health care workers are not implemented, these diseases can cause serious morbidity leading to mortality. Raising the socio-economic level of the most vulnerable part of the population: the poor, has been considered as the remedy which will be most successful in achieving the desired outcome. The U.K. governmental policies for child protection and for ensuring teenage sexual health are also discussed. Legislation to cover all aspects of child health and well-being is seen to be present, along with that of teenage pregnancy and A critical analysis of John’s Model of Reflection (1995) has revealed that on the whole, the model is well structured and is a useful tool for nurses to learn from personal work experience. REFERENCES Bekaert, Sarah. (2005). Adolescents and Sex: The Handbook for Professionals Working With Young People. United Kingdom: Radcliffe Publishing. Carper, B. (1978). “Fundamental Ways of Knowing in Nursing”. Advances in Nursing Science, Vol.1, No.1: pp.13-23 Department of Health. (2006). “Teenage Pregnancy Next Steps: Guidance for Local Authorities and Primary Care Trusts on Effective Delivery of Local Strategies”. Web site: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_4137536 Fitzgerald, M. (1994): “Theories of Reflection for Learning” in Reflective Practice in Nursing, A. Palmer and S. Burns (Eds). Oxford: Blackwell Scientific. Greenwood J (1993): “Reflective Practice: a Critique of the Work of Argyris & Schon”. Journal of Advanced Nursing, Vol.19: pp.1183-1187 John, C. (2004). Becoming a Reflective Practitioner. Oxford: Blackwell Publishing. Learning Unit, “Models of Reflection”. Web site: staffcentral.brighton.ac.uk/CLT/events/documents/Ramage%20Example%203.doc – Lifelong Learning Project Team, Greater Manchester AHP/ HCS. “Frameworks for Reflection: John’s Model of Structured Reflection”. Web site: www.bolton.nhs.uk/SHA/LLL/resources/reflective/Framework%20for%20Reflection.doc - TeacherNet, United Kingdom Government Policies on Child Protection. Web site: http://www.teachernet.gov.uk/wholeschool/familyandcommunity/childprotection/frequentlyaskedquestions/ Mental Health Nursing.“What is Reflection?” Web site: http://www.mentalhealthnursingstuff.co.uk/ Wilson, Heather; MacAndrew, Sue. (2000). Sexual Health: Foundations for Practice. United Kingdom: Elsevier Health Sciences. Wingood, Gina M; DiClemete, Ralph M. (Eds.), (2002). Handbook of Women’s Sexual and Reproductive Health. New York: Springer. Read More