The nursing profession has an obligation to meet the health demands of the public. Expectations for service are continuing to change in relation to ongoing challenges and developments in society. Such dynamic healthcare and patient needs present continuous challenges to the quality of nursing education. The issues and challenges faced by adolescents in the Western Pacific region are not unique; rather, they are of global concern (WHO 2009). However, it could be argued that the health issues of adolescents are under-recognized by healthcare providers (Lee & Loke 2011). In addition, services and programmes for adolescents are fragmented and underutilized. In spite of their potential to do so, child and adolescent health practitioners in the Chinese population have not played a major role in dealing with these adolescent health issues. Nurses' capacity to deal appropriately with adolescent health issues needs to be enhanced through education and training.
In the World Health Organization (WHO), Western Pacific region, children and adolescents face significant challenges to their health and well-being. Similar to other developed societies in this unstable world, the Chinese mainland and Hong Kong are also facing complex socio-economic challenges in the child and adolescent population. These include nutritional problems, high-risk behaviours, mental health problems, learning disabilities, sexual behaviours, serious family problems, lifestyle factors and communicable diseases. The health issues of adolescents in Hong Kong are greatly influenced by modern technology and socio-economic and cultural changes (Lee & Loke 2005, 2011), while a few key health issues are being identified, such as AIDS, substance abuse, obesity and mental problems (Piercy & Hayter 2007; Reeves et al. 2008).
The concerns of adolescent health and development are not considered a priority in the Western Pacific region, and the adolescent health development competence checklist is not available to healthcare providers. Thus, nursing programmes in the Western Pacific region do not adequately prepare undergraduate nursing students to deliver preventive health services for adolescents (Lee et al. 2006). It is important to integrate adolescent health domains into pre-service nursing education in order to enhance undergraduate nursing students' competencies in promoting adolescent health and development (Kelly et al. 2005).
Integration of adolescent health domains into nursing education
Nurses have a unique role to play in the health of adolescents. An appraisal of country-specific epidemiological data, existing health initiatives and actual field experience will guide the identification of priority adolescent health issues and challenges within each region. A few common adolescent health issues have been identified in the Western Pacific region, including reproductive health, substance use, unintended injury, nutrition and mental health (WHO 2001). Based on the expertise of nurses from around the world, the Department of Child and Adolescent Health and Development and the Department of Human Resources for Health of the WHO have outlined the core competencies to be developed through the training of professional nurses and midwives (Lee et al. 2006). Several instruments relevant to nurses and midwives are available, including an orientation programme on adolescent health and development (AHD) for healthcare providers (WHO 2010) and a handbook on Adolescent Job Aid (WHO 2009). This will assist in the development of core competencies for nurses from different countries in the Western Pacific region, enabling them to deliver appropriate and effective AHD services.
Develop a stand-alone adolescent health summer course
In addressing the issues faced by the adolescent population in the Western Pacific Region, the importance of enhancing competency cannot be overemphasized. In 2010, a 2-week summer programme with a stand-alone course on adolescent health was delivered for undergraduate nursing students from 42 institutes and/or universities in the Chinese mainland and Hong Kong. The aim of this study was to evaluate the perception of nursing students' competence variables in planning and delivering AHD services after attending a 2-week stand-alone adolescent health course. The course planning committee, including two adolescent health academic nursing colleagues and a technical officer in adolescent health, designed the course based on an analysis of lessons learned when integrating AHD curricular domains (Lee et al. 2006; WHO 2002) into an undergraduate nursing curriculum in a university in Hong Kong. The study adopted the four WHO AHD curricular domains (WHO 2002) and systematically integrated them into a 2-week stand-alone summer programme on adolescent health with project planning and service delivery in order to improve nursing students' competence in adolescent health services delivery in the community. The outcome of this study was an evaluation of the nursing students' experiences in delivering preventive services in adolescent health following the summer programme.
There is evidence that a stand-alone summer programme can prepare nursing students to respond to clients' health issues by enhancing their competencies in health needs assessment and service delivery (Lee et al. 2006). Thus, the planning and implementation of such a programme in adolescent health requires the identification of strategies for teaching/learning competencies and the necessary resources for operationalizing those strategies. The plan included adopting the WHO AHD curricular framework (WHO 2002), aligning course objectives and assessment with students' intended learning outcomes, engaging community stakeholders, adopting a competency checklist for promoting adolescent health (Lee et al. 2006) and exploring the needs of local adolescents based on the expertise of project team members. Prior to using the WHO AHD competency checklist, it was important to identify any additional core competencies for AHD that might be necessary within the learning objectives and syllabus of the three-credit course in this summer programme.
Nurses are change agents whose actions impact individual, family and community health. They are in a unique position to contribute to the health of adolescents due to their education, numbers and diversity of practice arenas. Meeting the unmet healthcare needs of adolescents is a continuing challenge for healthcare professionals in the region. Competent nurses can be educated through a carefully planned summer course using problem-based tutorial learning and experiential service learning approaches. Since the physical environment shapes health values, beliefs and practices, a nurse must be able to assess each setting in order to practice effectively. The integrated summer programme must therefore be culturally ‘competent and sensitive’, providing nursing students with the knowledge and skills necessary to assess health needs, assets and priorities, and to adopt appropriate strategies.
In order to utilize individual experts in the areas of AHD, the project team included academic staff, a WHO AHD technical officer, and clinical specialists and community workers in adolescent health. Members of academic staff provided expertise in integrating the curriculum, and clinical specialists provided expertise in the clinical field. Nurse specialists also acted as consultants in the area of AHD. Community health workers shared their insights into AHD issues and concerns. The contribution of each team member facilitated the process of integrating AHD into pre-service nursing education. This included revising the content for the definitive subject document ‘Adolescent Health and Development’, and developing a strategic plan for the process of integration.
This was a collaborative project between the WHO Collaborating Centre for Community Health Services in a university in Hong Kong and a university from mainland China. The teaching team included adolescent health nurses, a paediatrician, academic staff and nursing educators. During the planning sessions, the planning team emphasized a systematic approach to the design, development, implementation, analysis and evaluation of the integrated summer programme. The benefits of the intensive 2-week summer programme were to increase the participation of students from different institutions while minimizing the clashing of the regular class schedules of the different nursing curricula in the 44 participating institutions, the timing and short duration of the course also enabled it to benefit from the availability of experts and manpower support. The WHO AHD Competence Checklist was adopted, translated into Chinese and used as a pre-implementation planning tool for the development and integration of the curriculum into the summer programme. Curriculum development includes identifying the core competencies to be attained by students (Lee et al. 2006). A competence is a stated benchmark that spells out the possession of a satisfactory level of relevant knowledge and the acquisition of a range of relevant skills that include interpersonal and technical components in the educational process (Chiarella 2006); in the case of nursing, it should also meet the demands of nursing health policy brought about by globalization (Bradbury-Jones 2009).
The authors were the subject lecturers who taught this AHD summer course through a carefully planned nursing curriculum using problem-based learning and experiential services learning approaches. Thus, the focus of the teaching and learning activities included lectures, tutorials, community group projects and presentations in order to raise the students' awareness and enhance their competencies in promoting adolescent health and development as healthcare providers. The student nurses also had the opportunity to conduct an in-depth interview and perform a health assessment with adolescents in one of the tutorial sessions; this constituted one of the assessment portions of this summer course. They were then asked to present the findings of the interview to their tutors. Nursing students were also involved in planning a health promotion and education activity in a youth community centre, which provided the student nurses with an opportunity to conduct needs assessments for adolescents, to develop a community project plan, and to implement and evaluate the project. This field practice offered student nurses the opportunity to set priorities after identifying the health needs while providing health services to the community. As such, the problem-based learning and experiential service learning have considerable potential to facilitate the integration of content and the development of AHD competency in nursing education, which is consistent with the purpose of this study.