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Keywords:

  • Adolescent Care;
  • Capacity Building;
  • Curriculum Planning;
  • Education;
  • Health Service Management;
  • Nursing Competence;
  • Nursing

Abstract

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

Background

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.

Aim

To determine the effectiveness of a structured adolescent health summer programme for Chinese undergraduate nursing students.

Methods

A quasi-experimental design was used to evaluate differences in the Chinese undergraduate nursing students' perceived competency in promoting adolescent health. A stand-alone adolescent health course was implemented as an intervention with pre- and post-tests of a 2-week intensive summer programme in 2010. The questionnaire included demographics, adolescent health competency checklist and programme evaluation. Descriptive statistics with the Wilcoxon signed-ranks test and the Mann–Whitney U-test were used for data analysis.

Results

Of the 113 nursing students, seniors perceived higher adolescent health competence mean scores than the juniors in the post-test phase. Majority of nursing students revealed the increasing awareness of the importance in promoting healthy lifestyle behaviours and psychosocial well-being after attending the summer programme. They agreed that nurses do have a role to play.

Limitations

This 2-week summer programme may only have short-term impacts on students' perception.

Conclusions

A stand-alone adolescent health summer programme can prepare nursing students to respond to the health issues of adolescents by enhancing their competence in health need assessment and service delivery.

Implications for nursing and health policy

Nurses serve in a leadership role for health policies and programmes. In nursing education, it is important for students to understand how to put in place policies to resolve adolescent health issues.


Background

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

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.

Conceptual framework

The WHO has introduced an adolescent health and development community framework into the pre-service training and continuing education of healthcare professionals throughout the Western Pacific Region in order to foster professional development linked to teaching and learning (WHO 2002). The four domains are (1) a professional development subscale, (2) a psychosocial and physical well-being subscale, (3) a healthy behaviour and lifestyles subscale and (4) a sexuality and reproductive health subscale. This study adopted these four domains and integrated them into the summer programme in order to evaluate the nursing students' knowledge and skills in assessing, planning and implementing adolescent health community projects. The teaching activities in which nursing students engage could increase their awareness and foster their ability to promote adolescent health and development in the community. The experience of planning an adolescent health community project should motivate nursing students to enhance their communication and counselling skills, engage in team work and share their own experiences in promoting adolescent health. The WHO suggests that healthcare workers' enhanced knowledge and understanding of issues involving adolescents are imperative in order to successfully improve the health of adolescents in the region (Lee et al. 2006).

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.

Aim

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

Given the lack of nursing health policy concerning perceived competence among undergraduate nursing students in mainland China and Hong Kong in this global world, the purpose of this study was to evaluate the improvement in the competence variables of Chinese nursing students delivering AHD services after attending a 2-week summer programme on adolescent health.

Methods

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

Design

This was a quasi-experimental design and involving repeated measures with pre- and post-tests. The study was conducted using neither randomization nor a control group. Ethical approval was obtained prior to conducting the interviews. In order to assess changes before and after implementing the integrated AHD domains into the 2-week summer programme in terms of the level of WHO AHD Competence exhibited by the nursing students, the students completed the pre-test of the checklist before and after attending the summer programme. The two scheduled periods between July and August 2010 constituted the pre- and post-tests for this study. The nursing students were asked to complete the checklist before taking the credit-based adolescent health course as the pre-test phase, and after completing an interview with an adolescent and delivering a community adolescent health project as the post-test phase.

Sampling and power analysis

A moderate effect size Cohen's d of 0.6 was selected for generating power analysis (Cohen 1988). For a two-tailed t-test hypothesis, a sample size of 45 participants for each group was required. It is generally accepted that power should be 0.80 or greater, and probability level 0.05. The study used a convenience sample of 113 nursing students recruited from 44 member institutes and/or universities in mainland China and Hong Kong in the summer term of the 2010 academic year. The target population was full-time first, second, third and fourth year nursing students enrolled in a pre-service training programme in a university. Forty-four out of 82 institutes participated in this summer programme, giving a participation rate of 53.7%. Assuming a 10% dropout rate, 50 subjects were recruited to each group, giving a total of 100 students.

Data collection procedures and instrument

The tool used in this study was developed using the WHO adolescent health domains to measure the existence of adolescent health concepts taught in an adolescent health-integrated nursing curriculum by Lee et al. (2006). It included five domains (professional knowledge, cultural desire, cultural knowledge, cultural skill, cultural encounters) and components that are based on WHO Adolescent Health's conceptual model of healthcare workers' competence (WHO 2002). In brief, the English version of the WHO AHD Competence Checklist that was adopted in this study is a questionnaire with 64 competence variables. It is composed of four domains: a professional development subscale, a psychosocial and physical well-being subscale, a healthy behaviours and lifestyles subscale, and a sexuality and reproductive health subscale. Respondents were asked to indicate their levels of competence on a four-point scale in order to determine respondents' agreement level. The four-point Likert scale is also called a ‘forced’ Likert scale since the respondent is forced to form an opinion as there is no safe ‘neutral’ option. It has been used for recording opinion on products that the respondent has experienced (Hall 2010). The competencies under the grading of satisfaction and dissatisfaction referred to knowledge, attitudes and practices. The AHD checklist was tested to evaluate the competencies (knowledge, skills and practices) of nursing students following their field practice in their third year of nursing training (Lee et al. 2006). The validated AHD checklist was then translated into simplified Chinese and sent to a panel of five adolescent health experts who could understand both English and Chinese, for face validity testing. The panel included an adolescent health nurse, a school nurse, a paediatrician and two adolescent academic lecturers. The reliability, validity and appropriateness of the healthcare professionals' competence checklist on AHD were discussed. Areas were suggested as a guide for capturing key points on AHD within the Chinese cultural context. The Content Validity Index (CVI) was used, with minor changes, and total agreement was obtained. In Lee and her colleagues' study (2006), the overall intra-rater reliability was 0.91. The reliability coefficient for the four domains (subscales) ranged from 0.74 to 0.94. The alpha coefficient for the total scale of the AHD Competence Checklist was 0.96, and the alpha coefficients for the four domains (four subscales) ranged from 0.65 to 0.92 (Lee et al. 2006).

Data collection

The new learning objectives and syllabus for the AHD summer programme were based on a stand-alone course integrating four AHD Curricular Domains (WHO 2002). These domains represent broad classifications of adolescent health and development issues that are universal or globally relevant. The programme committee endorsed the new syllabus of the summer subject ‘Adolescent Health and Development’. Pre- and post-tests using the validated WHO AHD Checklist (Lee et al. 2006) were conducted before and after students completed the lectures and project plan, implementation and evaluation using the module materials, tutorials and case interview assessment skills from the HEADSSS (Goldenring & Rosen 2004) psychosocial screening tool and through experiential learning to promote healthy lifestyles in a youth centre in the community.

Ethical considerations

Approval was obtained from the university ethical committee; all nursing students who participated in the study were informed about the nature of the study by the researchers before the programme started. The purpose of the study and procedures for data collection were stated clearly in the briefing session. The consent forms were then signed by the nursing students prior to conducting the study.

Data analysis

Descriptive statistics were used to compute the demographic and AHD competence data. A Shapiro-Wilk's test was used to examine the normality of the AHD competence scores (Shapiro & Wilk 1965), the results suggested that non-parametric tests were appropriate. Chi-squared or Fisher's exact tests were also used to examine the associations between junior and senior groups, as well as the demographic factors. A Wilcoxon signed-ranks test was used to examine differences in each competence score between the pre- and post-results for each group, and a significance value of P < 0.05 was adopted. A Mann–Whitney U-test was used to examine differences in each competence score for the groups both pre- and post-test. All statistical analyses were performed using SPSS 17.0 (2007).

Results

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

Participant characteristics

Table 1 provides an overview of the characteristics of the sample, with their age distribution, gender and level of nursing education. A total of 113 undergraduate nursing students participated in this study, 61 (54%) juniors and 52 (47%) seniors, ranging from 19 to 30 years, with a mean age of 21.62 years. Of the total, 16.8% (n = 19) were males and 83.2% (n = 94) were females. One hundred and thirteen nursing students were recruited from 44 institutes and/or universities through the members of the Chinese Higher Nursing Education Consortium of institutions in Hong Kong, mainland China, Macau and Taiwan with an institutional participation rate of 53.7% [one institute with 20 participants (17.7%) from Hong Kong, two institutes with four participants from Taiwan (3.5%), two institutes from Macau (3.5%) and 37 institutes from mainland China (75.3%)]. The junior nursing students were currently enrolled in years one and two of the nursing programmes in their institutes, and the 52 senior nursing students were currently enrolled in years three and four of the nursing programmes in their institutes.

Table 1. Demographic characteristics of students (N = 113)
DemographicsJunior year (n= 61)Senior year (n= 52)P valueAll (N= 113)
Mean (SD)Mean (SD)Mean (SD)
  1. *Mann–Whitney U-test.

  2. †Chi-square test.

Age21.70 (2.20)21.52 (1.32)0.58*21.62 (1.84)
Gendern (%)n (%) n (%)
Male13 (21.3)6 (11.5)0.1719 (16.8)
Female48 (78.7)46 (88.5) 94 (83.2)

Perceived competence in promoting adolescent health

Table 2 displays the mean scores of the pre- and post-tests of the AHD Competence Checklist for 113 nursing students (61 juniors and 52 seniors) in this study. Wilcoxon's signed-rank tests were conducted to determine whether there were any significant differences in the competence variables between the pre- and post-test scores for both groups (Burns & Grove 2008). There was a significant increase from the pre- to the post-test in the total score for the variables in the AHD Competence Checklist (Z = −8.13, P < 0.001) and its four subscales: the professional development subscale (Z = −8.82, P < 0.001), the psychosocial and physical well-being subscale (Z = −8.58, P < 0.001), the health behaviour and lifestyles subscale (Z = −8.43, P < 0.001) and the sexuality and reproductive health subscale (Z = −8.66, P < 0.001).

Table 2. Comparison of students in the junior and senior year groups on the AHD Competency Checklist
Subscale of the ADH Competency ChecklistJunior year (n= 61)Senior year (n= 52)Mann–Whitney UAll (N= 113)
Mean (SD)RangeMean (SD)RangeU, P valueMean (SD)Range
  1. Professional development subscale consists of 17 items; scores ranged from 17 to 85, the higher the scores, the higher the perceived competent level.

  2. Psychosocial and physical well-being subscale consists of 27 items; scores ranged from 27 to 135, the higher the scores, the higher the perceived competent level.

  3. Health behaviours and lifestyles subscale consists of 10 items; scores ranged from 10 to 50, the higher the scores, the higher the perceived competent level.

  4. Reproductive health subscale consists of four items; scores ranged from 4 to 20, the higher the scores, the higher the perceived competent level.

  5. Total, sum of four subscales of the ADH Competence Checklists; the total scores ranged from 58 to 290, the higher the scores, the higher the perceived competent level.

  6. *Wilcoxon signed-ranks test.

Professional development subscale       
Pre-test42.03 (7.30)26–5743.33 (7.80)26–62−0.68, 0.49942.63 (7.52)26–62
Post-test65.29 (7.57)47–8066.44 (9.98)29–83−0.89, 0.37265.84 (8.77)29–83
Z, P value*−6.57, <0.001 −5.91, <0.001  −8.82, <0.001 
Psychosocial and physical well-being subscale       
Pre-test64.85 (12.32)40–9270.51 (14.73)44–103−1.84, 0.06667.39 (13.69)40–103
Post-test103.84 (13.07)72–133102.65 (16.29)36–129−0.05, 0.959103.28 (14.64)36–133
Z, P value*−6.50, <0.001 −5.63, <0.001  −8.58, <0.001 
Health behaviours and lifestyles subscale       
Pre-test22.38 (4.55)14–3324.51 (7.58)13–60−1.52, 0.13023.38 (6.21)13–60
Post-test36.88 (5.59)22–5037.15 (6.28)16–49−0.37, 0.71137.01 (5.90)16–50
Z, P value*−6.44, <0.001 −5.47, <0.001  −8.43, <0.001 
Reproductive health subscale       
Pre-test9.05 (2.18)4–159.87 (3.02)4–16−1.56, 0.1189.44 (2.63)4–16
Post-test15.50 (2.63)10–2015.71 (2.56)5–20−0.63, 0.53015.59 (2.59)5–20
Z, P value*−6.47, <0.001 −5.79, <0.001  −8.66, <0.001 
Total score       
Pre-test138.09 (23.43)92–191149.21 (29.89)94–212−1.87, 0.062143.32 (27.11)92–212
Post-test222.02 (26.24)160–269222.57 (33.23)86–280−0.22, 0.822222.27 (29.70)86–280
Z, P value*−5.97, <0.001 −5.56, <0.001  −8.13, <0.001 

Differences between seniors and juniors in perceiving competence on adolescent health

With regard to the perceived competence of adolescent health and development, there was a statistically significant increase in the post-test score from the pre-test score (143.32 vs. 222.27, P < 0.001). In particular, there was also a statistically significant increase from the pre-test scores to the post-test scores in both seniors (149.21 vs. 222.57, P < 0.001) and juniors (138.09 vs. 222.02, P < 0.001). Seniors fulfilled a higher level of competency than juniors, and obtained higher mean scores in all three subscales in the post-test: the professional development subscale (66.44 vs. 65.29, P < 0.001), the health behaviour and lifestyles subscale (37.15 vs. 36.88, P < 0.001) and the reproductive health subscale (15.71 vs. 15.50, P < 0.001), respectively. However, the differences in the subscales with AHD were not significant between the two groups (seniors and juniors). The Mann–Whitney U-test was used to determine whether there were differences in the subscales and total scores of the two groups in the pre- and post-tests (Burns & Grove 2008).

Discussion

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

This study is one of the first in mainland China to evaluate junior and senior student nurses' perceived competence in adolescent health in the nursing curriculum. This finding is similar to those of Gerrish et al.'s (2008) cross-sectional survey on evidence for the practice of junior and senior clinical nurses, revealing that all respondents demonstrated confidence in accessing and using evidence for practice. National and local guidelines for effectiveness and safe clinical practice are now more often made available to practitioners and promoted through clinical governance in healthcare delivery via the WHO's website. Thus, the findings of this study can be transferred to other nations in the networks of the WHO. This has added value to the evidence-based nursing practice in the region.

This study has limitations due to the fact that it was conducted among Chinese university nursing students only, but the findings add to the evidence-based practice on the significant gap in Chinese undergraduate nursing students' perceived knowledge of promoting adolescent health and development. This provides an overall picture of the concerns regarding nursing students' exposure to global cultural health issues among adolescents, which are very important in transcultural nursing practice as described by Leininger (1991). The study findings add to knowledge of the transcultural nursing society, which has developed a set of standards for cultural competence in the globalization of nursing practice. Nurses need to understand and appreciate inherent similarities and differences, not only locally, but regionally, nationally and globally as well. In order to provide morally competent care that respects individual values and needs, nurses must examine their own health-related values and beliefs, as well as those of the healthcare organization in which they work; only then can they support the principle of respect for persons and provide the ideal of transcultural care (Bjarnason et al. 2009).

In this study, most of the Chinese student nurses' AHD competence variables increased significantly in the post-test after attending the 2-week AHD summer programme. The competencies delineate the knowledge, attitudes and practices expected in basic nursing practice, as identified by Wojtczak (2002). This summer programme not only equipped the nursing students with the basic knowledge and skills for promoting adolescent health and development, but also gave them opportunities to understand the cultural aspects in assessing adolescent health issues using a holistic approach. This result is similar to those of Lee et al. (2006) and Hamilton Public Health Services (2010), which revealed the impacts of nursing students' attitudes to child and adolescent health using module materials from the summer programme. There have been other studies promoting adolescent health through service learning in a community (Lee et al. 2006; Okere et al. 2011). This is also consistent with the study results of Hsiao et al. (2011), which showed that integrating genetics into the nursing curriculum affected student nurses' perceived attitudes, knowledge of genetics, clinical comfort level in genetics and genetic education in the nursing curriculum. Wilson et al. (2012) and Jones et al. (2012) used pre- and post-paired t-tests to measure undergraduate nursing students' cultural competence after enrolling in overseas courses. They both found that there were statistically significant improvements in the pre- and post-tests in each group based on an increase in all group mean scores on the post-tests in the students' cultural competencies. These findings were very similar to those of the present study, except that the juniors' mean scores were higher than those of seniors in these two studies.

Hsiu-Chin (2010) also developed cultural competence among nursing students through service learning, which is similar to the programme development of this present study using service learning to measure students' competence. The present study findings are also similar to those of Walker (2010) and Kim (2001), which revealed the effects of career attitude maturity using the career education programme.

To address the increasing adolescent health issues of adolescents and their families, faculty nursing schools must teach students and child and adolescent health practitioners, especially juniors, to acquire adolescent-related competencies such as sexual and reproductive health counselling skills, or to make appropriate referrals (Edwards et al. 2006). It is crucial that nursing faculties build their adolescent health knowledge and skills, as well as competence and confidence in reading journals, attending conferences and taking online courses. There is an urgent need for Chinese nursing students to become knowledgeable in adolescent health and to integrate and advance adolescent health materials into multiple courses throughout all nursing programmes.

Implications for nursing and health policy

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

Nurses serve in a leadership role for health policies and programmes. In nursing education, it is important for students to understand how to put in place policies to resolve adolescent health issues. This study illustrates the importance of focused education on adolescent health, and has clear implications for the development of nursing curricula. Given that adolescent health is a major area of the public health agenda, not only in Asia but also in the world, this topic should be placed effectively in the educational preparation of nurses. It demonstrates what can be achieved through focused educational interventions on adolescent health, and adds weight to the argument that adolescent health should not be fragmented across the curriculum but seen as an integrated specialist subject field in its own right. This is important as it places adolescent health alongside, say, elderly care as a clearly recognized specialist area for nursing and healthcare education, research and service development. As the number of adolescents increases, and they face a growing litany of threats to their health, it is increasingly important that their health needs be recognized in nurse education. This study adds to this call.

Limitations

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

There were several limitations to this study. Firstly, it was limited to examining aspects of adolescent health with respect to Chinese undergraduate nursing students' perceived competence with the four domains of the WHO AHD framework. There are many cultural factors contributing to adolescents' high-risk behaviours, and they are not influenced by one single factor. Additional insight is needed into the ways in which information about adolescent health is integrated into the baccalaureate nursing curriculum. Secondly, this was an intensive 2-week summer programme, and as such, may only have had short-term impacts on students' perception. Third, the study sample was limited to Chinese nursing students.

Conclusion

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

It is concluded that the integrated adolescent health summer curriculum is essential in strengthening nurses' AHD competencies to promote the health and well-being of adolescents. Thus, adolescent health service providers need to have clinical competencies (WHO 2002). By virtue of their education, numbers and the diversity of their practice areas, nurses are in a unique position to contribute to the health of adolescents. Junior year nursing students are in particular need of such a curriculum, as they showed lower confidence in achieving the target aims to promote adolescent health after attending appropriate training. In Hong Kong, nurses make up the largest healthcare network and have the potential to address issues of adolescent health and development in individual, family and community practice settings. Preparing nurses to meet issues of adolescent health remains a challenging and complex task, requiring planned educational experiences throughout the nursing curriculum. Using an experiential service learning and transformative educational approach, it is hoped that the development of the integrated curriculum is timely and will be used to formulate a platform to develop guidelines for the concept of integrating AHD into nursing education. Recommendations based on the findings of this study will serve as a basis for developing sound policies and practical approaches, and for supporting the integration of content areas on adolescent health, such as the WHO AHD Curricular Integration Process Guidelines (2002).

Acknowledgements

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

We thank all the nursing students and staff members who participated in this study. We also thank Xio Xiao Ling, Samantha Lee and Amanda Leung for their kind assistance.

Author contributions

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Methods
  6. Results
  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References

Study design: RLL, MH. Data Collection: RLL. Data analysis: RLL. Manuscript writing: RLL, MH.

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  7. Discussion
  8. Implications for nursing and health policy
  9. Limitations
  10. Conclusion
  11. Acknowledgements
  12. Author contributions
  13. References
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