TEXTO DEL TRABAJO:
1 - INTRODUCTION:
Questions about sexuality are not exclusive of adolescents (Santos, 2003), since the psycho-sexual development of each individual starts well before adolescence. However, it is during this period that his / her sexual organisation starts to take a definite character, both at the somatic and the sociological / psychological levels (Coslin, 2003). Each adolescent tries to build his / her identity integrating feelings, needs and desires.Adolescence is when many people start their sexual activity (WHO, 2003). During the last decades, the work of several authors demonstrates that youngsters of both sexes initiate their sexual activity increasingly earlier (Rede Feminista de Saúde, 2004). The beginning of their sexual activity is not however related to a consistent sexual education, neither to the acquisition of physiological knowledge, or to familiarity with biological aspects of sex and reproduction. Since many adolescents do nor use any contraceptive methods (Santos, 2003), those adolescents that are sexually active risk an involuntary pregnancy – a girl sexually active that does not use a contraceptive method has a probability of 90% of getting pregnant during the first year (Brook Advisory, 2003) – as well as HIV and other sexually-transmitted infection (STI) (Vesely, 2004;
WHO, 2002).In a society where adolescents are constantly molested by images of sex, it is not enough – and may indeed be entirely inappropriate – to recommend sexual abstinence. What is important is to provide them education and information according to their development stage regarding sexuality / affectivity, freedom, equality, responsibility, sex and contraception. More maturity will enable them to refuse a relation if they so wish, to express their sexuality while respecting each others’ rights, to negotiate intimacy levels, to decide on the development of a relationship and to select (and make a correct use) of an appropriate contraceptive method.The sexual behaviour of adolescents that are sexually active shows a positive trend in recent years, since contraceptive methods are increasingly used (Vesely, 2004). However, contraceptive methods are not always considered a priority by adolescents in the beginning of their sexual life. Such myths as “pregnancy or STI only happen to the others”, “I am yet too young, so there are no problems”, “I don’t get pregnant on the first time”, “on this phase of the cycle there are no problems”, still persist (Bekaert, 2005). The negative consequences (physical, psychological, social) of pregnancy in adolescence and of STI, more than justify the implementation of policies and programs that aim to reduce sexual risk behaviours in adolescents.Sexual education for adolescents must also increase their awareness to the importance of health surveillance and to the places where they may go for this purpose. Due to the specific aspects of development of adolescents and to the fact that their needs concerning sexual and reproductive health are not the same as in adulthood, education and health care programs must find a proper approach to address this group. “It is essential for health- care providers caring for adolescents to understand sexuality during the teenage period to be familiar with ways to deal with teenagers’ questions, feelings, and problems” (Neinstein, 96, p. 627).
2 - AIM:
This research aims to:- Progress along a path where the context of evolution leads to better health, both to the adolescent and to the future adult- Propose nursing strategies that create health-search behaviours in adolescents
3 - OBJECTIVES:
The main objectives of this work consist identifying the sexual habits of high-school adolescents, and the health care concerns of high-school adolescents that are sexually active.
4 - METHODOLOGY
We carried out a descriptive and exploratory study. Data collection was done using an anonymous questionnaire, filled in on a voluntary basis (filled in the classroom, within the standard time-slot of one class), and took place between February and March of 2005.
5 - SAMPLE CHARACTERISATION
In total, the questionnaire was filled in by 287 adolescents attending the 10th (41,1%), 11th (47,8%) and 12th (11,1%) years, all from schools located in the district of Porto. The age of the adolescents participating in this study ranges from 15 to 19 years old, with an average of 16,6 years old, and a standard deviation of 1,01. Most of them are females (57,7%).
6 - RESULTS
A total of 30,3% of the 287 adolescents stated that they had already had sexual relations. The age at their first sexual relation was in the average 15,4 years old. Girls initiated their sexual activity earlier than boys.
Most adolescents (88,2%) used a contraceptive method in their first sexual relation. The condom was selected by 89,3%, the pill was used by 2,7%, and both methods were used by 8% of these adolescents.
From those adolescents that indicated why they did not use contraception on their first sexual relation, 57,1% said that they “did not have any available on the occasion”, 14,3% said that they
“were too young, so there was no problem”, 14,3% “forgot to use it”, and 14,3% “was too young and was sure that she had no diseases”.
Most of those that used a contraceptive method on their first sexual relation said that no one recommended them the method that they used. Friends were the main source of information, since 10,9% refer them as the only source; 1,4% refer friends and their own mother, 1,4% refer friends and the Internet, and 6,8% refer a medical doctor. No one referred nurses as their source of information.
From those adolescents that had already had sexual relations, 11,6% did not answer the question
“how regularly do you have sexual relations?”. From those who answered, the results indicate a range that extends from once a month to six times per week; 3,9% said that they do not have sexual relations frequently, and 17,1% said that “it depends”. The most common answer is twice a week (15,8%).
Most adolescents (95,7%) say that they use a contraceptive method in their sexual relations, 2,9%
do not use any method and 1,4% only use occasionally. The condom is the selected method for 77,9% of the adolescents, and 7,4% of them use both the pill and the condom.
The pharmacy is the place where most adolescents (73,4%) acquire contraceptives. In what concerns the place where they have relations, 58,9% said that they use their home.
Most girls (76,7%) only had one partner, and none had more than three. Boys had from one (42,1%) to eight (2,6%) sexual partners.
Most adolescents say that they never had STI or became pregnant as a consequence of their sexual encounters (respectively 97,7% and 98,8%).
In relation to looking for health care, 91,8% never attended a family planning session; from those who attended, 85,7% went to a healthcare centre and 14,3% to a maternity hospital. Concerning sexual activity counselling, 3,6% talked with a nurse and 16,7% with a doctor.
According to the qui-square test, we may conclude that the statistical relation between age and having sexual relations is very significant (p=0,0). Most of the adolescents that have already had sexual relations are students of 17 and 18 years old.
7 - CONCLUSIONS
The results obtained in our study concerning the beginning of sexual activity are in accordance with other works published with this respect, indicating that many youngsters begin their sexual activity while teenagers (Bekaert, 2005). The reasons may include their search for a sexual identity, curiosity, pressure from their peers, and their impulse for emancipation (Bekaert, 2005; Coslin, 2003).
The risk of STI increases significantly as the number of sexual partners grows. Even the adolescents who had three sexual partners have a higher risk, when compared with those that had only one partner (sexually faithful), or those who are abstinent (Price, 2005).Girls become sexually active earlier than boys, but boys have a higher number of sexual partners (Durex Report, 2004; Coslin, 2003). We also concluded that those girls who participated in this enquiry and had already initiated their sexual life, did it earlier and had fewer partners than boys – none had more than three partners, while boys had up to eight. Most adolescents in our sample refer to have used contraceptive methods in their first sexual relation – this result is not in accordance with the literature, which indicates that few adolescents use contraceptives methods in their first sexual relation(s), because they do not have them, believe to be invulnerable, or believe in common hoaxes, such as not getting
who use contraception, when compared to other published results, may reside in the fact that all youngsters considered were students. According to the work of other authors (Friedman, 1998;
Schutt-Aine, Maddaleno, 2003), those youngsters who study and have educational objectives, have a higher tendency to use contraception.
Regarding their willingness to obtain professional health care help, and once again in accordance with previous data that may be found in the literature, our results indicate that adolescents do not value that possibility. This fact leads us to conclude that health care professionals and their institutions must be proactive in offering help to this group, instead of waiting for them to take the first step.
Running risks is part of the identity building process during adolescence, but sexual risk behaviours are a significant threat to the health and well being of adolescents, both at the physical, psychological and social levels. The negative consequences of pregnancy in adolescence and of STI, are more than enough to justify the implementation of policies and programs to reduce sexual risk behaviours of adolescents.
Nurses and doctors must use all appointments with adolescents to enquiry about their sexuality and to contribute to their education in this area. Nurses from health care centres must participate in school programs addressing education for health in sexuality. It is also important to reinforce educational activities in the areas of sexuality and reproduction, based in schools and supported by health services (Ministério da Saúde, 2004).
BIBLIOGRAFÍA:
Bekaert, S. Adolescents and Sex: the handbook for professionals working with young people.
Oxford: Radcliffe Publishing. 2005
Brook Advisory. Putting Young People First - Teenage Conceptions: Statistics and Trends. 2003 : http://www.brook.org.uk/content/fact2_TeenageConceptions.pdf
Coslin, P. Les Conduites à Risque à L’Adolescence. Paris: Armand Colin Éditeur. 2003 Durex Report. 2004 : http://www.durex.com/cm/gss2004result.pdf
Friedman, S., et al. Comprehensive Adolescent Health Care. 2nd ed. St Louis:Mosby. 1998
Ministério da Saúde. Plano Nacional de Saúde 2004-2010 – Mais Saúde para Todos, Volume II- Orientações Estratégicas. Lisboa: MS; 2004, In: www.dgsaude.pt
Neinstein, L. Adolescent Health Care - A Practical Guide, 3rd ed, Baltimore: Williams & Wilkins.
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Price, B. Practical Guidance on Sexual Lifestyle and Risk. Nursing Standard 2005, 19(27):46-52
Rede Feminista de Saúde. Adolescentes Saúde Sexual Saúde Reprodutiva.
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SANTOS, MR. Gravidez na Adolescência . APEO 2003 4:36 –38
Schutt-Aine, J, Maddaleno, M. Sexual Health and Development of Adolescents and Youth in the Americas: Program and Policy Implications. Pan American Health Organization, Regional Office of the WHO 2003. http://www.paho.org/English/HPP/HPF/ADOL/SRH.pdf
Vesely, SK.et al. The Potential Protective Effects of Youth Assets From Adolescent Sexual Risk Behaviors. Journal of Adolescent Health 2004 34: 356-365.
World Health Organization. Progress in Reproductive Health Research. 2003.
www.who.int/reproductive-health/adolescent
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2002. http://www.who.int/child-adolescent-health/publications/AD/WHO_FCH_FCH_CAH_01.20.htm
AUTOR/ES:
M. Lluïsa Garcia Garrido, Sylvie Cossette, PhD.
TÍTULO:
Necesidades de aprendizaje y sentimiento de autoeficacia en los pacientes aquejados de un infarto de miocardio o de un angor.
TEXTO DEL TRABAJO:
Introducción:
El Síndrome Coronario Agudo (SCA), especialmente el infarto de miocardio y la angina inestable, representa la primera causa de mortalidad en los países desarrollados (1,2). Según Murray y Lopez (3) la enfermedad será la primera causa de mortalidad en el mundo entero de aquí al aňo 2020. Por otra parte, la prevención y el control de la enfermedad exigen un buen conocimiento de los factores de riesgo (4) como el sedentarismo, la alimentación inadecuada y el tabaquismo, factores
responsables del 75 % de los casos de la enfermedad cardiaca (5).
La lucha contra la enfermedad se sitúa, pues, no solamente en el ámbito del tratamiento, sino también en el de la prevención (6). En efecto, la prevención debe pretender disminuir los factores de riesgo modificables de la enfermedad cardiaca. Para el paciente aquejado de un SCA, esta
disminución de los factores de riesgo es en sí un cambio en sus hábitos de vida, cambio que no es fácil de hacer. A este respecto, la enfermera, en el rol de educadora para la salud, ocupa una posición privilegiada en todos los ámbitos asistenciales para favorecer los cambios de hábitos de vida en los pacientes aquejados por un SCA. No obstante, si quiere desarrollar su enseñanza sobre los factores de riesgo considerados importantes, la enfermera debe conocer sus necesidades de aprendizaje, estimadas importantes de aprender para el paciente, así como la percepción que tiene frente a su capacidad de seguir un régimen alimentario, practicar una actividad física y abandonar el hábito del tabaco.
El objetivo de este estudio es describir y comparar las necesidades de aprendizaje y el sentimiento de autoeficacia en la gestión de los factores de riesgo de la enfermedad coronaria en pacientes aquejados de un infarto de miocardio o de una angina inestable, durante la hospitalización y seis semanas después de su salida del hospital.
Método:
Estudio de tipo descriptivo y comparativo realizado en 52 pacientes hospitalizados en el Servicio de Cardiología del hospital Dr. Josep Trueta de Girona entre junio y octubre de 2005 (de estos 52, 46 participaron en el seguimiento seis semanas después de la hospitalización). La muestra de conveniencia está constituida por pacientes que presentan un primer infarto de miocardio o de angina inestable.
Las principales variables del estudio son las necesidades de aprendizaje y el sentimiento de autoeficacia. La definición de "necesidades de aprendizaje" corresponde al grado de importancia que los pacientes conceden a siete categorías de información: "la anatomía y fisiología, los factores psicológicos, los factores de riesgo, la información sobre la medicación, la información sobre la dieta, la actividad física, y la información en general". Se midieron las necesidades de aprendizaje del paciente con la ayuda del instrumento “Cardiac Patients Learning Needs Inventory (CPLNI)” de Gerard (1982) (7). Cada una de las categorías puede contener de cuatro a siete enunciados cuyo grado de importancia será mesurado por medio de una escala de tipo Likert siendo 1 "ninguna importancia" y 5 "muy importante". El sentimiento de autoeficacia se define como la convicción que tiene un individuo en su capacidad para organizar y adoptar un comportamiento conforme a los objetivos que se ha fijado (12). En este estudio, el sentimiento de autoeficacia corresponde al grado de confianza del paciente frente a su capacidad de adoptar sanos hábitos de vida en lo que concierne a la dieta, la práctica del ejercicio físico y el tabaquismo. El sentimiento de autoeficacia será medido con la ayuda del instrumento “Cardiac Diet Self-Efficacy Instrument” (CDSEI) y
“Cardiac Exercise Self-Efficacy Instrument” (CESEI) de Hickey, Owen y Froman (1992) (8) y, finalmente, « Smoking Self-efficacy Questionnaire (SEQ-12) » de Etter, Bergman, Humair y
Mesa Redonda 3 (Español): Profesión / Gestión en Enfermería
Perneger (2000) (9). El grado de confianza frente a cada uno de los enunciados es medido a través de una escala de tipo Likert siendo 1 "ninguna confianza" y 5 "mucha confianza". Tras una demanda realizada a cada uno de los autores, estos han permitido utilizar y traducir los instrumentos de medida. Los instrumentos fueron traducidos según el método de traducción invertida paralela de su versión original, inglesa para el CPLNI, el CDSEI y el CESEI o francesa para el SEQ-12 al castellano y catalán. Con el propósito de trazar un perfil de los participantes, se elaboró un cuestionario sociodemográfico que concierne a la edad, el nivel de escolaridad, el trabajo, la naturaleza de la enfermedad (infarto de miocardio o angina inestable), igual que ciertos hábitos de vida (tabaquismo, actividad física y régimen alimentario). Los datos sociodemográficos fueron obtenidos a partir de preguntas cerradas y semiabiertas.
La estadística descriptiva se utilizó para la descripción de las características sociodemográficas de la muestra, al igual que para la medida del grado de importancia de las necesidades de aprendizajes y el grado de confianza durante la hospitalización y seis semanas después de la salida del hospital. Igualmente, las necesidades de aprendizaje han sido clasificadas por orden de importancia asignando un resultado de 1 para la media más elevada y 7 a la media más pequeña.
Esta técnica es utilizada en los estudios científicos sobre necesidades de aprendizaje (10,7,11). El test t de Student para datos apareados es utilizado para evaluar las diferencias entre la importancia acordada por el paciente a las necesidades de aprendizaje para cada una de las siete categorías del CPLNI y su grado de confianza para la administración de los tres factores de riesgo, durante la hospitalización y seis semanas después de la salida del hospital. Todos los cálculos estadísticos han sido efectuados con la ayuda del logicial SPSS y los tests estadísticos han sido considerados como significativos si la p< 0,05.
Resultados:
La edad de los pacientes, la mayoría hombres, variaba de 31 a 78 años. La media de edad de la muestra era de 53,94 años. Todos eran aquejados de un primer ataque cardiaco y, todos menos uno, habían sufrido un infarto de miocardio. El 71,2 % (37) eran hipertensos, el 63,5% (33) presentaban hipercolesterolemia y el 21,2 % eran diabéticos.
Entre los dos periodos, los cambios sobrevenidos en los hábitos de vida entre la hospitalización y seis semanas después al alta eran notables en cuanto al tabaquismo, la dieta y la actividad física.
Durante la hospitalización, más de la mitad de los pacientes [61,5 % (32/54)] eran fumadores; seis semanas más tarde, 78 % (25/32) de entre ellos habían dejado de fumar. En cuanto a la actividad física, sólo un cuarto de los pacientes practicaban una actividad física antes de la hospitalización, la más practicada era la marcha, con una duración de unos 30 minutos al día. Sin embargo, seis semanas después de la hospitalización, casi todos (89,1%) practicaban una actividad física, una vez más era la marcha con una duración de más de media hora al día. Referente a la dieta, antes de la hospitalización, solamente el 21, 2 % (11) de los pacientes seguían una dieta pobre en grasa, en sal o en hidratos de carbono. No obstante, seis semanas después de la hospitalización, cerca de la totalidad (93,5 %) seguían un régimen alimentario.
De manera general, para los dos periodos, los pacientes consideraban como muy importantes las siete categorías de necesidades de aprendizaje del instrumento CPLNI. Durante la hospitalización los resultados de las categorias variaban de 4,22 (±0,58) a 4,48 (±0,36) y seis semanas después del alta hospitalaria de 4,18 (±0,61) a 4,54 (±0,39). No se observaban diferencias significativas (p>0,05) entre los dos periodos. Para los dos periodos, las categorías más importantes de aprender eran
"los factores de riesgo" y "la anatomía y fisiología". Por lo contrario, las categorías consideradas menos importantes eran la información sobre "la actividad física" y "los factores psicológicos".
En lo que concierne al sentimiento de autoeficacia de los pacientes, es bastante elevado durante la hospitalización. Las medias se situan a 3,75 (±0,54) en la confianza de modificar sus habitos frente a la dieta, a 3,69 (± 0,71) frenta a la actividad física y a 3,82 (±0,99) frente al tabaquismo. Sin embargo, observamos que seis semanas después de la hospitalización el grado de confianza aumentó frente a la gestión de la dieta 4,01 (±0,70), de la actividad física 3,93 (±0,58) y del tabaquismo 4,34 (±0,79). Estos cambios son estadísticamente significativos para la dieta (p= 0,010 y el tabaquismo (p= 0,023) pero no para la actividad física (p= 0,099).
Discusión:
Los resultados del presente estudio indican que los pacientes consiguieron modificar, de manera