Nurse practitioners’ experience screening for risk behaviors in adolescents with chronic medical conditions

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Risk-taking may be an expectation of adolescent development, but negative outcomes related to risky behaviors such as use of drugs, alcohol, and sexual activity require attention from healthcare professionals. For the population of adolescents with chronic medical conditions, the motivation to engage in risk behaviors and outcomes of participation may be complicated by the chronic illness. Adolescents with chronic conditions may not receive routine screenings, due to a disease focus, lack of a primary care provider, or for other reasons. Nurse Practitioners (NP) providing care for adolescents with chronic conditions have a critical role in screening. Despite frequent contact with healthcare professionals, adolescents with chronic conditions are not less likely than other adolescents to participate in risky behaviors but may be less likely to receive routine screening. This descriptive phenomenological study describes the
NPs’ experiences of screening for risk behaviors in adolescents with chronic medical conditions. Interviews were conducted with NPs employed in outpatient settings and whose patient population included adolescents with chronic medical conditions. Data analysis followed Colaizzi’s method. Three integrated themes emerged: the act of screening with skills and resources to facilitate the practice, influence of the “delicate and complex” relationship between NP and adolescent, and the perceived “responsibility,” or role of the NP. Screening practice varied. Routine screening occurred when skills and resources, the relationship, and NP perception of the role intersected. Approximately half of NPs incorporated consistent screening. For others, decision-making was guided by multiple factors, including the priority of the medical condition, NP comfort with risk behaviors, time, risk of the condition or treatment, the NP-patient relationship, and the NP’s view of the responsibility of screening. The findings of the study demonstrate that screening is a complex process. Given the prevalence of risk behaviors, routine screening should take place. NPs caring for adolescents with chronic conditions are in a position to incorporate screening. Implications for practice include increasing awareness of risk behaviors in adolescents with chronic conditions, provision of tools and skills to facilitate screening, and institutional support. Implications for research include additional studies evaluating the impact of screening on risk behavior outcomes.

Adolescent, Risk behavior, Screening, Chronic medical condition, Nurse practitioner