Adolescence: The Developmental Stages of the Learner

Adolescence (12-18 Years of Age)

■ Marks the transition from childhood to Adulthood
■ How they think about themselves
■ The world significantly influences many healthcare issues facing them (Anorexia,
Diabetes, etc)
■ Teenage thought and behaviour give insight into the etiology of some major healthcare
problems of this group of learners (Elkind, 1984)
■ Known to be among the most at-risk populations (ANA, 1994)
■ For Patient education to be effective, an understanding of the characteristics of the
adolescent phase of development is crucial
The Adolescent Stage of Development
■ The developmental stages of adolescence, which include physical, cognitive and social
emotional development, are divided into early, middle and late adolescence.
■ The goal of adolescent development is to move toward a more mature sense of self and
purpose.
Early Adolescence:
During the first stage, a teen is entering puberty. This is an uncomfortable period of
physical growth and sexual development. Although it’s uncomfortable, puberty is often over by
mid-adolescence, meaning that a teen is often at their adult height by mid-adolescence. The
physical growth in teens can certainly have an influence on their emotional and psychological
growth, especially if they are concerned about their looks among peers.

Mid Adolescence:
This stage consists of emotional and psychological development. Teens are beginning to
assert their independence. They might do this by pulling away from their parents and their family
in general. They might wish to spend more time with friends or new adults in their life whom they
admire. Teens are searching for an identity and might want to spend time with people whose
traits they want to adopt. One conflict, however, about the emotional and psychological
development that teens go through is that they are both reaching for their independence while at
the same time fearing losing the security of their parents.
Late Adolescence:
Throughout adolescence, and most prominently during this stage, teens are finding their
way through the social scene. They might gain more and more confidence and begin to expand
their social circles to include those they might not otherwise spend time with. They might pull
more and more away from parents, find a job and form relationships with those at work, and
they might begin to date. All of these are ways that teens are slowly taking steps toward
adulthood.
Physical, Cognitive, and Psychosocial Development
Physical:
■ Between 11 and 13 years, many physical changes occur as teens enter early
adolescence.
■ Between the ages of 14 and 18, middle adolescence begins and physical growth slows
for girls.
■ In boys, growth continues to late adolescence, which occurs between 19 and 21 years of
age. 
■ While girls are fully physically developed by the beginning of late adolescence,
■ young men will continue to gain weight, muscle mass, body hair and height.
■ Adolescents vary greatly in their biological, psychological, social and cognitive
development
■ They must adapt to rapid and significant bodily changes which can temporarily result in
clumsiness and poor coordination
■ Alterations in physical size, shape and function of their bodies, along with the
appearance and development secondary sex characteristics, bring about a significant
preoccupation with their appearance (Falvo 1994)

Cognitive:
■ Piaget termed this stage of cognitive development as the period of formal operations.
■ Adolescents are capable of abstract thought and logical reasoning that is both inductive
and deductive
■ Can debate various points of view, understand cause and effect, comprehend complex
concepts and respond appropriately to multiple-step directions (Heiney, 1991)
■ Become obsessed with what others are thinking and begin to believe that everyone is
focusing on the same things they are namely themselves and their activities
■ Elkind (1984) labeled this belief as the imaginary audience – considerable influence over
an adolescent’s behavior.
■ Able to understand the concept of health and illness, the multiple causes of diseases,
and the influence of variables on health status.
■ Can identify healthy behaviors and understand the benefits of health promotion and
disease prevention activities but may reject practicing them or begin to engage in risk-
taking behaviors
■ Elkind (1984) has called this belief personal fable
■ They can understand implications for future outcomes, but their immediate concern is
with the present
Psychosocial:
 ■ Erikson (1968) has labeled the psychosocial dilemma adolescents face as one of
identity versus role confusion
■ These children indulge in comparing their self-image with an ideal image
■ Adolescents find themselves in a struggle to establish their own identity
■ Teens at this stage of development begin to see that Mom and Dad aren’t perfect, and
conflicts may arise as their desire for independence and the influence of their peer group
increase. 
■ They work to separate themselves from their parents, so that they can emerge as more
distinct and independent
■ Teenagers have a strong need of peer acceptance and peer support
■ Their concern over personal appearance and their need to look and act like their peers
drive them to conform to the dress and behavior of this age group. This usually
contradicts parent’s generations.
■ Conflict, toleration or alienation often characterizes the relationship between adolescents
and their parents and other authority figures.
■ They demand personal space, control, privacy and confidentiality
■ To them, illness or injury means dependency, loss of identity, a change in body image
and functioning, bodily embarrassment, confinement and separation from peers.
■ They need coping skills to successfully complete this stage of development (Grey,
Kanner, & Lacey, 1999)
Challenges adolescents may face includes:
1. Chronic illness
2. A range of disabilities as a result of injury
3. Psychological problems as a results of depression or physical and/or emotional
maltreatment
4. High risk for teen pregnancy
5. Effects of poverty
6. Drug and alcohol abuse
7. Suicide and sexually transmitted diseases

■ Despite all of these potential threats to their well-being, adolescents use medical
services the least frequently of all age groups.
■ Their health has not been a national priority and their health issues have been largely
ignored by healthcare system (American Association of Colleges of Nursing, Nursing.)
■ Educational needs of adolescents are broad and varied
■ Healthy teens have difficulty imagining themselves as sick or injured
 ■ Those with an illness and disability often comply poorly with medical regimens and
continue to indulge in risk-taking behaviors
■ They view health recommendations as a threat to their autonomy and sense of control
■ Greatest challenge to nurse responsible for teaching an adolescent to be able to develop
a mutually respectful, trusting relationship.
■ Adolescents are able to participate fully in all aspects of learning, but they need:
■ Privacy
■ Understanding
■ An honest and straightforward approach
■ Unqualified acceptance in the face of their fears of losing independence, identity
and self-control
■ Patient education should be done directly with adolescents to respect their right to
individuality, privacy, and confidentiality.
■ Nurse should give guidance and support to families to help them to better understand
adolescents behavior.
■ Parents may need to be taught how to set realistic limits while at the same time foster
the adolescent’s sense of independence.

For Short-Term Learning

■ Use one-to-one instruction to ensure confidentiality.
■ Choose peer group discussion sessions as an effective approach to deal with health
topics. (Such as smoking, alcohol and drug use, safety measures, and teenage
sexuality)
■ Use group discussion, role playing, and gaming as methods to clarify values and
problem solve. Getting groups of peers together can be very effective in helping teens
confront health challenges and learn how to significantly change behaviour. (Fey &
Deyes, 1989)
■ Use instructional tools; models, diagrams, audiotapes, videotapes, simulated games,
and computers are attractive and comfortable approaches to learning.
■ Clarify any scientific terminology and medical jargon used. Do not assume they
understand.
■ Allow them to participate in decision making.
■ Include them in formulating teaching plans related to teaching strategies and expected
outcomes to meet their needs for autonomy.
■ Offers options so that they feel that they have a choice about courses of action.
■ Give a rationale for all that is said and done to help adolescents feel a sense of control.
 ■ Approach them with respect, tact, openness, and flexibility to elicit their attention and
encourage their involvement.
■ Expect negatives responses, which are common when their self-image and self-integrity
are threatened.
■ Avoid Confrontation and acting like an authority figure. Acknowledge their thoughts and
then casually suggest an alternative viewpoint.(Such as “Yes, I can see your point. But
what about the possibility of it?”)
For Long-Term Learning
■ Accepts adolescents’ personal fable and imaginary audience as valid.
■ Acknowledge that their feelings are very real.
■ Allow them the opportunity to test their own convictions. When safe and appropriate, let
them try out some ideas of their ideas.
References
■ Bastable, S. B. (2006). Essentials of Patient Education. Retrieved from Google Books:
https://books.google.com.ph/books/about/Essentials_of_Patient_Education.html?
id=hyCLMdheGmwC&redir_esc=y
■ Miller, R. (2018). Retrieved January 12, 2019, from Livestrong:
https://www.livestrong.com/article/560195-the-adolescent-stage-of-human-development/