Nursing · Across the life stages
Whether they ever come back is decided by how the first consultation went
Adolescents are roughly a sixth of the world's population, they are healthy as a group, and they are served worse by health systems than any other age. Most adult health is decided here — smoking, alcohol, activity, diet, sexual health patterns — and most lifelong mental illness begins before the mid-twenties, so intervening now has decades of effect. They also die of preventable things: injury, road collisions, drowning, violence, suicide and pregnancy complications, not disease. And services are built either for children, where everything is said to the parent, or for adults, where self-management is assumed, so adolescents fall between and are lost at transition. That is a design failure, and it is why whether a young person returns depends almost entirely on how they were treated the first time.
Adolescents make up roughly a sixth of the world's population, and the number has never been higher. They are healthy as a group and they are served worse by health systems than any other age.
Smoking, alcohol, physical activity, diet, mental illness and sexual health patterns are largely established during adolescence, and most lifelong mental illness begins before the mid-twenties. Intervening here has decades of effect.
Injury, road traffic collision, drowning, violence, suicide and pregnancy complications account for most adolescent deaths, and almost all of them are preventable. This is not a group dying of disease.
Paediatric services talk to parents and adult services expect self-management, and adolescents fall between, which is why they attend less, disengage more and are lost at transition. That is a design failure.
Whether a young person comes back depends almost entirely on how they were treated the first time — whether they were spoken to rather than about, whether confidentiality was explained, whether they were believed.
It runs from the start of puberty to the assumption of adult roles, which takes a decade or more and does not end at a birthday. Legal thresholds and biological development do not coincide.
Becoming physically adult, becoming psychologically separate from parents, and finding a place among peers. Almost every behaviour that adults find baffling serves one of those three.
Trying things, testing limits and seeking novelty is how independence is acquired, and it is developmentally normal rather than pathological. The task is reducing harm rather than eliminating the impulse.
Peer opinion outweighs adult advice during this period, which is why interventions framed around what peers actually do work better than authority. Lecturing is close to useless.
How much autonomy is expected, at what age, and about what, differs completely between families and societies. Assuming a single model of adolescence produces advice that cannot be followed at home.
The brain continues developing well into the twenties, and the parts governing planning, impulse control and consequence mature later than those driving reward-seeking and emotion. That gap explains a great deal.
Adolescents are not poor at understanding risk in the abstract; they weight immediate reward more heavily, particularly with peers present and when emotionally aroused. Information alone therefore changes little.
Emotional responses are more intense and regulation is less developed, so distress is genuinely more overwhelming rather than exaggerated. Treating it as drama misreads the biology.
The biological clock moves later in adolescence, so early school starts create chronic sleep deprivation that worsens mood, concentration and impulse control. This is physiology rather than laziness.
The same developmental openness that makes adolescents vulnerable to substances, trauma and mental illness also makes them highly responsive to intervention. It is the most changeable period after infancy.
Puberty follows a broadly fixed order in each sex, over several years, with wide variation in when it starts. Knowing the usual order is what allows an unusual pattern to be recognised.
The growth spurt occurs earlier in girls relative to other changes and later in boys, which is why girls are taller in early adolescence. Explaining this relieves a surprising amount of anxiety.
Young people frequently reach puberty with inaccurate information from peers and the internet, and specific gaps — periods, erections, discharge, body odour, breast development in boys — cause real distress. Plain information is the intervention.
Developing much earlier or later than peers affects self-image, bullying, and in girls early puberty is associated with additional risks. Both warrant asking about rather than only measuring.
Breast development in boys, asymmetry, irregular early periods, discharge, acne, spots and hair in new places. Naming them as normal, unprompted, saves months of private worry.
Puberty beginning well before the expected age warrants investigation, because causes include hormonal and rarely serious conditions, and because it affects final height and psychological wellbeing.
Puberty that has not begun by the expected age, or that starts and stops, needs assessment for hormonal, chromosomal, nutritional and chronic disease causes. Reassurance without assessment loses treatable time.
Serious long-term illness, malnutrition, intensive exercise and eating disorders all delay puberty and growth, and that delay is itself a marker of how well the underlying condition is controlled.
Some people have bodies that do not fit typical categories, and their care requires specialist involvement, extreme care with language, and avoidance of anything irreversible done without their own informed involvement.
Being the only one not developing, or developing first, dominates a young person's experience far more than clinicians assume. Asking how they feel about it is part of the assessment.
How they look matters more during adolescence than at any other time, and dismissing that as vanity ends the conversation. Acne, weight, height, breasts, hair and skin are clinical concerns because of what they cost.
It causes measurable depression and anxiety and permanent scarring, and effective treatment exists. Telling a teenager they will grow out of it while they scar is a failure with lasting consequences.
Adolescence is when disordered eating begins, and clumsy weight advice can precipitate it. Focusing on health behaviours rather than weight, and never commenting on appearance, is the safer approach.
Muscularity, height, penis size and body hair cause significant distress in boys, who are almost never asked and who use supplements and steroids in response. This is systematically overlooked.
Constant comparison with edited images correlates with body dissatisfaction, and it is the background against which every conversation about appearance happens. Acknowledging it is more useful than condemning it.
Adolescents go hungry in wealthy countries as well as poor ones, and they conceal it out of shame, eat one meal a day, or go without so younger siblings can eat. A young person who is always hungry at appointments, or who never has money for anything, is telling you something.
A young person needs to know at the start what will be kept confidential and what cannot be, and what would happen if you were worried about their safety. Explaining it first is what makes disclosure possible.
Fear that parents will be told is the single biggest barrier to adolescents seeking help for sexual health, mental health and substance use. That fear is well founded in many services.
Where there is serious risk of harm, information is shared, and doing so is explained to the young person rather than done behind their back where that is at all possible. How it is handled determines whether they ever trust anybody again.
Notes are seen by many people and sometimes by parents, and a young person should know what is written. Recording sensitive information thoughtlessly can cause harm outside the consultation.
Being seen attending a service, being called by name, and having a parent in the room all breach confidentiality before a word is spoken. Practical arrangements matter as much as policy.
Addressing questions to the young person, using their name, and letting them answer even when the parent interrupts is the foundation. Adolescents describe being talked over as the defining feature of bad care.
Some of the consultation should happen without the parent present, offered routinely rather than as an accusation, and framed as normal practice for their age. Nothing important is disclosed with a parent in the room.
Home, education, activities, eating, drugs and alcohol, sexuality and relationships, safety, mood and suicidal thoughts. A structured way of covering these prevents the consultation being only about the presenting complaint.
Visible shock, disapproval or moralising at a disclosure ends the conversation and every future one. A neutral, interested response is a skill worth practising deliberately.
Asking whether it is all right to talk about something, offering to stop, and letting them decide what is discussed returns control to somebody who has little. It also produces better information.
The majority of lifetime mental disorders begin before the mid-twenties, which makes adolescence the period where prevention and early treatment have the greatest possible effect.
A substantial proportion of adolescents experience a mental health condition, and most receive no treatment anywhere in the world. The gap between need and provision is larger here than in almost any other area.
Suicide is among the leading causes of death in adolescents globally, and the majority of those who die have had contact with services. That contact is the opportunity.
Adolescent unhappiness can be a normal response to bullying, poverty, family breakdown, racism, discrimination or violence, and treating it as a disorder while leaving the cause untouched helps nobody.
Headaches, abdominal pain, tiredness, dizziness and chest pain with no physical cause are common expressions of distress in adolescents. Investigating endlessly without asking about their life is the standard error.
Irritability rather than sadness, withdrawal from friends, dropping activities, falling school performance, changed sleep and appetite, and physical complaints. It is regularly read as laziness or bad behaviour.
School refusal, avoiding social situations, panic attacks, constant reassurance-seeking and physical symptoms. The avoidance itself maintains the anxiety, which is why gradual exposure rather than accommodation is the treatment.
A young person who has stopped attending school is frequently anxious or depressed rather than truanting, and school non-attendance is one of the most useful single questions in an adolescent consultation.
For most mild to moderate problems, psychological approaches are recommended before medicine, and access to them is the limiting factor almost everywhere. Saying that honestly is better than implying a prescription is the answer.
Sleep, exercise, reducing isolation, resolving bullying, a trusted adult, and treating the practical problem where there is one. These are not lesser interventions.
Self-harm is far commoner in adolescents than adults realise, is usually a way of managing unbearable feelings rather than an attempt to die, and the attention-seeking framing is both inaccurate and harmful.
People who self-harm have a substantially raised risk of later death by suicide, which makes every presentation a clinical opportunity rather than a nuisance. Dismissing it is dangerous as well as unkind.
Understanding what function it serves — relief, control, punishment, feeling something — is what allows an alternative to be found. Demanding they stop without that is ineffective.
Wounds from self-harm are treated with the same care, analgesia and respect as any other, and the frequent failure to do so is something young people report specifically. Treating it dismissively confirms what they already believe.
Extracted promises produce concealment rather than cessation, and the young person then presents later with more serious injury. Harm reduction and honesty are more useful than a commitment they cannot keep.
Asking plainly whether they have thought about ending their life does not plant the idea, and it is the only way to find out. This is the most important single question in adolescent mental health.
Whether they have thought how, whether they have access to means, whether they have made any preparation, and what has stopped them. Specificity of plan and access to means are what matter most.
Removing or limiting access to medicines, ligature points and other means measurably reduces deaths, because adolescent suicidal crises are frequently short-lived and impulsive. That conversation with a family is concrete and effective.
Previous attempt, self-harm, mental illness, substance use, bullying, abuse, bereavement by suicide, isolation, and being from a group facing discrimination. Risk is dynamic and a single assessment does not hold.
A plan naming warning signs, things that help, people to contact and how to make the environment safer is useful. A contract promising not to act is not, and it gives false reassurance to everybody.
Most eating disorders start during adolescence, they have among the highest mortality of any mental illness, and early treatment substantially improves outcome. Delay is the main determinant of chronicity.
These are serious psychiatric illnesses involving control, anxiety and distorted perception rather than a wish to look good. Understanding that changes how the conversation is conducted.
People of any weight have eating disorders, and those who are not underweight are diagnosed later and treated less, which is a documented failure. Weight is not the diagnostic criterion.
Food avoidance and rules, eating alone, disappearing after meals, excessive exercise, preoccupation with food, cold intolerance, dizziness, stopped periods, and social withdrawal around eating.
Reintroducing nutrition to a severely malnourished person causes dangerous shifts in blood chemistry and is done with monitoring in a medical setting. This is a specific and serious risk nurses need to know exists.
Neurodevelopmental differences are common, frequently unrecognised, and particularly under-recognised in girls, who mask more and are misdiagnosed with anxiety or personality difficulties instead.
Young people diagnosed late describe relief at an explanation for a lifetime of difficulty, and frustration at years of being told they were difficult. That reframing is therapeutic in itself.
Anxiety, depression, eating difficulties and self-harm are substantially more common in autistic and attention-different young people, and their distress is frequently attributed to the diagnosis instead of treated.
Sensory adjustments, written information, predictability, extra time, and not requiring eye contact make healthcare usable. Small accommodations change whether somebody attends at all.
Not answering, taking things literally, needing time, or becoming distressed by an unexpected change is not rudeness or non-cooperation. Reading it as such is the commonest failure in these encounters.
Adolescents need substantially more sleep than adults and almost universally get less, and the deficit affects mood, concentration, impulse control, immunity and weight.
Their biological clock moves later, so falling asleep early is genuinely difficult and early starts produce chronic deprivation. This is physiology and treating it as a discipline problem is inaccurate.
Light exposure and stimulating content before bed delay sleep, and energy drinks contain very large amounts of caffeine. Both are modifiable and neither is usually asked about.
Irritability, poor concentration, low mood and falling school performance are all produced by insufficient sleep, and are frequently investigated as depression or attention difficulties. Asking about sleep first is efficient.
Consistent times, no screens in the last period before bed, a dark cool room, no caffeine after the afternoon, and catching up moderately at weekends rather than by many hours. Realistic advice is followed; ideal advice is not.
Online life is where friendships, bullying, romance, sexual exploration, harassment and identity all happen, and treating it as a distraction from real life misunderstands their experience entirely.
Bullying that follows them home, comparison with edited images, content promoting self-harm and disordered eating, grooming, sextortion, and gambling. Naming the specific harm is more useful than condemning screens.
Isolated young people, those with rare conditions, disabled young people and those who are gay or trans in hostile environments find community and information online that exists nowhere near them.
Sharing intimate images is common, the consequences of onward sharing are severe, and young people need to know there is help rather than only prohibition. A young person being blackmailed with images needs support, not blame.
What they use, what happens there, whether anything has worried them, and whether anybody has asked them for anything. A moralising question about screen time produces nothing.
Bullying used to end at the school gate and now continues on a phone all evening, which removes the only refuge a bullied young person had. It is strongly associated with depression, self-harm and suicide, and a direct question about whether anybody is making their life difficult finds what a question about mood does not.
Headaches, abdominal pain, poor sleep, school refusal and repeated attendances are common presentations of bullying, and the young person almost never names it as the reason. Adults frequently advise them to ignore it, which is advice that has never worked and which teaches them not to tell anybody again.
Comprehensive, accurate information about bodies, consent, contraception and infection reduces risk and does not increase sexual activity. Withholding it does not delay sex; it removes protection.
Young people avoid sexual health services because of fear of being recognised, recorded or reported. Explaining exactly what is confidential is what makes a service usable.
Chlamydia in particular is common in young people and usually symptomless while damaging fertility, which is why testing rather than symptom-based diagnosis is the strategy.
What consent is, that it can be withdrawn, that it cannot be given under pressure or when intoxicated, and that pressure from a partner is not normal. Many young people have never had this explained by an adult.
Do not assume gender of partners, type of sex, or that a young person is or is not sexually active. Assumptions produce incomplete histories and tell the young person you have not understood them.
In most jurisdictions a young person who understands the decision may consent to contraception confidentially, subject to assessing understanding and safeguarding. Turning them away produces the pregnancy everybody wanted to avoid.
Methods requiring daily action are far less effective in practice for anybody, and particularly for somebody with an unpredictable routine. Explaining that difference honestly is central to a real choice.
Most contraception does not protect against infection, and that needs saying explicitly rather than assuming it is understood. Dual protection is a specific conversation.
Time matters, judgement drives people away, and a brisk kind practical response is the clinically effective one. The consultation is also an opportunity to discuss ongoing methods and testing.
Age of the partner, coercion, exchange of anything for sex, and control over contraception are all asked about. Providing contraception without those questions can enable exploitation.
Pregnancy and childbirth complications are among the leading causes of death in older adolescent girls worldwide, and younger mothers face higher risks to themselves and their babies.
Adolescent pregnancy is strongly associated with poverty, limited education, early marriage and lack of contraception access, and its consequences deepen all of those. It is a social outcome as much as a clinical one.
Continuing the pregnancy, abortion where lawful, and adoption are options to be explained without steering, whatever the clinician thinks. A young person who feels judged makes a worse decision and returns to nobody.
Young pregnant women attend later, are treated with more disapproval, and have poorer outcomes partly as a result. Care that is welcoming rather than disapproving measurably changes attendance.
A pregnancy in a young adolescent raises questions about the partner's age, coercion and exploitation that must be asked. Not asking is a safeguarding failure.
Young people being exploited frequently believe they are in a relationship or are being looked after, and describe the person harming them as a boyfriend or a friend. Expecting them to identify as a victim is the commonest error.
Older partners, unexplained money, phones or clothes, going missing, drug or alcohol use, repeated sexual infections, school non-attendance, and injuries. A pattern of several matters more than any one.
Attention, gifts, alcohol, a sense of being special and being separated from family and friends come first, which is why the young person defends the person exploiting them. Understanding that prevents a confrontational approach.
Sexual exploitation of boys and young men is substantially under-recognised and under-reported, and they are more likely to be treated as offenders than victims. Assumptions here cause real harm.
Concerns are recorded, shared through the safeguarding pathway and discussed with somebody experienced rather than investigated alone. Doing nothing because the young person denies it is not an option.
Gay, lesbian, bisexual and trans young people have substantially higher rates of depression, self-harm, suicide attempts and substance use, driven by rejection, bullying and discrimination rather than by their identity.
The presence of at least one supportive adult substantially reduces risk in these young people. A nurse can be that person in a single consultation by responding without surprise or disapproval.
Using the name and pronouns a young person gives, not assuming the gender of partners, and not reacting to a disclosure is achievable immediately and is what they notice. Getting it wrong repeatedly is what they remember.
Disclosure to a clinician is not permission to tell a parent, and being outed to family has caused young people to be thrown out of home. Confidentiality here can be a safety matter.
Trans and non-binary young people need cervical screening, contraception, sexual health care and mental health care according to their bodies and their lives, and are frequently denied all of it while a gender conversation dominates.
Most drinking behaviour is established in adolescence, and earlier onset is associated with heavier use and more problems later. It remains the most widely used substance in this age group in most countries.
Injury, road collisions, drowning, violence, unprotected or non-consensual sex, and alcohol poisoning. Adolescent alcohol harm is mostly acute rather than about long-term liver disease.
Heavy drinking during adolescence affects the developing brain, memory and learning more than it does in adults. That is a more persuasive argument to a young person than a warning about their fifties.
Asking how much they drink on a typical occasion, and what happens when they do, produces better information than asking whether they drink. A neutral, non-lecturing tone is the technique.
Advice about eating first, pacing, staying with friends, not swimming, and how to help someone who is unconscious saves lives whatever one thinks about the drinking. Abstinence-only advice leaves them unprotected.
Nearly everybody who smokes began in adolescence, which makes this the point at which the most preventable cause of death in the world is either established or avoided.
Vaping is now widespread among adolescents, delivers high doses of nicotine, and creates dependence in young people who would never have smoked. It is less harmful than smoking and it is not harmless.
Adolescents become dependent more quickly and at lower exposures than adults, and many describe being unable to stop within months. Telling them that before they start is more useful than afterwards.
Flavours, packaging, influencers and social media promotion target this age group deliberately. Pointing that out — that they are being sold to — lands better with adolescents than a health warning.
Many young people who vape or smoke want to quit and are offered nothing, because cessation services are designed for adults. Asking whether they want help is the first step.
Most adolescent drug use is occasional and does not become dependence, and treating every instance as addiction loses credibility. Identifying the minority in trouble is the task.
Daily use, using alone, using to cope with feelings, spending money they do not have, missing school, withdrawal symptoms, and using increasing amounts. Function, not substance, defines the problem.
Unknown strength and contents, mixing with alcohol, using alone, and the particular risk of overdose from strong synthetic opioids appearing in the supply. Practical safety information saves lives.
Exaggerated warnings that contradict their own experience destroy credibility on everything else you say. Accurate information, including that a drug is less dangerous than they were told, buys trust for the parts that matter.
Drug use that manages anxiety, trauma, sleep or pain will not stop until that need is addressed. Understanding the function is the whole of the intervention.
Road traffic collisions, drowning, violence and self-harm account for most adolescent deaths, and almost every one involves something modifiable — a helmet, a seatbelt, alcohol, swimming ability, a weapon.
Young drivers and riders, passengers of young drivers, and pedestrians in this age group are at markedly raised risk. Passengers, night driving and alcohol are the specific factors.
Drowning is a leading cause of death in adolescents in many countries, associated with inability to swim, alcohol and open water. Asking whether somebody can swim is a genuine preventive question.
Involvement in violence, carrying weapons for protection, and being a victim are interrelated, and fear rather than aggression is frequently the reason for carrying. Understanding that changes the conversation.
Adolescents make poor decisions in the moment with peers present, so rehearsing what to do — how to get out, who to call, an agreed excuse — is more effective than general advice.
A long-term condition collides with independence, appearance, peer belonging, school and the future, and a treatment that interferes with any of those will be abandoned. That is the core of adolescent chronic illness care.
Treatment taking drops markedly during adolescence across every condition, and it is the commonest cause of deterioration. It is developmental rather than a character flaw in that particular young person.
Wanting to be normal, not wanting to be seen taking medicine, side effects affecting appearance, feeling well, resenting being told, forgetting, and cost. Asking which of those applies finds it.
Challenging a young person about missed treatment reliably reduces honesty, and a young person who stops telling the truth about their treatment is in more danger than one whose control is imperfect.
Handing over responsibility progressively, with the parent stepping back over years rather than at one appointment, is what produces somebody able to manage their own condition. Sudden transfer fails.
Young people disengage at the point of transfer between children's and adult services across every condition, and complications accumulate silently afterwards. It is one of the best-documented failures in healthcare.
Transition begins years before the transfer, with preparation, growing independence, seeing clinicians alone, and knowing their own condition, medicines and history. A discharge letter is not a transition.
Joint appointments, a visit, a named contact and an overlap period substantially improve engagement. Arriving alone at an unfamiliar adult clinic is how people stop attending.
Adult services assume self-management, are less flexible about missed appointments, and involve parents less. Young people need warning about those differences rather than discovering them.
Following up whether a young person attended the first adult appointment, and chasing them if not, catches the people who would otherwise vanish. Somebody has to own that.
Staying in education, particularly for girls, is one of the strongest predictors of lifelong health, delayed pregnancy and income. Anything that keeps a young person in school is a health intervention.
School non-attendance is associated with anxiety, depression, bullying, caring responsibilities, exploitation and abuse. Asking about attendance is one of the highest-yield questions available.
Hunger, unstable housing, no money for transport or sanitary products, and working long hours all affect adolescent health directly and are rarely asked about in a clinical consultation.
Not being able to afford sanitary products, and inadequate school toilets, cause girls to miss school regularly in many countries. It is a concrete, solvable problem that clinicians rarely raise.
Many adolescents work, sometimes in hazardous conditions, sometimes instead of school, and workplace injury in this group is common. Asking whether they work, and at what, occasionally reveals a great deal.
Large numbers of adolescents provide substantial care for a parent or sibling, missing school, sleep and social life, and almost none are identified by health services who see the person they care for weekly.
A single question about whether they help look after anybody at home identifies them. They rarely volunteer it, because it is simply their life and they fear the family being separated.
Those in or leaving state care have markedly worse health, education and mental health outcomes, frequently move repeatedly, and lose continuity of care. Extra effort to maintain contact with them is justified.
Support frequently ends abruptly at a fixed age, leaving a young person managing housing, money, health and education alone at eighteen. Health services should expect that and not treat non-attendance as disinterest.
Adolescents who have migrated alone carry trauma, interrupted healthcare, no records, language barriers and uncertain status. Their age is sometimes disputed, which affects everything about their care.
Safeguarding effort concentrates on younger children, and adolescents suffering abuse, neglect or exploitation are more often seen as difficult or as making choices. That framing is a documented failure.
Going missing, injuries, older partners, unexplained possessions, substance use, school non-attendance, repeated attendances, self-harm, and a young person accompanied by someone controlling.
Physical and sexual abuse and neglect do not stop when a child becomes a teenager, and disclosure is harder because they fear not being believed and fear the consequences for the family.
Adolescents experience controlling and violent intimate relationships, frequently without recognising them as abuse, and services rarely ask. A direct question about how a partner treats them is warranted.
Believe them, record their own words, share through the proper route, and tell them what you are doing. The response in the first minutes determines whether they ever disclose to anybody again.
Parents of adolescents are worried, losing control, and unsure of their role, and a clinician who ignores them entirely loses an ally. Supporting the parent while protecting the young person's confidentiality is the skill.
Parents accept not being told far better when the reason is explained in advance as normal practice for this age. Ambushing them with it in the moment produces conflict.
Arguments about autonomy, rules and privacy are a normal feature of adolescence rather than evidence of family dysfunction. Saying so relieves both sides.
Rejection over sexuality, control, violence, and refusal of necessary treatment happen, and the young person's safety takes precedence over family cohesion. Recognising which situation you are in matters enormously.
How much independence is expected, who makes decisions, and what may be discussed vary greatly between families. Working within that, rather than against it, is what makes advice followable at home.
Adolescents living with domestic abuse between adults are affected as severely as those assaulted themselves, and they are rarely asked because the abuse is recorded as a problem between the parents. A question about whether anybody at home frightens them is warranted and almost never posed.
Vaccination against the virus that causes cervical cancer is given in adolescence, before exposure, and it prevents most of that cancer. Explaining it to a young person and to a hesitant parent is among the highest-value conversations in the whole of nursing, and it is frequently handled as a form-filling exercise rather than a conversation.
Adolescence is the last chance to complete childhood immunisations, and young people who migrated, who were in care, who moved schools repeatedly or who were unwell as children commonly have gaps nobody has checked. Asking to see a record, and offering catch-up without implying fault, closes those gaps.
Iron requirements rise sharply with growth and menstruation, and iron deficiency is very common in adolescent girls, producing exhaustion, breathlessness and poor concentration that is attributed to laziness or to being a teenager. A blood count in a tired adolescent girl with heavy periods finds a great deal.
Physical activity falls steeply during these years, particularly in girls, and the reasons are specific — school sport that humiliates, changing rooms, periods, appearance, cost and safety walking anywhere. Addressing the actual barrier is more useful than repeating a recommendation about minutes per week.
Dental decay is among the commonest conditions in this age group and causes pain, missed school and lasting damage, while unrecognised short sight and hearing loss are regularly mistaken for inattention or poor school performance. All three are cheap to find and are rarely asked about in a health consultation.
Confidentiality and consent in young people; seeing them without a parent; asking directly about suicide; self-harm as a predictor of suicide; transition to adult services; and recognising exploitation.
Talking to the parent instead of the young person; failing to explain confidentiality before asking sensitive questions; treating self-harm as attention seeking; assuming an eating disorder requires low weight; extracting a promise not to self-harm; taking a young person's denial of exploitation at face value; treating adolescent non-adherence as a character problem.
Explain confidentiality first. See them alone for part of it. Ask directly about suicide and about means. Believe them. Record their words. Share through the proper route and tell them you are doing it.
Ask whether they are at school and attending. Ask who they look after at home. Ask how a partner treats them. Ask what the drug or the self-harm does for them. Use their name and their pronouns. Do not visibly react.
Whether an adolescent ever returns to healthcare is decided by how the first consultation went. Being spoken to rather than about, being believed, and not being lectured is most of what determines it.
Written in plain sentences on purpose. Nursing is studied in a second language by a large share of the students who will read this, and a sentence that has to be decoded twice is a sentence that teaches less.
These are the twelve questions written with this SUNYRA nursing manual, to check what it teaches. They are not past papers and were not written to any one examination's pattern; an examination tag means only that the examination's published blueprint covers this subject. Difficulty was not graded in the source, so every question is marked medium.
These notes are free to read here, with no account.
What the Laisha app adds:
Free for ten days, then a subscription. We would rather write that here than have you find it later.