When Teens Talk, Nurses Listen: The Rise in Adolescent Medicine

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By Christina Orlovsky, senior staff writer

The ages between 11 and 21 can be tough times for anyone—with physical, emotional and life changes occurring at every turn. During this time, most adolescents and young adults need a lot of support, not only from their parents, but also from their health care providers. In recent years, a growing number of doctors and nurses have realized this need to care for patients that are no longer children, but aren’t yet adults, and have leaned toward a rising specialty: adolescent medicine.

Although the specialization of adolescent medicine has been around since the 1950s, a medical subspecialty certificate has only been available to pediatricians and internal medicine physicians since 1994 and family medicine practitioners since 2001. To date, the Center for Adolescent Nursing at the University of Minnesota, in Minneapolis, is the only federally funded center dedicated to advancing the education of nurses specializing in adolescent health. It is the mission of the center to “educate nurses who can be expert clinicians, teachers, researchers, and leaders in settings serving young people.” Opened in 1993, the center recently received another five-year grant to work further toward its goal.

Nurses across the country have found themselves working toward the same goal of improving the health and well being of adolescents and young adults. More than 30 nurses and nurse practitioners are current members of the Society for Adolescent Medicine, a multidisciplinary organization dedicated to the mission of improving the physical and psychosocial lives of younger health care patients.

One member, Lisa Culler, MSN, CRNP, started her career at the Penn State Milton S. Hershey Medical Center, in Hershey, Pennsylvania, as a registered nurse in pediatrics. After completing her nurse practitioner education, Culler had three favorite specialties: pediatrics, women’s health and adolescence. When a job opened up in the newly established Penn State Eating Disorder Program, Culler went for it.

“I knew nothing about eating disorders, but I knew a lot about teens,” Culler recalled. “Plus, at the time, we had a Planned Parenthood-type program as well, so because of my interest in women’s health, I took the role.”

Although the family planning program has since been eliminated, Culler has thrived in her role working with eating disorder patients—the majority of whom are between the ages of 11 and 25. For the past five years, Culler has managed the office and treated adolescent patients in outpatient, intensive outpatient and inpatient settings. One of the biggest challenges she has faced, she explained, has been learning to treat the patients as they are—neither children nor adults.

“I had to overcome the mentality that adolescents are not just young adults,” she said. “You have to look at teens as independent health care patients. They’re my top priority. I do include families, but when I’m addressing a patient, that’s where my questions go.”

Ensuring that the answers to these questions will remain confidential is especially important when treating adolescents. It is also crucial to let them know that confidentiality must be broken if the nurse believes they are at risk of hurting themselves or others. Still, Culler added that once trust is established, it is not that difficult to get teens to open up.

“If you ask, they will tell,” she said. “If you ask general questions, like ‘Do you use drugs?’ often they’ll say no, but if you say, ‘Do you use marijuana or over-the-counter medications?’ they will answer. You have to be specific.”

Learning the unique ways to communicate with adolescents is one of the main goals of adolescent health specialists.

“There is a need for providers that know how to treat teens and communicate with them,” Culler said. “There is a difference between adolescents and children and adolescents and adults. The adolescents are at a point when they’re trying to seek independence and figure out their personality.”

The unique personality traits and emotions are often interrelated with the physical health needs of adolescent patients, said Jane Tuttle, RN, Ph.D., a professor of clinical nursing and pediatrics at the University of Rochester, in Rochester, New York, and a specialist in adolescent health. Health care providers need to understand this delicate situation.

“Their bodies are changing so quickly, and psychologically they are in a different place,” Tuttle said. “How they see themselves is really changing, and they need a lot of support.”

Tuttle believes that this support should come from both their parents and their health care providers, and she is quick to offer it. A family nurse practitioner since 1984, Tuttle became passionate about adolescent medicine partly because, at the time, she had an adolescent of her own.

“I saw that they were an underserved population and they really need adults interested in them and their well being to help them make good choices,” she said.

Tuttle was able to subspecialize in her master’s degree education and focus her coursework and research on adolescence.

“It has remained my passion, even though my son is now grown,” she added. “This is where my efforts belong.”

Along with education and research, Tuttle spends two half days per week working with adolescents in a primary care clinic. Like Culler, she has found that most of her patients are willing to open up about “all sorts of things.”

“You’ll find some that won’t tell family secrets, but typically, if kids see that the provider is comfortable with them and genuinely interested in them, they do open up,” she said.

Tuttle added that the field of adolescent health is growing as the need becomes greater.

“It’s a growing population,” she said.

Tuttle encourages nurses interested in getting involved in adolescent health to inquire with the Center for Adolescent Nursing at the University of Minnesota or seek out a Leadership Education in Adolescent Health (LEAH) program.

“They are looking for people in post-graduate programs to come for a year and get additional training in adolescent health,” she said. Those that can’t take a full year off can seek out continuing education courses with an adolescent health focus.

“Nurses can also contact any of the nursing group within the Society of Adolescent Medicine,” she added. “Any of us would be happy to speak to people about how to get involved in this specialty.”

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