Nursing Interventions IN Adolescent SEX Education A Review OF THE Literature PDF

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It is accompanied by intense physical, psychological, emotional and social changes. Neuroscience shows that, during adolescence, there is a marked neurodevelopment, a process that explains, among others, adolescent behavior. Adolescence is not a continuous and uniform process; the different biologic...

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"NURSING INTERVENTIONS IN ADOLESCENT SEX EDUCATION: A REVIEW OF THE LITERATURE" Adolescence is defined as the period of human growth and development that occurs after childhood and before adulthood, between the ages of 10 and 191. The SAHM (American Society for Adolescent Health and Medicine) places adolescence between 10-21 years of age, distinguishing three phases: initial adolescence 10-14 years, middle adolescence 15-17 years, and late adolescence between 18-21 years2. It is accompanied by intense physical, psychological, emotional and social changes. Neuroscience shows that, during adolescence, there is a marked neurodevelopment, a process that explains, among others, adolescent behavior. Adolescence is not a continuous and uniform process; the different biological, intellectual, emotional or social aspects may not have the same maturational rhythm and setbacks or stagnations may occur, especially in times of stress3. For adolescents, the social pressure to which they are potentially exposed can lead them from the consumption of alcohol, tobacco and other psychoactive substances, to the early initiation of sexual relations, situations that can translate into accidents, suicides, unplanned pregnancies and, of course, sexually transmitted infections, including human immunodeficiency virus (HIV) 2. According to the World Health Organization, sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasant and safe sexual experiences, free from all coercion, discrimination and violence4. Risky sexual behaviors can lead to sexually transmitted diseases and / or infections (STDs / STIs), which are spread predominantly through sexual contact, including vaginal, anal and oral sex. They can also be spread through non-sexual means, such as blood transfusions or blood products, not related to sexual risk practices5. One of these infections is HIV, which infects the cells of the immune system, altering or canceling their function. The infection produces a progressive deterioration of the immune system, with the consequent "immunodeficiency". The immune system is considered to be deficient when it is unable to fulfill its function of fighting against

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infections and diseases. The Acquired Immune Deficiency Syndrome (AIDS) is a term that is applied to the most advanced stages of HIV infection and is defined by the presence of one of the more than 20 opportunistic infections or cancers related to HIV6. 45% of cases occur among adolescents and young adults, aged 15 to 29 years7. Another of the most common infections is the human papillomavirus (HPV) also called Papillomavirus, which causes skin and mucosal lesions, with the ability to infect the genital tract, although most HPV infections do not cause symptoms, genital infection persistent HPV can cause cervical cancer in women8. A study from Chile showed a prevalence of 14% of HPV infection, the prevalence age being between 15 and 24 years9. There are vaccines that act as prophylaxis and do not offer protection for the viral type for which the woman is already infected. Vaccinating the unexposed population will allow for maximum effectiveness. The optimal time to start vaccination is before the woman's sexual debut. Teenage pregnancy continues to be one of the main contributing factors to maternal and infant mortality and the cycle of disease and poverty. There are low- and middleincome countries where there is no sex education11. It is considered a public health problem, with 16 million girls between the ages of 15-19 who are mothers each year, and of them 95% live in developing countries12. Contraceptive methods for adolescents should be the same methods as adults and should have access to a variety of contraceptive options. Age in itself does not constitute a medical reason to deny any method to adolescents13. Bearing in mind that the only contraceptive method doubly effective for preventing unwanted pregnancy and for avoiding the transmission of any sexually transmitted infection is the condom, it should be discussed whenever it is suspected that he or the adolescent is going to start or already have sex14.

1. JUSTIFICATION The information available on sexual behaviors during adolescence reflects current sexual habits. It has been seen that sexual relations are initiated earlier in the adolescent population.15 High-risk sexual behaviors usually begin in adolescence and more than half of new infections worldwide occur in the population between 15 and 24 years of age16 . In developed countries, a high proportion of young people who complete compulsory school report having participated in risky sexual behaviors17. In addition, the estimates of the National Institute of Statistics are that the number of adolescent mothers will continue to increase in this decade and by 2019 1047 children will be born to mothers under 15 years of age14. On the other hand, the infection caused by the human papillomavirus has increased alarmingly in recent years. The highest prevalence is in adolescents and young women, reflecting changes in sexual behavior associated with biological developmental factors in adolescents. Another noteworthy fact is that adolescents who start sexual activity early have a higher risk of suffering from precursor lesions and cervical-uterine cancer18. The data mentioned show the need for nursing professionals to carry out activities to promote health and favor healthy environments based on current needs.

2. OBJECTIVES The main objective of this bibliographic review is to know the nursing interventions that are carried out to adolescents regarding sexual education. As specific objectives, we propose to verify if the nursing interventions carried out on adolescents give favorable results that improve their sexual education, as well as to know how these interventions are carried out.

3. METHODOLOGY: A review of the bibliography of scientific articles published on sexual education nursing interventions carried out with adolescents has been carried out. First, a search was carried out with the terms and / or descriptors that appear in table 1 in different databases such as “CUIDEN”, “DIALNET” and “IBECS”. From the articles found in this first search, a selection was made, including those that had free access to the full text and were epidemiological studies. Second, the inclusion criteria were used to finish searching for the articles for this study. The inclusion criteria for the selection of articles were the following: 

Target population are adolescents aged 10-19.

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Articles in which the role of nursing is part of research and / or intervention.



Articles that are made in schools and / or educational institutes.

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Articles published between 2009 and 2019.

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Articles that carry out interventions in sexuality education and detail said interventions, as well as detail the results of the interventions.

On the other hand, the search for terminology has been carried out using the Health Sciences Descriptors (DeCS). (Table 1) Spanish descriptor "Sexuality"

English descriptor "Sexuality"

"Teen"

"Adolescent"

"Sex education"

"Sex education"

"Contraception"

"Contraception"

"sexually transmitted diseases" "Sexual health"

"Sexually Transmitted Diseases" "Sexual Health"

"Nursing"

"Nursing"

"Education"

"Education"

The search procedure was carried out during the month of February, March and April 2019 in the databases "CUIDEN", "DIALNET" and "IBECS". The strategy

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search

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the base

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data

Take care is:

(("Adolescent") OR ("adolescent")) AND ((("sexuality") OR ("sexuality")) OR ((("Infection nes ") AND ((" de ") AND ((" transmission ") AND ((" sexual ") OR ((" Sexually ") AND ((" Transmitte d ") AND (" Diseases "))))))) OR (((" health ") AND ((" sexual ") OR ((" sexual ") AND (" health ")))) OR ((( "contraception") OR ("contraception")) OR (("education") AND (("sexual") OR (("se x") AND ("education"))))))). Initially, 530 results were found, after establishing a series of filters, years, full text, article, original, revision, a reading of the title of the articles was made, discarding those that were not directly related to the objective of the study. After that first reading, the abstract was read and then an in-depth reading was carried out, including a total of 5 articles for this research. Regarding Dialnet, the search strategy was: (sexuality OR sexuality) AND (adolescent OR adolescent OR youth OR adolescence) OR (contraception OR contraception) OR ((sexually transmitted diseases) OR (sexually transmitted diseases)) OR ( sexual health OR sexual health) OR (nursing OR nursing). Finding a total of 225 articles and marking a series of filters such as: Type of document: journal articles, full texts: yes, subjects Dialnet: Health Sciences, sub-subjects Dialnet: Nursing, range of years: 2010-2019, title of Global Nursing Journal: Semi-annual Electronic Journal of Nursing, where another relevant study for this work was found. The search strategy used in IBECS: (sexuality OR sexuality) [Words] and (adolescence OR adolescent OR youth OR adolescent) [Words] and (education OR education) [Words]. 50 results were found. An exhaustive reading of the title discarded results. Followed with an abstract reading, another study relevant to this investigation was chosen. Other databases were searched in which articles were eventually discarded for not meeting the inclusion criteria. Finally, for bibliographic references, a Bibliographic References manager "Refworks" was used to order and archive the articles obtained.

4. RESULTS Finally, a total of 7 articles were chosen from among the different previous databases to investigate the interventions that nurses carry out to adolescents in terms of sex education. After studying the reviewed articles, a content analysis has been carried out to see if these interventions that are carried out to adolescents about sexuality education have improved their knowledge after the interventions. The article by Antonio Hernández et al19 is a study whose objective is to evaluate the effectiveness of a sexual education program in the acquisition of knowledge about contraceptive methods and emergency contraception, as well as the change in attitude towards the use of condoms. A first questionnaire was made to the adolescents about knowledge. The intervention under study was based on the development of an educational program consisting of 5 sessions of 50 min each, and which was carried out by educators with training and experience in sex education, with a participatory methodology and with support. of standardized audiovisual material. The content of the talks was about the use of contraceptive methods and emergency contraception, myths, sexually transmitted diseases (STDs) and self-esteem reinforcement. After the intervention, another questionnaire was carried out and, 6 months after the intervention, another questionnaire. The mean age of the participants was 16.85 years. The vast majority of young people identified the condom as the only method that prevents STDs, A global and sustained improvement was also observed in the acquisition of knowledge about contraceptive methods after the intervention. The attitude towards the use of condoms changed in a positive way. There is also an increase in knowledge about emergency contraception. 15-16% of the pretest participants knew the maximum time to take the postcoital pill and that after the intervention the results improved. With all this, it has been found that the

development of sex education programs for the acquisition of knowledge in adolescents. (Table 2) The objective of the article by Ana Isabel Antón20 is to design a training activity on healthy sexual education adapted to the needs of an adolescent population and to identify the felt needs in terms of sexual education of a population of 6th year Primary students. It consists of two phases, a first for assessment and a second for intervention. There are 5 interventions to two classes, with a duration of 50 minutes. The students anonymously enter questions regarding sexuality into the ballot boxes and the school nurse conducts a workshop after collecting the questions from the ballot box. Through videos, illustrations and answers with explanations according to their age, the topics to be discussed are exposed. The doubts that arise are resolved in a colloquial way and thus an active feedback is obtained. After they are finished, an urn is placed again where they can write more doubts as well as new questions or concerns, in order to measure the intervention. A total of 10 notes are collected reflecting that the doubts had been resolved. Although the study author has not expressly asked, The most notable characteristics of this article has been that the information about masturbation and sexual thinking is the most common among adolescents. Being anonymous, it does not allow us to know what issues are most disturbing by sex. The feed-back shows that boys ask more questions than girls during the intervention. Boys ask more about their physical change and girls about mood swings. The absence of questions about sexually transmitted diseases reflects the need to intervene on this issue. In addition, the use of the ballot box and the maintenance of confidentiality and privacy has allowed the connection between adolescents and the nurse, so that adolescents can ask any questions without having to feel ashamed when they ask. The author has not quantified the results. (Table 3) The article by Antonia Raya Tena et al21, aims to evaluate the impact of an intervention about knowledge related to sexually transmitted infections (STIs) and the health services available in school adolescents in the Raval Nord neighborhood

It is a pre-post intervention study. Carrying out a pre-intervention questionnaire, the intervention itself and post-intervention and a satisfaction survey. The intervention is 90 minutes. At the beginning, the theoretical contents are briefly explained, then the viewing of a video and two practical cases that favored discussion in small groups. Three didactic units were developed to work on the contents. Regarding the results, the mean age of participation was 15.4 years. The study was carried out in a neighborhood with a high percentage of immigrant population. Of all the students, 63 had initiated sexual intercourse and 20 always used a condom. In the pre-intervention questionnaire, HIV was the best known STD. Maintaining a relationship with a person who suffers from it was identified as the behavior with the highest risk of contracting STDs. The comparative pre-post intervention results showed an increase in the percentage of students who recognized as STD, syphilis, gonorrhea and HIV. The most significant increase was that of gonorrhea. The mean risk perception of the different behaviors also increased after the intervention. There was also an increase in the number of students who collected sanitary devices (Salut i Escola, Tarde Jove, CAP ITS, CUAP, ASSIR) of which information was given. (Table 4) The article by Edgardo GR et al22 aims to identify the effectiveness of the educational intervention in order to increase the knowledge of adolescents in matters of sexual health and in this way contribute to the reduction of adolescent pregnancy, in such a way that they can enjoy of risk-free sexuality. It is a quasi-experimental study with a pre and post intervention measurement. The study was developed in three phases, a questionnaire, intervention and another questionnaire. Lasting one full hour per week for three months. The sessions were verbally evaluated on knowledge. After this, an exhibition of the subject was held with the support of a multimedia projector or material prepared by the exhibitors. Once the program was finished, the same questionnaire was applied as in the first phase. The first knowledge assessment, the grades had an average of 6.0, classified as fair. The ratings for each of the items showed that in terms of general concepts about sexuality, the majority were classified as bad in 36.2%; Regarding Sexually Transmitted Infections 36.5%

they showed excellent knowledge; 43.5% showed good knowledge of conception and pregnancy, almost similar in the case of hygiene according to sex and adolescent pregnancy; 31.0% have excellent knowledge of family planning methods; contrary case to what happens with multidetections where 61.4% demonstrated to have bad information; drug addiction 77.8% have excellent information. The post-intervention evaluation was a 7.0. For each of the items, an excellent rating in 36.5%, regarding sexually transmitted infections 42.9% obtained an excellent rating; in the subject of adolescent pregnancy it obtained a qualification of good in 48.0%; Regarding family planning methods, 52.3% obtained a qualification of excellent, while in multidtection 35.0% obtained a regular qualification and in drug addiction 86.3% obtained a qualification of excellent. In the pre-test and post-test scores, none of the adolescents obtained scores in the poor category. Excellent grades increased. (Table 5) The article by Amaya Gómez Calduch et al23 aims to determine whether adolescents improve their knowledge about sexuality, gender equality and personal identity, sexually transmitted diseases and contraception after completing the Sexual Education Intervention Program (PIES). The intervention consists of three workshops lasting approximately two hours. In the first, it is intended that adolescents reflect on sexuality with a partner, with oneself, enhance respect for relationships between different sexes and achieve a conceptual development of personal identity and sexual roles. The second intervention of personal reflection. In the third intervention, risk behavior in sexual relations, unwanted pregnancies, STDs and contraception are prevented. After the intervention, it is obtained that 52.20% of the sample corresponds to the male sex, the average age is 15 years, 6.52% have had complete sexual relations. The PIES program has contributed to improving the concept of sexual orientation and respect between genders. Better acceptance of the different forms of sexual identity and intercourse is demystified as the central axis of a relationship. The concept of “shame” has been reduced when proposing the use of a condom, it also improves when asked about what they would do if they were proposed to perform unprotected sex,

answering that they would refuse to do so. A better knowledge of the different contraceptive methods is observed, which one provides the greatest benefits, when and where to go in the event that a barrier method fails. Knowledge about sexually transmitted diseases improves in terms of risks, prevention and treatment. The PIES program improves knowledge and attitudes, but it is important that they start at an early age. (Table 6) The article by Rodrigues MGS et al24, aims to sensitize adolescents about the transformation of social reality through educational actions aimed at sexual and reproductive health, in a responsible and healthy way, minimizing vulnerabilities and health problems. The interventions were 5 sessions of 1 hour and 40 minutes. After this, the adolescents demonstrated a better knowledge of contraceptive methods and those most indicated for their age group, Sexually Transmitted Diseases and the ways to prevent them, the importance of having their first sexual relationship with responsibility and care for themselves and of your partner and the prevention of unintended pregnancy. Evaluating the topics addressed in the works that they prepared and presented, the acquisition of new knowledge, respect for oneself and for others, the better integration of the group and the co...