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Running head: PEDIATRIC HEALTH PROMOTION 1 Pediatric Health Promotion Emmah Kargbo. NSG 200. 11/23/2020. PEDIATRIC HEALTH PROMOTION 2 Pediatric Health Promotion Health promotion refers to the approach integrated into the health care system to allow people to increase control over, as improve their health. In that regard, health promotion emphasizes more on environmental and social interventions than individual behaviour (Daley et al., 2020). In this assessment, the client to be considered is Peter James, an 18-year-old male. Peter is in the adolescent stage, and he has demonstrated several behaviours that depict that he has met the developmental milestone of a person in the adolescent stage. For example, he describes volatile emotions, develops a sense of independence, develops an interest in a romantic relationship, develops a commitment to education, and spend a lot of time with his peers. In other words, the client is mature in the sense that he can distinguish between right and wrong when making judgments and decisions. It is also essential to examine different developmental theories on human growth and development based on the adolescent agent of the client. Some of these theories include Erick Erikson theory, social learning theory, and Maslow Hierarchy of Needs. According to Erikson, human personality changes in a predetermined order. Therefore, there are different stages of psychosocial development that depict the development of a person from infancy to adulthood. In each stage, the experience for each individual makes him or her face psychosocial crisis to demonstrate personality development. Erikson psychosocial theory has eight stages of development that explain changes in different stages of human development. In this case, the client is 18 years old in the adolescent stage. According to Erikson, the psychosocial stage for an adolescent is known as identity vs role confusion (Gross, 2020). This is the 5th stage that Erikson uses to demonstrate how adolescent PEDIATRIC HEALTH PROMOTION 3 develop based on their behaviours and other aspects. The stage mainly explores psychosocial develop for persons aged between 12 to 18 years. As children transform to adulthood, this stage is paramount in shaping their future in terms of roles in adulthood. Moreover, Erikson considers this stage as “role confusion” because adolescents will see changes in their body (Gross, 2020). They also become responsible when they develop both mentally and physically, such that they explore different social roles. However, the 5th psychosocial stage also focuses on the identity crisis that may affect adolescents as they determine their identity. This explains why adolescents explore different lifestyles to understand their real identity. More importantly, the adolescent stage can be explored through Maslow’s Hierarchy of Needs. Mainly, this theory consists of five components that demonstrate survival. The relevance of this theory at the adolescent stage is the component at the bottom of the pyramid called “basic needs” (Crandall et al., 2020). In that regard, adolescents require basic needs from their health, growth, and development. Therefore, they require food for physical growth and mental development. This theory also consists of “safe needs” that can be used in adolescent stage to ensure they reside in a safe environment that will facilitate their transformation to adulthood. Maslow’s theory also expresses the importance of “social needs”. These needs are relevant in the adolescent stage because they require attention and love from parents, peers, siblings, and the community. The “esteem needs” also influence the development of adolescents. The environment for adolescents is determined by the impact of this component, especially when making decisions. Overall, Maslow’s theory explores how “self- actualization” affects human development (Crandall et al., 2020). It is relevant in the adolescent stage because they focus on their identity in life. PEDIATRIC HEALTH PROMOTION 4 The last theory that explores human development at the adolescent stage is the social learning theory. This theory argues that people develop new behaviours through imitation and observation. In that regard, adolescents can develop new behaviours by imitating other people by watching what they do (Pringle et al., 2018). However, some behaviours achieved through social learning theory can mislead adolescents. Therefore, it is paramount to guide them to ensure they only observe and imitate the right actions. Consequently, health promotion for a client at the adolescent stage is paramount and proper communication is a crucial skill for completing the assessment. Therefore, at 18 years old, the client can be distracted by many factors. It is essential to embrace effective communication to ensure the client develop confidence, respect, and trust. It is also paramount to ensure that client has consent about the assessment and assure him that data collected will be handled with ultimate privacy and confidentiality (Daley et al., 2020). More importantly, it is essential to inform the client the reason for asking personalized questions and how they help in health promotion. The client can choose to be assessed in the absence of the parent to ensure they fully open up without fear of intimidation and to promote privacy. Client: P J, is The client in the health promotion assessment. He is 18 years old. In the interview, the client’s father will be present as an informant. It is also paramount to acknowledge that PJ, completed the required documentation such as Guidelines for Adolescent Prevention Survey. Health History: Biographic Data: The client, P J, is 18 years old. He was born on 14th November 2002 as an AfricanAmerican. PEDIATRIC HEALTH PROMOTION 5 Reason for Seeking Care: Well Visit History of Present Illness: The client has no record of depression. Present Health Status: The client is taking antidepressants such as citalopram and escitalopram. The client is also receiving cognitive behaviour therapy. Past Health History: The client has no history of any medical condition. All physical examinations for vision, immunization, dental health, and other requirements are up to date. Family History: Brother: 16 years old, asthmatic Sister: 13-year old, type 1 diabetes Father: 57 years old, Rheumatoid arthritis Mother: 55 years old, Hypertension Paternal Grandfather: 82 years old, type 2 diabetes Paternal Grandmother: 78 years old, type 2 diabetes Maternal Grandfather: 80 years old, stroke Maternal Grandmother: 77 years old, Kidney failure Person Status: Client’s father describes him as “sharp, diligent, and intelligent”. During the interview, the client was restless and lost concentration in the larger part of the interview. When asked “what is going on?” He replied with a loud voice, “I am ok!” Then the client expressed sadness and his mood changes almost immediately. The client is the basketball captain in his school and has propelled his to best performance in the last competition. However, the client indicated on the Guidelines for Adolescent Prevention PEDIATRIC HEALTH PROMOTION 6 Survey, his plans to quit basketball because he lost interest in the game, despite being the best player in the region. Family and Social Relationships: The client states that his relationship with his family is not good. Although his siblings are the best, his father and mother engage in domestic conflict most of the times. His father is violent, and the family faces domestic violence that affects the welfare of the family. The client also claims that he spends most of his time with two close friends whenever his family has domestic violence. The client also states he is a romantic relationship with a 17-year-old girl he met in a piano training program in the community centre. Diet and Nutrition: The client does not like eating fast foods and prefers to eat food prepared by his mother at home. He also likes eating organic vegetables and fruits for breakfast. For both lunch and dinner, the client eats rice with fish and blended juice. The client stated in the interview that his organic diet to help him lose body weight. Sleep: The client acknowledges that his sleeping pattern has changed in the last six months. He states that sleep deprivation has affected his daily activities at school. Despite going to bed at 10 pm, the client expresses that his only sleep for 4 hours due to sleep deprivation. Mental Health: The client claims that for the past six months, his depression level has increased. He even claims that suicidal thoughts have been haunting him for that period. He also experiences sadness and mood swings. He claims that her depression is caused by domestic violence PEDIATRIC HEALTH PROMOTION 7 experienced in his family. He also claims that basketball used to relieve his stress, but in the past six months, the depression level has increased. He even decided to quit playing basketball. Sexuality: The client states that he started feeling attracted to girls at the age of 12 years. His male reproductive organs are fully developed. Although he is in a romantic relationship with a girl, he is not engaging in a sexual relationship. He is only attracted to the opposite sex, which means he is heterosexual. Development: In terms of personal development, the Bright Futures Pre-Visit Questionnaire indicates the following aspects of the client.  He understands the importance of eating healthy food to prevent adverse impacts associated with fast foods.  He has great friends who support him whenever his family engages in domestic violence.  He is excellent in co-curricular activities such as basketball.  He is independent and makes personal choices.  He is also excellent at playing the piano. Health Promotion Activities: The client plays the piano every evening as a way to control stress. He also played basketball to improve his mental health. He does not abuse substances such as alcohol and narcotic drugs. Home Environment: The home environment is safe, and only a few criminal activities are reported. The environment is also clean, with no pollution identified in the area. Also, the public park is PEDIATRIC HEALTH PROMOTION 8 excellent for physical exercise. His home is also equipped with sustainable water supply, electricity, heating system during winter, and cooling system during summer. General Survey: The client has a black skin colour which demonstrates his African-American ethnicity. He does not maintain eye contact and seems restless due to lack of concentration. There are signs of acute distress and prefer spending time alone at school but only socialize with at least three friends at home environment. Vital Signs: Temperature: 96.3 F, Oral Blood Pressure: 115/70, Sitting Pulse: 72 beats/min Respiratory Rate: 15 beats/min Weight: 76. 5 kg Height: 60 inches or 1.524 meters BMI: 32.94 kg/m2, he is overweight Pain: The client rated his pain level at 3. At 0, it indicates that there is no pain while 10 means the worst pain. Therefore, at 3, the client was having moderate pain. Analysis of Data: Based on GAPS, health history interview, pre-visit questionnaire, general survey, and vital signs, it is possible to determine the wellness of the client. First, the client claims that domestic violence exposes him to depression. His BMI is high at 32.94 kg/m2, which indicate he is overweight. He also expresses restless, lack of concentration, and sadness as signs of PEDIATRIC HEALTH PROMOTION 9 depression. Therefore, the care plan involves addressing depression caused by domestic violence. It is also essential to improve his BMI level to a normal healthy weight. Nursing Diagnosis: The client has chronic depression, as evidenced by suicidal thoughts as expressed by the client. Goal: The goal involves engaging his parents to end domestic violence to ensure the client experience an excellent home environment and family love. Objective 1: The client identifies ways to improve mental health and implement them. Objective 2: The client identifies strategies to reduce body weight and implement them. Objective 3: The client should resume playing basketball to reduce stress and depression. Interventions: 1. It is essential to encourage the client to engage in activities that reduce depression. 2. It is essential to engage the client through active listening to motivate him on how to reduce depression. 3. Mainly, privacy and confidentiality should be considered when engaging the client. 4. His parents should be engaged to end domestic violence that affects the mental health. Evaluation: 1. It is vital to review the journey when the client visits next time to determine if there is any improvement. 2. The client can continue feeding on a healthy diet to manage his weight. PEDIATRIC HEALTH PROMOTION 10 References Crandall, A., Powell, E. A., Bradford, G. C., Magnusson, B. M., Hanson, C. L., Barnes, M. D., … & Bean, R. A. (2020). Maslow’s Hierarchy of Needs as a Framework for Understanding Adolescent Depressive Symptoms over Time. Journal of Child and Family Studies, 29(2), 273-281. Daley, A. M., Lestishock, L., & White, P. H. (2020). Pediatric Nurse Practitioners’ Perspectives on Engaging Adolescents to Shift from Pediatric to Adolescent-Focused Health Care Services. Journal of Pediatric Health Care, 34(6), 550-559. Gross, Y. (2020). Erikson’s Stages of Psychosocial Development. The Wiley Encyclopedia of Personality and Individual Differences: Models and Theories, 179-184. Pringle, J., Doi, L., Jepson, R., & McAteer, J. (2018). Developing an evidence and theory based intervention that seeks to promote positive adolescent health and education outcomes. The Lancet, 392, S73.