Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

School-Based Youth Health Nurses and Adolescent Decision-Making concerning Reproductive and Sexual Health Advice: How Can the Law Guide Healthcare Practitioners in This Context?

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

School-Based Youth Health Nurses and Adolescent Decision-Making concerning Reproductive and Sexual Health Advice: How Can the Law Guide Healthcare Practitioners in This Context?

Article excerpt

School-based health care (SBHC) is viewed as 'one of the most effective strategies for deliv- ering comprehensive primary and preventative health services to young people' (Mason-Jones et al., 2012). In the late 1990s, the Queensland Labor Government introduced the 'School- Based Youth Health Nurse Program' (SBYHNP) (Barnes, Courtney, Pratt, & Walsh, 2004). The Program was commenced as a partnership between Queensland Health and Education Queensland primarily to provide opportunities for public high-school students, their parents, and mem- bers of the school community to access limited health services in the school setting (Barnes et al., 2004; Department of Education, Queensland Government, 2011). Nurses employed under the programme provide primary health care services aimed at promoting positive health outcomes for adolescents. The programme focuses on health promotion by targetting issues that are considered to be of priority at either a local level within the school community, or at a national or State level. The initiative also prioritises illness prevention and/or early intervention strategies. This means SBYHNs are often responsible for initiating referrals of students to appropriate external health services or community agencies (Department of Education, Queensland Government, 2011). SBYHNs also play an active role in providing contraceptive advice, pregnancy testing services, and non-prescriptive contraception, such as con- doms. This paper considers some of the challenges faced by SBYHNs in relation to the provision of sexual health advice and services. In particular, we seek to outline the legal principles that underpin adolescent decision-making and the protection of confidentiality in this context. The question of decision-making capacity concerning adolescents is particularly pertinent to SBYHNs working in Queensland due to the transitioning of educa- tion of year 7 students being moved from primary school providers to secondary school providers from 2013. Thus, some SBYHNs are dealing with adolescents aged 11-years and over.

In August 2012, the authors were invited to present to a group of SBYHNs on the key legal and ethical principles impacting upon adolescent decision-making within the sphere of sexual health. The presentation took place in Brisbane and was made to a group of 45 nurses who work in Queensland high schools. The feedback the authors obtained, both during and after the presentation, suggested that nurses employed under the programme wish to receive more training and information about the legal and ethical issues that impact upon their day- to-day interactions with adolescents who seek advice on health-related issues, particularly in relation to decision-making capacity and sexual health matters. This paper summarises some of the key legal principles that are of relevance to nurses working within this field, and elaborates upon a number of specific issues that were raised by SBYHNs during the presentation. Although the discussion is focussed on the primary issues highlighted by nurses working within the Queensland setting, the principles outlined in this paper are relevant to all health practitioners working with adolescents in other Australian states and territories.

adolescents and sexual health

It has been observed that the 'sexual and repro- ductive health (SRH) of young people is rec- ognised as key to the development of nations, demographically, economically, socially, cultur- ally, and politically' (Shaw, 2009). There is a recognised need to strengthen positive tenden- cies towards sexual health and sexual health education in adolescents (Sundby, 2006). Moreover, preventing access to sexual health advice and services is unlikely to reduce ado- lescents' exposure to voluntary and involun- tary sexual activity (Marston & King, 2006). As noted by Marston and King (2006), any failure to recognise adolescents' sexual health rights has the potential to result in serious consequences, including the potential for increases in sexually transmitted infections (STIs) (Marston & King, 2006; Mason-Jones et al. …

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