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RESEARCH ARTICLES

 

Resilience among adolescents: the regard of nursing

 

Rosangela da Silva SantosI; Ana Claudia Mateus BarretoII

 

INurse, PhD in Nursing, Assistant Professor in the Nursing Graduate Program at the State University of Rio de Janeiro, Researcher 1 C of the National Council of Scientific and Technological Development / Research Support Foundation of the State of Rio de Janeiro. Representative in AC Nursing of the National Council for Scientific and Technological Development:Email: rosangelaufrj@gmail.com
IINurse at the Maternity Hospital Leila Diniz. PhD in Nursing from the School of Nursing Anna Nery, Federal University of Rio de Janeiro, Municipal Health Department / Rio de Janeiro, Brazil. Email: amateusbarreto@yahoo.com.br.

 


ABSTRACT: This study aimed at [1] identifying how adolescents activate resilience mechanisms in adverse situations; [2] analyzing the resilience capacity of adolescents and their contribution to nursing practice.  Qualitative research with 12 hospitalized adolescents occurred in February, 2008. Narratives were treated with thematic analysis. The   adolescents investigated were daughters of married, divorced parents, some having lived and others not, with their stepfathers. Either they were unaware of their biological father’s identity or they were raised by grandparents.  Parental conflicts, sexual violence, physical aggression, and broken families produced sequels, such as low self-esteem. We emphasize the relevance of the resilience framework and its applicability in nursing care to adolescents in adverse situations, to help them restore self-esteem by working on their empowerment. The dialogic relationship between adolescents and nurses enhances resilience and reduces vulnerability. 

Keywords: Vulnerability; adolescent; resilience; nursing.


INTRODUCTION

 

The concern for this research originated from the observation of the high incidence of adolescents with condylomatosis cesarean deliveries due to the degree of impairment of the birth canal and of newborn infants, children of adolescent mothers, treated for congenital syphilis. The object of this study is the resilience of adolescents who experienced adverse situations and as objectives:Identify how these adolescents use resilience mechanisms in adverse situations; analyze the resilience capacity of adolescents and their contribution to nursing practice.

The results showed that the adolescents interviewed were victims of violence, and experienced negative situations in their families. These situations of lack of family cohesion, paternal and maternal absence and difficulties from a low economic situation. Despite the hostile situations experienced by adolescents, each in their own way and within the limits of their possibilities, tried to overcome their adversities.

Resiliency is distinguished by the ability of human beings respond to the demands of daily life in a positive way, in spite of diversities encountered along their life cycle of development, resulting in the combination between the attributes of the individual, his or her family environment, socially and culturally1.

LITERATURE REVIEW

Resiliency is distinguished by the ability of human beings respond to the demands of daily life in a positive way, in spite of adversities encountered along its life cycle of development, resulting in the combination between the attributes of the individual, his or her family environment, socially and culturally. It is called resiliency1,2 the ability to overcome the most difficult situations, while others are trapped in misery and anguish that prey on them.

It comes from the Latin word resilio, which denotes return to a previous state, being employed, in engineering and physics, to define the capacity of a physical body returning to its normal state, after having suffered a pressure on it.Subsequently, the term has been adapted to the human sciences and health, expressing the ability that some individuals have to resist adversity, the strength necessary for mental health to stabilize during life, even after exposure to risks. Demonstrating the ability to accommodate and balance facing adversity3,4.

In the conception of risk, it confuses an adolescent at risk with one that shows behavioral risk. Within a framework of risk and resiliency, the risk factors are less related to the consequences of the behavior and the factors that limit the likelihood of success, to the extent that they are exposing themselves to the risk and focuses on the behavior itself2,5.

Individuals exposed to risk situations that do not develop the capacity of resilience are seen as more vulnerable to these events. They show apparent changes in physical and/or psychological development when subjected to stressors and risks. Such changes are evident in the trajectory of adaptation of these individuals, such as susceptibility and propensity for presenting symptoms and diseases. Individuals can be so vulnerable, yet resilient facing a certain event. They may also be vulnerable in some areas of their development and resilient in others. Many factors interact to increase vulnerability or reduce the effects of stress on the individual6.

Resilience is not a sealed nor linear process, an individual may present themselves as resilient in the face of a given situation, but, subsequently, not being able to face another. In this way, we cannot speak of resilient individuals, but on the capacity of the individual, in certain occasions and in accordance with the circumstances, dealing with adversity, not diminishing it. Thus, the overcoming aspect of potentially stressful events, pointed in some definitions of resilience, it must also be relativized in function of the individual and the context7.

The response of individuals to a situation of risk can be influenced by some mediator mechanisms. These mechanisms are called protective factors and have been identified as those responsible for reducing the impact of risk and negative chain reactions. Individual characteristics, such as self-esteem and self-efficacy, are some of them. Resilience is considered as the final result of the protection processes that does not eliminate the risks experienced, but stimulate the individual to deal effectively with the situation and emerge stronger from it2,6.

The family environment is essential in the development of resilience in children and adolescents. The existence of interaction in the family context will enable these individuals to develop a high self-esteem, making them less vulnerable to adverse situations experienced in their daily lives. The childhood and adolescence periods are essential for the creation of a solid resilience foundation, which will be tested, reinforced or undermined in the course of the life cycle3.

The human development process, including the potential for resilience, begins even before conception, with the family history, the fantasies, the expectations and desires around the child that will be born. During pregnancy, whose apex is at birth, begins a vital emotional connection. At this stage of mother-baby symbiosis, sensations and feelings experienced by the mother can affect the sensoria of the child and, in turn, the potential for resilience3.

Social support is considered a secure foundation, vital and necessary in the period of childhood, adolescence, adulthood and in old age. In childhood, the first and main source comes from the maternal care or other caregivers who adopt this function; during the adolescence and adulthood periods, other characters and institutions occupy a prominent position. It is from the social support received that establishes the individual capacity to recognize and make exchanges with other people, building a stable basis throughout life. In this way, the feeling of being supported needs to be formed, maintained and renewed in the course of existence2.

METHODOLOGY:

Descriptive qualitative research, adopting thelife narrative method and methodological framework of Daniel Bertaux8, which makes it possible to know the essence of the life history of the participants from their own narratives.

The research scenario was a municipal maternity, the city of Rio de Janeiro, a reference center in the care of adolescents. The participants were 12 adolescents seen in the Rooming sector whom signed the Consent and their legal representatives the Statement of Informed Consent Form (ICF).

The project was approved by the CEP SMS-RJ opinion No CAAE- 0275.0.314.000 -08 in January 2008. The narratives were obtained with a digital recorder. The transcriptions were made immediately after the completion of the interview as recommended by Bertaux8. The guiding question of the interview was: Tell me about your life that is related to your sexual experience. The analytical procedure was the thematic analysis. Concomitant to transcripts of interviews, began the analysis of the narratives, to enable identify the data saturation and /or making adjustments and redirect them if necessary8.

The analysis categories were constructed from the narratives that were grouped after the theme selection. In order to ensure the confidentiality and anonymity of participants, these were identified by the letter A associated with the sequence number of participation (for instance: A1, A2, A3) and the age of each one.

These emerged from two analytical categories: The adolescent, family structure, social and resiliency; and sexuality of adolescents and their vulnerability to IST. Partially portrayed here the results obtained by analyzing the first category, through which we were able to identify the resilience capacity of adolescents to adverse situations and used as resilience mechanisms.

RESULTS AND DISCUSSION

Family relationships are fundamental to the promotion of a healthy life and social well-being, because it favors the development of the potential of children and adolescents1. The life narratives of adolescents interviewed showed that their family contexts were diverse, were daughters of parents who are married, separated, that lived and not coexisted with the stepfather, unaware of their biological father or were created by their grandparents. Only one did not mention his family throughout the course of their narrative. In this study, family was considered as, a community consisting of a man and a woman united in marriage bond, and the children born of this union9.

The experiences during the adolescence period

The grandparents of two adolescents from very early took responsibility for raising their grandchildren because their mothers desire to seek better financial situation looking for work outside their hometowns.

Living with my mother I never lived [...] I came to know her [...] I was [...]. is [...] about 9 years old, where I met her, I liked her as well, but [...] not feel that love [...] that is to feel for a mother [...] (A1, age 18)

[...]She was living without me, was living far away, when I was a child, then [...]I am teenager today, she doesn't know very well what it is to have a teenage daughter today, you know [...] I was raised by my grandmother [...](A2, age 17)

The contemporary life has undergone significant changes with new forms of family composition. The family nucleus is currently reduced in number of children and households, such as relatives and neighborhood. The increase in the incidence of separation between couples leads the children to live with a parent or with the new partner of one of their parents.There was also an increase in the quantity of single mothers, of whom are frequently the livelihood of their family and the new roles assigned to grandparents10.

It should be noted that there has never been a definitive model of the family, since it is continuously transformed during the story to accompany the social, economic and cultural changes. The idea of unstructured family is grounded in those formed by separated parents, homosexual couples, single mothers, grandparents responsible for grandchildren and other settings that comprise cores that can even escape the idealized by society, but that is fully capable of achieving success in the education of children and young people under their responsibility.Many factors affect their configuration, how to relate its members and their way of being and educating children. There was never a definitive model of the family, especially in western culture11.

Regardless of the type of family nucleus, it showed that the majority of these groups were not cohesive; there were conflicts and violence, accompanied by physical aggression, according to the narratives:

[...] Since I was a child, my father and my mother fought a lot. [...] Fought a lot of [...] is [...] aggression towards one another [...] then I saw that a lot [...] aggression, and [...] until times when my father would beat my mother, I [...] I interfered. [...] do you understand [...] (A4, age 18)

[...] Because he beat my mother a lot [...]... [...] He was from the church and still beat my mother [...] (A3, age 19)

The adolescents were impelled to understand, in an unexpected way, the universe that surrounded them. The fact that one of them had witnessed and interfered with, sometimes, in your parents' disputes, certainly no longer, in addition to the memories, some sequels. The experiences in unstructured families harm children, especially those who are in the adolescence period.

Adolescents can be identified as a high vulnerability population segment and vulnerability may be exacerbated by various aspects, such as the call family disintegration (within the meaning of broad concept), lack of reference, low intellectual and affective stimulation, favoring the low self-esteem, exposure to violence12.

Among the adolescents interviewed, it was possible to identify that some have suffered physical attacks on behalf of their partners.

I lived with him. We lived in the Cidade Deus. Don't know if you know [...] I lived there. I have suffered the bread that the devil crumpled in his hand, because he beat me [...] (A3, age 19)

[...] When he drinks, so [...] loses his head [...] beats [...] there so I prefer to 'stay' in the shelter [...] because [...] every day one comes home drunk, I 'get beat' [...] it does not work [...] there [...] he [...] only when he's working, he [...] does not lose his mind [...] comes home 'drunk' already wanting to beat me [...] (A5, age 17)

Violence against adult and / or teenage woman independent of the social layer to which it belongs is seen through the prism of banality. Many times the fear, shame and silence prevails. The latter plays the role mediator and separates the private world (home) of society (street). Violent acts, whether they are visible or not, are bound to the power relationship, where the strong subdue the weak, making use of various strategies to ensure the maintenance of that power, whether by the use of physical or psychological resources13,14.

Another type of violence that emerged in their narratives was sexual violence.

[...] Yes he tried, but he would put anything no [...] he only stroked me [...] and threatened me because he was beating my mother [...] he said 'If you say anything I will beat your mother '[...] (A3, age 19)

[...] No [...] we try, if you do not want I'll stop. Then I said: - Ah, then okay, so far so good [...] Then began trying, and when [...] was arriving at the end finally, I told him - I do not want [...] I do not want to. [...] Being that he [...] know, he was rough [...], pretended that he was not listening to me and took my virginity [...] (A6, age 17) 

One of the teenagers in her narrative that emphasized repeatedly was sexually assaulted by one of her brothers. However, her mother gave her no credibility when the teenager tried on different occasions alert her of what was happening. According to adolescent, her mother only came to believe, when the girl's stepfather confirmed the veracity of the story told by the adolescent.

[...] My brother, when I was little [...] he 'tried to abuse me' [...] my mother did not believe 'me' [...] I said: 'Mother, my brother tryin' pass' on hand me [...] then my luck that the boy saw [...] and [...] her [...] her husband at the time, saw [...] and told her: - No, he's trying to 'abuse' her every night, he goes there in her bed [...] and I have already noticed [...]―. But it ' even ' thus did not believe, and until a time she saw ' even ', it coming 'abusing' me, there came the guys there to where we lived and they beat him [...] beat him and today, says that he was the person who killed my mother [...](A5, age 17)

Sexual violence is surrounded by fear, shame and discredit dismissed for teenage or adult woman. In the majority of sexual abuse cases against adolescents, the offender is male and a known person, evidenced in the narratives of the interviewed adolescents. In relation to sexual abuse, the victims are mostly female and the aggressors are the parents, the stepfather, boyfriend, brothers, cousins, spouse, or even people they know, and family related15.

Based on the narratives of the researched universe, it was possible to identify that the adolescents who lived with a family breakdown, were exposed to all kinds of violence, and have developed low self-esteem.

Even so, one of the girls, who had been raped by her stepfather, at the time of the completion of the study tried to live with him and to overcome the entire trauma she had experienced. The narrative of the life of this teenager is emblematic: experienced difficult times with her partner first, separated from him and got a job and rebuilt her life with a new relationship.

Another example of resilience has been presented to us by one of the adolescents interviewed since its narrative highlights the many difficulties that she has faced in her short existence. However, the adolescent demonstrates courage to fight for justice for the care of their children, despite the fact that her future is so uncertain.

The narrative of the adolescents indicates that each, in their own way and within the limits of its possibilities, showed resilience to overcome the lack of family cohesion, the violence, the absences paternal and maternal and the difficulties arising from a low economic situation.

Resilience was also evidenced with teenager who lived with aparental absence from a young age;she was raised by her maternal grandmother, and remained steady in her goal of studying in order to get a good job placement, further establishing her own family differently from that in which she was raised.

After I go to college and have a good [emphasizes good] job, I think about having a child, because then I'll have had everything I wanted... From my mother and my father, so I guess so, I have to study hard to get a good job, for when I have a child, I give everything [emphasis on everything] for my kid what they want... (Stutterer) always be there by my kid's side, helping them... I want this, not what my mother did with me... (A2, age 17)

In her narrative, the adolescent highlights the great love of her grandmother and the importance of her participation in her life.

My grandmother always there, educating me, supporting me in things that I have always needed... Was there helping me, what I wanted, and my grandmother did... the impossible (emphasizes impossible (A2, age 17)

Family life and the development of resiliency

Family relationships are important, especially in childhood, while vectors in fundamental training of individuals, generating capacity of these withstand crises, as well as overcome them. In this context, the resilience represents the practical ability of individuals to not only return to the natural state of excellence, overcoming their critical situations, but also to use them in their processes of personal development, unmoved negatively, capitalizing on the negative forces in a constructive manner2.

A person's ability to turn their negative experiences into something positive is directly related to self-esteem, which is closely embraced by the quality of their family relationships. The higher the self-esteem of the individual, the greater will be its ability to resilience, making greater their capacity to overcome the daily hardships.

The resilience is based on two major poles: the adversity, which is represented by the events of life unfavorable: and the shield, which points to the understanding of the forms of support - internal and external of the individual, which lead to a unique reconstruction before the suffering, caused by an adversity3.

The greater the protection offered to the individual throughout their childhood and adolescence; in particular, by those who make up their family group, the greater will be their ability to overcome the obstacles.A similar study showed that the more relational and communicational character aspects seem to have greater predominance and weight, when the theme is resiliency. Between the family aspects, we can highlight difficult relationship with the mother or other relatives; the lack of supervision of the family in adolescent; depletion of parental authority in conjunction to violence as a form of communication in the family16.

When watching the clientele, especially during adolescence, it is essential that the nurse have a sensitive listening the patient's history and its problems in order to recognize and analyze the possible signs indicating their potential for resilience. Through this listening, the nurse is able to understand the mechanisms used by their patients and family members in the resolution of their difficulties and strengthen protective aspects. Contributing in this way with the ability to overcome difficulties of adolescents17.

To the extent that the resilience of the individual is maximized, its vulnerability decreases and vice versa. Some factors act as facilitators of child and adolescent vulnerability, while others act proactively functioning as protection mechanisms. One of the factors essential for the development of resiliency is the support and acceptance by the members of their personal and social network2.

CONCLUSION

The research showed that despite these girls have experienced adverse situations such as relations of family conflicts and situations of violence, none of them proved to be influenced in a negative way by the experiences.

We stress the importance of the dialogic relationship between the adolescents and the nurses with the purpose to transcend the simple game of active questions of these health professionals with the passive responses of clients, in order to build a field of trade, with a view to being incorporated into the knowledge of nurses on the experiences of adolescents. With this, it will be possible to establish relationships based on partnership for both parties, with the goal of finding the shortest path to restoring self-esteem of these clients, making them more resilient to possible future adversities.

As smooth as the adolescents a sensitive listening and appreciation of their individuality and their feelings, repealing the paradigm of a technicality care and contribute to the enhancement of self-esteem of these clients. Therefore, the nurse must adopt the posture that contributes to increased self-esteem and resilience of these adolescents, in order to make them autonomous and protagonists of their own lives.

This study has limitations, in the face of reduced sample that prevents the generalization of the results.
The results of this study may also contribute to base the best care provided by nurses to the family of this clientele, with a view to a better understanding the importance of their role in the formation and development of these adolescents.

REFERENCES

1. Noronha MGRS, Cardoso PS, Moraes TNP, Centa ML. Resiliência: nova perspectiva na promoção da Saúde da família? RevCiênc saúde coletiva. 2009; 14: 497-506.

2. Ferreira AL, Leal AL. Formação humana e adolescência: a espiritualidade como fator de promoção da resiliência. [citadoem 2014 jan 25]. Available at: http://elogica.br.inter.net/ferdinan/aurinolima_com.pdf

3. Barlach, L, Limongi França, A.C, Malvezzi, S. O conceito de resiliência aplicado ao trabalho nas organizações. Revista Interamericana de Psicologia. [Internet] 2008 [citado em: 23 abr 2014]; 42(1): 101-12. Available at: <http://redalyc.uaemex.mx/redalyc/pdf/284/28442111.pdf>.

4. Assis SG, Pesce RP, Avanci JQ. Resiliência enfatizando a proteção dos adolescentes. Porto Alegre: Artmed; 2006.

5. Blum RW. Risco e resiliência. Sumário para desenvolvimento de um programa.RevAdolescLatinoam. 1997; 1(1): 16-9.

6. Koller SH. Resiliência e vulnerabilidade em crianças que trabalham e vivem na rua. Educar em revista. [Internet] 1999 [citado em 22 mar 2014]; 15: 1-3. Available at: http://ojs.c3sl.ufpr.br/ojs2/index. php/educar/article/view/2052

7. Paulilo MAS, Bello MGD. Jovens no contexto contemporâneo: vulnerabilidade, risco e violência. Serviço social em revista. [Internet] 2002 [citado em 20 fev 2014]; 2(1). Available at: http://www.uel.br/revistas/ssrevista/c-v2n1.htm

8. Bertaux D. Narrativas de vida: a pesquisa e seus métodos. Tradução de Zuleide Alves Cardoso Cavalcante, Denise Maria Gurgel Lavallée. São Paulo: Paulus. 2010.

9. Ferreira ABH. Dicionário Aurélio de Língua Portuguesa: edição Histórica 100 anos. 8ª ed. Curitiba (Pr). Editora Positivo; 2010.

10. Maciel RA, Rosemburg CP. A relação mãe-bebê e a estruturação da personalidade. RevSaude Soc. 2006; 15: 96-112.

11. Mandelbaum B [Belinda Mandelbaum fala sobre estrutura familiar e aprendizagem]. Entrevista concedida a Revista Nova Escola. 2010. [citado em 20 jan 2014]. Available at: http://revistaescola.abril.com.br/formacao/formaçãocontinuada/belindamandelbeli-fala-estrutura-familiar-aprendizagem-584531shtml.

12. Ayres JRCM. O jovem que buscamos e o encontro que queremos ser: a vulnerabilidade como eixo de avaliação de ações preventivas do abuso de drogas, IST e AIDS entre crianças e adolescentes. In: Tozzi D, Santos NL, Amaro CM, Almeida E, Silva EJ, Pereira ML, organizadores. Papel da educação na ação preventiva ao abuso de drogas e às IST/AIDS. São Paulo: Fundação para o Desenvolvimento da Educação; 1996. p.15-24.

13. Barreto ACM, Santos RS. A vulnerabilidade da adolescente às doenças Sexualmente transmissíveis: contribuições para a prática da enfermagem. Revenferm Anna Nery. 2009; 13(4): 809-16.

14. Cardoso ES, Santana JSS, Ferriani, MGC. Criança e adolescente vítimas de maus-tratos: informações dos enfermeiros de um hospital público.Revenferm UERJ. 2006; 14: 524-30.

15. Oliveira MT, Lima MLC, Barros MDA, Paz AM, Barbosa AMF, Leite RMB. Sub-registro da violência doméstica em adolescentes: a (in) visibilidade na demanda ambulatorial de um serviço de saúde no Recife-PE, Brasil.Rev Bras SaúdeMatern Infant.2011; 11(1): 29-39.

16. Rozemberg L, Avancini J, Schenker M, Pires Thiago. Resiliência, gênero e família na adolescência. Rev Ciência & Saúde Coletiva. 2014; 19:673-84.

17. Assis SG, Avanci JQ, Pesce RP, Deslandes SF. Superação de dificuldades na infância e adolescência: conversando com profissionais de saúde sobre resiliência e promoção da saúde. Rio de Janeiro: Fiocruz; 2006.