Open access peer-reviewed chapter
Abstract
Nurses are important in primary care and community contexts to apply actions and interventions to the needs and interests of young adults. This chapter aims to explore health-promotive actions for young adults with mental illness and move nursing theories into the context. The journey of recovery from substance use disorder is a complex and multifaceted process, particularly poignant in the lives of young adults. This developmental period is marked by identity formation, exploration, and navigating societal expectations. Recognizing and understanding the dynamic nature of recovery, the pivotal role of social support, and the inherent resilience of this population provides a foundation for developing targeted interventions. Another aspect is to enrich the development of skills for nurses by the use of more knowledge of nursing theories. Primary prevention efforts should be tailored to meet the needs of both nurses and young adults. These thoughts are both challenging and create new possibilities. Furthermore, nurses need more knowledge, which will give them the opportunity to make a difference.
Keywords
- community
- intervention
- mental health
- mental illness
- nursing
- perspectives
- primary care
- young adults
1. Introduction
Mental illness is a widespread public health problem, and a large proportion of those who suffer from it are young adults. Young adults are overrepresented among people with mental illness, and the condition can cause both physical and psychological problems. It creates a huge barrier of suffering, financial loss through a dysfunctional working life, and reduced quality of life. There is a stigma around mental illness, which is often considered to be due to a lack of knowledge about mental illness. This constitutes a basis for poorer treatment [1]. This, in turn, constitutes a basis for poorer treatment [1, 2]. Adolescents and young adults hold stigmatizing beliefs about mental health treatments, health professionals, and access to care. The sources of these beliefs remain unclear, although some may be influenced by culture [2].
Mental illness encompasses a spectrum of health conditions characterized by alterations in emotion, cognition, and behavior. Despite its prevalence and impact, the absence of definition underscores the complexity of this phenomenon. Serving as an overarching term, mental illness incorporates diverse conditions that vary in duration and intensity, collectively impinging on a young adult’s capacity to navigate and adapt to daily life challenges. This term encompasses a wide array of mental illness, spanning from severe psychiatric disorders to milder and moderate conditions. The array of mental illness includes well-known conditions such as depression, schizophrenia, autism spectrum disorder (ASD), anxiety disorders, obsessive-compulsive disorder, adjustment disorder, eating disorders, personality disorders, attention deficit hyperactivity disorder (ADHD), and substance use disorder (SUD). Each condition presents unique challenges, affecting young adults to varying extents [3].
Young adults’ experiences from primary care are described as facing difficulties in accepting help, relational preconditions, structural and organizational hindrances, and satisfaction with youth-focused mental health interventions. They experience difficulties in accessing and receiving proper help from primary care. Further, they do not believe in recovery from mental illness, and they also express a lack of mental health literacy [4]. Primary care nurses (PCN) are advanced nurses in primary care or community context. Further, in the text, nurse or nurses will be mentioned.
On average, young students spend 3.38 ± 0.80 h on social media. Most-used social networks are shown as YouTube (98.8%), WhatsApp (98.4%), Facebook (93.2%), Instagram (88.1%), and Snapchat (48.5%) or TikTok (47.3%). The main reasons why students use these networks are shown as primarily socialization (49.0%, n = 209) and entertainment (31.1%, n = 133) [5].
Prevalence of loneliness for adolescents ranges from 9.2% in South-East Asia to 14.4% (12.2 to 17.1%) in the Eastern Mediterranean region. The lowest prevalence of loneliness is observed in northern European countries (2.9, 1.8 to 4.5% for young adults and the highest in eastern European countries (7.5, 5.9 to 9.4% for young adults [6].
About one in ten young adults has an income that is below the threshold for what is required for a reasonable standard of living, and about one in four young adults has had difficulties meeting their current expenses. The economic vulnerability of young people draws attention to the fact that there are large differences in the financial situation of young adults aged 20–25. The majority of the group has good living conditions, but there are large differences within the youth group. The higher financial income relates to higher self-esteem [5]. Data from suicide research indicates that in the age group 15–24 years, the number of suicides has increased by approximately one percent per year over the past 20 years [7].
2. Recovery perspectives among young adults with substance use disorder
Substance use disorder (SUD) is understood as a biopsychosocial disorder. Young adults who want to stop using substances or improve their well-being while using substances need to undergo a recovery process [8]. The road to recovery for young adults living with mental illness is often long and looks different depending on the condition and problem. SUD and recovery should be understood using the same coherent approach – as an interplay between biological and psychological factors and social, political, and cultural contexts [8]. Recovery is a way to achieve developmental milestones shared by other young adults and a way to return to normalcy. It is described as multifaceted, with many participants citing the integral role that mental health played in their substance use disorder (SUD), and the need to address this in their recovery. Recovery from SUD is therefore increasingly recognized as a dynamic and individualized process, encompassing various dimensions such as physical, emotional, and social well-being [9]. The interplay of physical, emotional, and social dimensions in their recovery process underscores the need for comprehensive, holistic interventions [9]. Young adults feel stressed that recovery from substance use disorder (SUD) has to be self-motivated and is a process that requires consistent work. The recovery perspectives of young adults unveil narratives of transformation marked by both vulnerability and strength.
The challenges faced by young adults in recovery are manifold, ranging from societal stigma to internal struggles with identity and purpose [10]. Despite these hurdles, many exhibit remarkable resilience, drawing on factors such as self-efficacy, motivation, and a sense of purpose to sustain their recovery efforts [11, 12]. Unfortunately, there are societal barriers that reduce the opportunities for young adults with mental health challenges to enter the job market and advance in their careers. Societal attitudes, various policies, and organizational practices are examples of such barriers [13]. In working life, young adults with mental health challenges are seen as less attractive to hire, and difficulties in meeting work demands are reported by young adults with mental illness [14]. This can lead to mental health challenges, ultimately resulting in sick leave [14, 15].
For young adults involved, recuperation served to attain the developmental goals common among their peers, aiming to regain a sense of “normalcy.” They depicted recovery as a complex journey, with a significant emphasis on the pivotal role of mental health in their SUD and the necessity to address it during their recovery. Young adults emphasize that the recovery process from SUD had to be driven by their own motivation and demanded unwavering, continuous effort [12].
Furthermore, they highlighted the need for access to professional and social support during the recovery process [8]. Young adults, in particular, often rely heavily on their social networks for encouragement and validation [16]. Primary care, peers, family, and community support can serve as crucial catalysts or barriers to recovery.
3. The perspective of nurses meeting young adults with mental illness in primary care or community context
The most common way for a person with mental illness is contact with a primary care nurse (PCN) [17]. Effective treatment of young adults with mental illness provides them with the opportunity to be actively involved in their care. A reciprocal relationship marked by dedication from healthcare professionals enhances patient engagement. Nurses engaging with young adults affected by mental illness underscore the critical role of knowledge in this context. A profound understanding of mental illness enables the comprehensive collection of patient history and facilitates appropriate referrals for specialized assistance. Emphasizing the importance of accessing the right healthcare professional for mental health concerns, Nurses reveal a disconcerting reality – they perceive that young adults grappling with mental health issues often experience a lapse in the provision of adequate care. Furthermore, nurses lament the inadequacy of resources and knowledge within primary care settings, asserting that this deficit impedes the establishment of a trustworthy therapeutic relationship with young adults affected by mental illness (Figure 1) [18].
Figure 1.
The therapeutic relationship illustrated by Aline Grindatto.
The experience of nurses engaging with young adults with mental illness is characterized by a recognition of the considerable time investment required for these young adults. Furthermore, there is a discernible upward trend in the number of young adults presenting with mental illness in primary care [18]. These young adults encounter difficulties in accepting assistance, contend with relational barriers, grapple with structural and organizational impediments, and express satisfaction with mental health interventions [4]. This encounter is described as emotionally challenging by nurses, who convey a sense of frustration and helplessness in their work with mental illness [18].
The confluence of numerous demands and societal pressures exerted on young adults, emanating primarily from educational institutions and broader societal expectations, has the potential to evoke a sense of frustration among nurses. This frustration, in turn, contributes to an increased complexity in managing their interactions. The nurses articulate that the escalating demands and pressures on young adults serve as significant contributing factors to the onset of mental illness, with contemporary society being identified as a source of heightened stress.
The strategies of “Listen, confirm, and dare to ask” have demonstrated significance in comprehending the experiences of young adults when they seek assistance at health centers. The study established that young adults are frequently perceived as delicate, underscoring the importance of active listening and trust-building as pivotal tools in facilitating effective communication. The exploration of family dynamics and social networks emerges as an integral component of these conversations [18].
4. Theories in nursing for recovery
4.1 The tidal model
The Tidal model is considered a person-centered and holistic theory. The theory was created in the late 1990s. The model is based on a philosophical approach to recovery and to the identification of mental illness. The focus is on a person’s stories, the person, and their experiences. The theory states that healthcare professionals need to learn about these stories and experiences to provide the right support and help young adults living with mental illness. One part of the model is described as the commitment of the healthcare professionals. The commitment determines whether a genuine relationship with the person can be created or not. With a genuine relationship, life problems can be identified. The commitment strengthens the relationship, which contributes to the development and recovery of the young adult. Through guidance to the right choice in life, the young adult is guided through difficulties in life. The greatest need for young adults with mental illness is support, and they need someone who can meet their needs without being drawn into the process themselves. The experiences need to be shared with someone. As nurses become involved in young adult’s problems, they get to share stories, and they need to show that they are not afraid to meet the person where they are with their life problems. The theory points out that nurses should not be emotionally or spiritually affected in the process. The nurse is seen as a help to the young adult to regain control over life, the life conditions, the experiences, and continue the life journey. Autonomy and empowerment are at the center [19].
The theory was first created for acute psychiatric care but is seen to be relevant in other care units such as primary care and community contexts. The study of nursing theories, Phil Barker’s model, brings contributions to the theoretical framework of nursing when thinking of concepts that make up the metaparadigm of science nursing, contributing to care science. Contributions to nursing practice, enabling person-centered care and experiences of the young adults, giving voice to subjects and reorienting the mental health care paradigm. The theory emphasizes a paradigm for mental health nursing, with a view to interdisciplinary work and the empowerment of nurses and subjects in mental illness [19].
Numerous studies in mental health nursing care draw upon the Tidal model. This model remains in a continuous state of development, enjoys international utilization and manifests in diverse life cycles within various services pertaining to mental and psychiatric health nursing practices. It is advisable to conduct research that delves deeper into the theoretical concepts, refining the model and tailoring it to the varied contexts within mental health [19].
4.2 Mental health continuum: flourishing
As a persistent and substantial deviation from normal functioning, mental illness impairs the execution of social roles, and it is associated with emotional suffering. The mental health continuum applies an operationalization of mental health as a syndrome of symptoms of positive feelings and positive functioning in life. It summarizes the scales and dimensions of subjective well-being, which are symptoms of mental health. The presence of mental health is described as flourishing; the absence of mental health is characterized as languishing in life. Positive functioning consists of six dimensions of psychological well-being: self-acceptance, positive relations with others, personal growth, purpose in life, environmental mastery, and autonomy. However, there is more to functioning well in life than psychological well-being. Positive functioning includes social challenges and tasks and is expressed in five dimensions of social well-being. Psychological well-being represents more private and personal criteria for evaluation of one’s functioning, and social well-being epitomizes the more public and social criteria whereby people evaluate their functioning in life. These social dimensions consist of
4.3 The self-determination theory
The self-determination theory (SDT) is a well-researched theoretical framework that can be applied to gain a better understanding of recovery [21]. A motivational theory that posits three fundamental human needs (autonomy, competence, and relatedness to others), the self-determination theory shows striking similarity to basic ideas on recovery [22]. Social environments that contribute to the development of these three basic needs are autonomy-supportive, well-structured, warm, and responsive. Autonomy-supportive environments foster the growth of young adults’ intrinsic motivation by cultivating their inner resources. Internal motivation refers to “the inherent tendency to seek out novelty and challenges, to extend and exercise one’s capacities, to explore, and to learn.” Such motivation reflects our human capacities, the need to explore, show curiosity, express interest, and seek mastery. The achievement of internal motivation likely occurs as young adults progress to more advanced stages of recovery. An assumption in SDT is that motivation exists on a continuum ranging from amotivation (lack of motivation to engage) to extrinsic motivation or intrinsic motivation, with intrinsic motivation being the most effective in well-being and ongoing behavior. Communication within autonomy-supportive environments relies on informal and noncontrolling language, emphasizing collaboration and understanding [21].
5. Application of theories and opportunities of nursing to promote health for young adults in communities and primary care
The young adult’s story represents the start and endpoint of the helping encounter. It embraces not only an account of the young adult’s distress but also the young adult’s hope for its resolution. The Tidal model seeks to help young adults express their experiences in a version of “their story.” The nurse needs to demonstrate a capacity to listen actively to the young adults’ story and help to record their story in their own words at every stage of the caring relationship. By valuing – and using – the young adult’s own language, the nurse shows the simplest, yet most powerful, respect for the young adult. The nurse helps the young adult express their understanding of personal anecdotes, similes, or metaphors [19]. The Tidal model features commitments described in fundamental values that represent the essence of the therapeutic process. Specific competencies that nurses should have and which facilitate the use of the model in primary care and community context [23, 24].
The SDT approach helps young adults grasp the purpose behind it, reinforcing their sense of autonomy and engagement in the recovery process. Moreover, autonomy-supportive environments promote respect for diverse perspectives, fostering an atmosphere of mutual understanding and open communication. By valuing and acknowledging different perspectives, these environments contribute to a more inclusive and enriching recovery experience. The SDT can also be used to examine work motivation and implementation strategies within primary care and community organizations [21]. The flouring perspective is important according to the positive functioning with dimensions of psychological well-being with self-acceptance, positive relations with others, personal growth, purpose in life, environmental mastery, and autonomy. Positive functioning also includes social challenges and represents private areas of functioning. The social dimensions are also an important aspect of the flourishing perspective [20].
5.1 Reawakening of hope
The reawakening of hope, reclaiming a positive self and meaning through personal growth. Antecedents include the disruption of illness, stigmatization, internal inventory, and contemplative recovery. Identified consequences include the return to normality, reconstruction of self, and active social connection. The conceptual definition is the reawakening of hope and rediscovery of a positive sense of self through finding meaning and purpose within personal growth and connection using creative self-care coping strategies. Hope is essential in the Tidal model [19, 24]. The implication for nursing is the congruence of recovery-orientated practice with the process of recovery experienced by young adults [25].
5.2 Support from others
Young adults with mental illness need support from others. Someone who believes in their ability to regain well-being and helps them start believing in themselves. Conversation plays a significant role in recovery, giving these young adults the opportunity to open. The courage to do so exists in a non-judgmental approach where trust can be built. A changed thought pattern, where acceptance is the key factor, provides strength to young adults. To manage thoughts and emotions, to shift the focus away from distress [19].
Generating knowledge about recovery factors can equip nurses to support young adults with mental illness, ultimately promoting better mental health among young adults. The support to believe in oneself facilitated the recovery and brought them to where they are today. The significance of the social context is emphasized, as it contributes to recovery, increased quality of life, and functionality [26]. For many, the social context is their workplace, where friends and tasks can distract from issues or symptoms in young adults with mental illness. Work also provides a source of income, boosts self-esteem, and empowers. Some may view work as their contribution to society through tax payments. The society affects our health and our socioeconomic status [13, 27]. Positive relations with others and personal growth are important factors [19, 20, 24].
5.3 The importance of time
The perception of time can be deceptive or not entirely consistent with its objective nature, but it is so valuable. The core concern lies in how we opt to utilize the time at our disposal. In the end, our most essential contribution is our time. It is imperative to allocate this time generously and judiciously. The nurse plays a crucial role in making the individual cognizant that focused time is being devoted to addressing challenges in life. The nurse must express an understanding of the significance of the time the young adult is investing in the process [19, 24].
5.4 To promote nature experiences
The allocation of time in natural settings can yield health benefits by facilitating contact with natural elements, engaging in physical activity, promoting the restoration of mental and emotional well-being, and providing opportunities for social interactions. These advantages may manifest immediately, as evidenced by reductions in blood pressure and stress levels, enhanced immune system functioning, and restored attention. Alternatively, some benefits may accrue gradually over time, including weight loss, decreased symptoms of depression, and an overarching improvement in overall wellness [28]. The investment in and active interaction with nature during early life emerges as a predictive factor for later-life involvement in nature-based activities. Moreover, it is indicative of subsequent pro-environmental attitudes, with a probable correlation to pro-environmental behaviors. Consequently, fostering a connection with nature in the next generation should be regarded as a pivotal and collaborative priority in the integration of health and sustainability agendas [29]. A study reveals a significant correlation between connectedness to nature and mental well-being among psychosomatic patients, with both aspects demonstrating noteworthy improvement over time. The young adults’ perspectives are reported in the study and highlight positive outcomes in terms of effectiveness, satisfaction, mood and soul-level enhancements, overall well-being, interpersonal connections, and coping mechanisms for addressing problems [30]. Consensus statements provide guidance for healthcare professionals on best-practice approaches to using physical activity to maximize benefits for mental health and well-being. Recommendations are made regarding the type, delivery, social and physical environments, and domain of physical activity to optimize mental health outcomes [31].
The nurses role is to promote health and prevent mental illness; nature experiences and outdoor life can be used as a gateway to a healthier lifestyle. By encouraging young adult to be outside more, and change negative lifestyle, the nurse can encourage young adults to have healthier lifestyle in primary care and community context. Nature can be seen as a stress-relieving factor, both to promote mental health and to treat anxiety and depression. Nature experiences not only have positive effects directly but also cause young adults with depressive symptoms to develop hope for the future and security. For young adults with mental illness, nature can be a refuge that is accessible to all without rules, requirements, and special approaches to consider. There, in the freedom and lack of negative thoughts, you do not put effort into fitting in. Instead, the focus can be on taking in nature’s healing properties and not having to worry about being judged by others. Shared moments with others provided them with the opportunity to process their own challenges, but it also afforded them the chance to listen and understand the problems of others [32].
5.5 To develop awareness and motivation
Nurses need to express genuine interest in the young adult’s story to create a better understanding. Genuine curiosity reflects an interest in the young adult and the young adult’s unique experience. Discovering what is unique about this young adult is quite important and must be the nursing focus. Genuine curiosity is the means to realize it. The nurse shows interest in the young adult’s story by asking for clarification and asking for further details. The nurse need to help the young adult to unfold the story at their own pace [19, 24].
The nurse needs to help the young adult to develop awareness of the changes in thoughts, feeling or actions. The nurse helps to develop awareness of how these subtle changes have been influenced by their own actions, the actions of others or by other circumstances. The young adult and the nurse are to become a team. Nurses are in a privileged position and should model confidence by being always transparent; helping the person understand exactly what is being done and why. By using the person’s own language, and by completing all assessments and care plan records with the person, the collaborative nature of the nurse-young adult relationship becomes even more transparent. The nurse also needs to be transparent and make the young adult aware of the purpose of all processes of care. The nurse needs to help the young adults develop awareness of personal assets, strengths, or weaknesses. This helps the young adult to get a sense of autonomy or self-belief, promoting an awareness of their ability to help themselves to sustain the young adult throughout the voyage of recovery [23, 24].
5.6 Health conversations
Discussions about lifestyle habits are a crucial component of the nurse’s work. These conversations are based on the patient’s own perspective on their health and motivation for changing their lifestyle habits. The effects of targeted health discussions have been illuminated in numerous studies [33]. Motivational interviewing is a conversational technique that seeks to elicit the patient’s reasons for change and enhance motivation to implement lifestyle changes. The methodology is evidence-based not only for discussions about lifestyle habits but also for other prevalent behavior changes [34].
6. Conclusion
There is hope for young adults’ mental health if there is support from those around them and a belief in themselves. The conversation is an important part of the recovery and gives the young adult the opportunity to open. The courage to dare to do so is found in a non-judgmental approach where trust can be created. Confirmation from others through care is empowering for young adults. Acceptance is a key factor that gives strength. To be able to manage the thoughts and feelings, something is needed that can shift the focus from the troublesome. To facilitate the recovery of people with mental illness and in preventive work, the nurse has an important role. Collection of anamneses, guidance for further help and changed behavior as well as coordination of services, are parts of the nurse’s work. The recovery perspectives of young adults with SUD illuminate a tapestry of experiences, challenges, and triumphs. Understanding the recovery perspectives of young adults with SUD is crucial for tailoring effective interventions that resonate with their unique challenges. Generating knowledge about factors that favor recovery can lead to the nurses getting tools to support young adults with mental illness. It enables person-centered care and strengthening of empowerment in young adults.
The young adults require support from their surroundings, positive interactions, conversations with others, validation of their feelings, the ability to change their thought patterns, and the discovery of their own methods for managing thoughts and emotions. Everyone needs to find their own motivation. With an understanding of these factors and in line with nursing theories, nurses can promote person-centered care in their interactions in primary care and community context. The responsibilities of nurses encompass the collection of comprehensive anamneses, provision of guidance for further assistance, facilitation of behavioral change, and coordination of services. The accrual of knowledge concerning factors conducive to recovery equips nurses with tools to effectively support young adults grappling with mental illness. This knowledge serves as the foundation for the implementation of person-centered care strategies, thereby fostering empowerment among young adults. Additionally, insights contribute to a ripple effect, mitigating societal stigma and fostering a more permissive environment for young adults contending with mental health challenges.
Acknowledgments
Acknowledgment is to be extended to the youth grappling with mental illness challenges, as, for the primary care nurse, it is important to implement preventive measures and promote health among young adults to establish a foundation for a sustainable society.
Conflict of interest
The author declares that there is no conflict of interest to disclose.
Acronyms and abbreviations
autism spectrum disorder | |
attention deficit hyperactivity disorder | |
primary care nurse | |
self-determination theory | |
substance use disorder |
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