The Effect of Shelter Residency and Parental Interactions on the Resilience Levels of Adolescents

Sunday, 28 July 2019: 3:10 PM

Karen Dominguez-Cancino, MPH, BSN, RN1
Edith Choque-Medrano, BSN, RN2
Hernan Hugo Matta-Solis, EdD, MD, MSc3
Zarely Glenni-Garay, MSc, BSN, RN2
Patrick A. Palmieri, DHSc, EdS, PGDip(Oxon), MBA, MSN, RN, CPHQ, CPHRM, FACHE, FAAN2
(1)Center for Health Sciences Research, Universidad María Auxiliadora, Lima, Peru
(2)School of Nursing, Universidad Norbert Wiener, Lima, Peru
(3)School of Nursing, Universidad de Ciencias y Humanidades, Lima, Peru

Introduction: The stage of adolescence is a moment in the development of people that involves diverse changes that result in stress (Esquivel et al., 2013). The nurse must able to approach this stage not only from the traditional perspective of risk prevention, but also as a promoter of the positive attitudes that allow for an integral development (Esquivel et al., 2013). From the psychology literature, we have observed a movement from focusing on identifying deficits to one that focuses on supporting the positive abilities and attributes, highlighting the concept of resilience (Rodríguez-Fernández, Ramos-Díaz, Ros, & Fernández-Zabala, 2015). Resilience corresponds to the set of positive qualities that favors adaptation rather than surrendering to challenges (Rodríguez-Fernández et al., 2015). Resilience is influenced by the internal factors of an adolescent, and external factors such as family support (Bustos-Vargas, 2012; Leiva, Pineda, & Encina, 2013).

Purpose: For years, the institutionalization of adolescents due to situations of social vulnerability has been identified as a factor that negatively affects the development of resilience (Bustos-Vargas, 2012). Adolescents who reside in shelters could have been exposed not only to traumatic events which resulted in their institutionalization, but also additional trauma due to the lack of significant persons given the high turnover of personnel in the shelters (Bustos-Vargas, 2012). This study aims to determine the relationship between resilience and adolescent residence, internal or external, in a shelter located in Peru. The adolescents in this study either live in the shelter but visit their families on weekends and holidays (external modality) or completely reside within the shelter without external visits (internal modality).

Methods: This is a cross-sectional correlation study of adolescents residing in a shelter in Perú. A non-probability convenience sample resulted in the participation of 452 adolescents. To measure the variable of interest, a 44-item demographic questionnaire collected the variables such as age, sex, level of education, type of family (nuclear or extended), members of the family (father, mother, grandparent, grandmother, among others) perceived family functionality, if they were with the internal (spend the most of the time in the shelter) or external (visited their family on the weekends) modality and level of resilience. The Connor-Davidson Resilience Scale (CD-RISC), 25-itmes with five dimensions, was used to measure resilience. The five dimensions included: 1) personal competence, high standards and tenacity, 2) to trust in one´s instincts, tolerance of negative affect, and strengthening effects of stress, 3) positive acceptance of change and secure relationships, 4) control, and 5) spiritual influences, with possible responses as "not true at all” (0 points), “rarely true” (1 point), “sometimes true” (2 points), often true ( 3 points) and “true nearly all of the time” (4 points). The score can be between 0 and 100 points, with the higher score reflecting stronger resilience (Connor & Davidson, 2003; Palomar-Lever & Gómez-Valdez, 2010). The instrument face validity was excellent with very good reliability (Cronbach alpha =0.89). The data collection process occurred between March and May of 2017 in the classrooms of the shelter; requiring 45 minutes to complete. This study was approved by the ethics committee of the institutional review board at the participating university. Prior to participation in the study, a parent or legal guardian completed an informed consent and the teenagers were asked to assent. The collected data was organized into an Excel database and analyzed with the statistical package STATA 12.0. Descriptive statistics and analysis of the study variables were performed. In the case of resilience, a graphical analysis and the Shapiro–Wilk test was completed. To establish association between level of resilience and modality residence in the shelter the Mann-Whitney’s test was completed with an α = 0.05.

Results: The study included 452 participants between 11 and 18 years of age (mean=13.7 years, SD=1.7), the majority of the participants were female (51.3%,), high school students (86.3%), residency in Ventanilla (87.8%), with a nuclear family (67.0%), and high levels of family dysfunctional (only 23.0% has a good family function). About 65% of the participants resided completely within the shelter (internal modality), or external to their parents. The overall mean resilience score was 62.1 points (SD=15.9 points), moderate level. For the relationship between resilience and the residence modality, the internal modality participants had the highest scores on the resilience scale (Internal=65.2, SD 16.1; External=60.4, SD 15.3), statistically significant (p=0.00096). Despite the results being adjusted for educational level (age as proxy), the finding remained significant. As such, the stronger resilience level for internal residence modality was not attributable to the age of the participant.

Discussion: Overall, the resilience level in this population was moderate. We found a strong association between resilience and the residence modality that favors the internal modality, or separated from their parents. This finding suggests adolescent internal modality functions as a protective factor for the development of high levels of resilience, contrary to the popular belief reported in the literature about the importance of the parental relationship, even when negative (Bustos-Vargas, 2012). This finding in this population indicates the adolescents successfully established protective relationships within the shelter, with peers and care-givers, that improved self-esteem and self-confidence (Bustos-Vargas, 2012; Leiva et al., 2013; Rodríguez-Fernández et al., 2015; Rodríguez-Fernández et al., 2016). As the adolescents consider their families to be dysfunctional, the external residence modality probably increases their exposure to complex negative situations that are difficult to manage (Bustos-Vargas M, 2012). Additional research is necessary; however, to establish the causal factors for this finding.

Conclusion: The nurse working within the shelter environment has the challenge of developing the protective interventions and positive reinforcement strategies to help the adolescents strengthen their resilience while living external to their family. In addition, the nurse needs to recognize the adolescents visiting families on the weekends and holidays are actually the more vulnerable group requiring tailored interventions to manage the weekend immersions into a dysfunctional family situation. Overall, nurses need to actively work with the adolescents to strengthen their resilience levels as an important psychological protection to constant change and negative events.

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