The aim of this 3-year project is to test the efficacy of a nursing role supplementation program, a longitudinal intervention consisting of prescriptive nursing practices with first-time adolescent mothers between the ages of 14 and 18 years of age who deliver healthy infants. The intervention group (n=70) will receive the nursing role supplementation intervention provided by a primary nurse in well child settings and the home over the first two years of the infant's life. Interventions are timed to coincide with well child visits for health monitoring. A control group (n=80) will receive their usual well child care. Nursing protocols focus on parenting and health decisions making. The theoretical framework for the study integrates theories of stress and adaptation, social support, cognitive development, decision-making, and role function. Nursing role supplementation, the independent variable, attempts to ameliorate role insufficiency and promote positive adaptive outcomes, specifically, roletaking/role making by providing role modeling, role rehearsal, information-sharing, and support by a primary nurse. Social support and maturity of adolescent decision-making are viewed as interaction variables that potentially buffer the effects of stress experienced relative to role insufficiency. Maturity of adolescent decision-making is measured by an investigator modified interview instrument, the Adolescent Decision-making inventory. Social support is measured by the Norbeck Social Support Questionnaire. Dependent variables are indices of parent-child interaction (Nursing Child Assessment Teaching Scale), parent stress (Parent Stress Index), parental developmental expectations (Developmental Expectations I, II, III, and IV), environment (Home Observation for Measurement of the Environment), and adolescent and infant health outcomes and accomplishment of developmental tasks (Health Outcome Index). Dependent and mediating variables will be measured at 7, 13, and 24 months. Comparison of data between control and intervention groups will be analyzed using multivariate analysis of variance.
