Leadership in Nursing Skills

Leadership in Nursing Skills Leadership is process of persuading others to work toward achieving the common desired outcomes (Whitehead, Weiss and Tappen, 2007). In healthcare settings, leadership and quality of care are interlinked. Nursing leadership plays vital role in organisational success as it is client oriented. It facilitates and ensures the delivery of best possible care to the clients (Zori Morrison, 2009) There are certain leadership characteristics that determine the effectiveness of a nurse leader. This essay critically discusses these attributes and also discusses the significance of these characteristics in context of nursing leadership. Furthermore, it briefly explains the effect of change and use of power in nursing to accommodate the change. A leader is anyone who influences his followers to do what he want them to do for attaining the organisational goals (Sullivan Decker, 2009). Leaders possess many leadership traits that make them different from their followers and enable them to lead the group effectively (Marquis and Huston, 2009). Key personal qualities of an effective nurse leader are self awareness, integrity, courage and perseverance. Development of an ability to think critically, to share common vision, to manage conflict, delegation and communicating skilfully are essential leadership behaviours that make a nurse leader effective (Whitehead, Weiss and Tappen, 2007). Identifying the one` leadership skills is very crucial as it enables the person to achieve the organisational goals. The leaders must set an example to influence their followers. They must have high emotional intelligence to understand themselves and others (Linda, 2005). A leader must be self aware. He should know his own strengths and weaknesses. If he recognises his strengths or weaknesses and likes or dislikes, it is much easier for him to identify othersà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢. Then, they can work together neutralising their weaknesses (Whitehead, Weiss and Tappen, 2007). The focus of leadership should not be they, but, it must be the client. They should emphasize on improving the quality of care provided to their clients (Hiscock Shuldham, 2008). Leading an organisation or department is very challenging. The leaders confront many problematic issues everyday, resolving these issues is complex. Successful leaders are critical thinkers too. They must be able to critically analyse the situation using their expertise knowledge and skills. Critical thinking is one of the components of decision making. Using the critical thinking skills, a leader examines the situation, looks for different alternatives and becomes aware of all the risks that may prevent the success of decision being made. Therefore, the leader attempts to avoid such pitfalls and decide the best possible alternative. Critical thinking is not innate, however, it can be learnt during one`s own experiences (Sullivan and Decker, 2009). Ability to share a common vision should be part of an effective leader`s behaviour. Nursing leaders think à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"outside the boxà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ã‚ . They are capable to think about better future when the things are currently getting harder to deal with. They are open minded, ready to think laterally and search for different ways to tackle the problems (Morgan, 2010). They should be able to influence others to develop this vision and become involved in different strategies to initiate change (Grossman Valiga, 2009). Delegation is also a key attribute of nursing leadership which is learnt with practice. Delegation is reassigning the task to another person which you are supposed to do. Even though, you have delegated the task to anyone else, you are accountable for the task accomplishment. In healthcare settings, the nurse leader uses her professional judgement while delegating the nursing care to nurses depending upon their abilities and supervises their work too. By doing this, the nurses can gain more confidence and competence in their own performance. As the main focus of leadership is providing quality care to the client, supervision of work by leader nurse ensures that the patient receives standardised care. Hence, it brings them together as a team leading towards attaining the goal of providing safe and quality care to their clients (Whitehead, Weiss and Tappen, 2007). Communication plays a vital role in successful leadership. To be successful, leaders must develop excellent communication skills. Nurse leaders promote two-way communication. Effective leaders can successfully convey their messages to their followers by verbal and non-verbal communication and they are good listeners also. They encourage valuable suggestions from staff members that can help leaders for bringing about effective changes in organisation. Effective communication facilitates the constructive relationship between them (Marquis and Huston, 2009). Nowadays, nursing leadership is considered as very crucial factor in promoting health and catering for the unique health needs of the people by providing safe and quality care. It is very important for nurses to develop these leadership characteristics if they want to become a nurse leader (Davison, 2010). It focuses on evidence based practice. Being nurses, they are committed to provide best quality care to the clients. Nurses should believe and understand that their role impacts the clients and the outcomes. Therefore, they should make best use of their leadership skills to bring improvement in the client care (Hiscock and Shuldham, 2008). Nurse leaders model high emotional intelligence. It is very useful as it enables them to understand their own and clients` behaviour. Better understanding of client will assist them to recognise and fulfil unique health needs of client and achieve organisational goals. Nurse leaders use critical thinking skills everyday because they engage in making complex decisions related to client care. Critical thinking enables nurses to scrutinize particular situation and choose appropriate action using their sound professional knowledge. This can bring changes and achieve positive health outcomes (Hood, 2010). The nurse leaders have ability to see a changed reality. They also inspire others to see the change and persuade them to contribute towards achievement of the outcome. They must value the contributions of followers (Grossman Valiga, 2009). Nurse leaders should exhibit excellent communication skills. As they work as health team member, they need to communicate with all other members of health organisation with a common aim of achieving positive patient outcomes. They share their views and convey the messages clearly to the clients and subordinates. Besides this, nurse leaders are active listeners. They encourage active participation of clients in their own care. Nurse leaders maintain written records, which serves as evidence of care being given. These records can be used to track the delivery of health care. On the other hand, if nurses are unable to communicate effectively, it may lead to chaos as the clients will not receive appropriate care (Grossman Valiga, 2009). Delegation is an essential leadership trait. Nurse leaders delegate their work to their subordinates; however, they are accountable for their task. It acts as a tool as it facilitates development of skills of others. It also enables leader to carry out m ore tasks at the same time. Apart from these, it also develops teamwork (Sullivan Decker, 2009). Power can be defined as an ability to influence others to get work done. In healthcare organisations, the power is essential for the organisational effectiveness and workers` satisfaction. Nurses use power to influence clients and other health professionals. To use power effectively, nurses must be knowledgeable about different sources and types of power. All nurses exercise power in one or other way (Whitehead, Weiss Tappen, 2007). The nurses can use power to improve practice and achieve the goals of an organisation. When there is a change occurring, it is not taken as granted. The people may resist the change. In such situation, nurses can make effective use of their power to influence others and initiate change. Nurses aim to reduce the resistance by sharing the information, disconfirming currently held beliefs, providing psychological safety and dictating change (Whitehead, Weiss and Tappen, 2007). For instance, nurses can use informational power by sharing the information about the proposed change. They can influence clients by providing knowledge and sharing their vision about improvement of delivery of care (Huntington Gilmour, 2010). By using expert power, the nurse leaders can explain the reasons why the change is being brought in? They will ensure others that this change will improve their performance. They will appreciate suggestions from them and their concerns about it. Once, the nurse leaders successfully influenced others, they can implement change. There are many examples of use o f power by nurse leaders that brought changes in nursing practice. For instance, in Australia and New Zealand nurses used their power in form of legislative procedure and it enabled nurse practitioners to prescribe medicine (Huntington Gilmour, 2010). Nurses are obliged to protect the clients. When the clients need assistance to speak for them, the nurses act as their advocates. Using their power, nurses can present their views and suggestions and can demand for improving the quality of care being delivered to the clients. Nurse leaders should have understanding of clientsà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ rights, ethical issues to protect clients from any harm. For example, when working in Intensive Care Unit, if a nurse recognizes that one of other staff member does not practice good hand hygiene practice as per the norms of the hospital despite of previous warnings given. At first glance, nurse might find it challenging to report this issue to their superiors. However, keeping the client care as focus she will address this problem. This is an effective use of her legitimate power. When the client is not receiving appropriate care and there is need to change the situation, nurses act as protectors. Nurses preserve the rights of clients, protect the clients and monitor the quality of client care (Hood, 2010). Nurse leaders can use their power effectively by empowering others. They should work together as a team rather than competing with their co-workers. It prevents conflicts and promotes harmony in the healthcare setting. The clients may feel powerlessness due to their diseased conditions. Nurses can empower clients by actively engaging them in their care i.e. by giving them informed choices about their treatment, seeking suggestions to promote their health. This will strengthen their relationship by building trust between nurse and client and will enable patients to become an active partner rather than a passive recipient (Hood, 2010). In conclusion, effective leadership is a key element in organisational success. Effective leaders along with their team members, work together in order to achieve organisational goals. Leaders develop certain leadership attributes that enable leaders to influence others to follow them. Nursing leadership is an indispensable part of health care system. It plays a vital role in promoting health and delivery of quality client care. Nursing leadership is client oriented as it works for the best interests of their clients. Nurse leaders exercise power to influence clients, their families and other healthcare professionals in order to achieve positive health outcomes. Change is inevitable in health care. New changes can be introduced successfully with the effective use of power. The focus of care remains clients. The nurse leaders should communicate the change with their colleagues and clients and persuade them to allow this change. The nurses are obliged to protect the rights of clients a nd ensure optimal delivery of health care services. The changes are made to improve the quality of care and client safety.

Counseling in the Church

Abstract Select (highlight) this text and then begin typing your abstract, which should be limited to one paragraph of not more than 120 words Introduction Christian counseling has been conducted since the origin of Christianity. Even in biblical times counseling was a part of the churches spiritual life and development. In the Pauline epistles it is clear that God ordained and approved church based counseling.Paul states in Romans 1 5:14: â€Å"l myself am convinced; my brothers that you yourselves are full of goodness, complete in knowledge and competent to instruct (counsel) one another†. Like the pagan nations of the time, Christianity also addressed grief and sin. (Deadlocked-Haynes, 2010) There is a need for Christian counseling in today's church. The need stems for a larger social, cultural, and professional dynamic. In Christ centered soul care, the church is the primary place where healing, growth and healthy relationships take place. Christ centered soul care views h urt as a soul wound.It meaner making connections instead of Just skilled talking. The impact of care and maturity of the counselor outweighs the techniques used. Soul care incorporates the belief that God is the ultimate healer. Soul care goes beyond psychotherapy into spiritual transformation and discipleship. Psychotherapy has its place but should be done in adjudication to the work of the church. (Clinton ; Leaseholder, 2002) Major Themes Pastoral Counseling The term pastoral comes from the Bible; it is the human effort of man responding to Gods call to care. Bock, 2007) It is God ordained for â€Å"some to be pastors and teachers for the equipping of the saints for the work of ministry, for the edifying of the body of Christ, to which all come to the unity of the faith and of the knowledge of he son of God to a perfect man, to the measure of statue of the fullness of Christ† ( Ephesians 4:11-13) Pastors are essential to the success of today's church. The preaching and tea ching, as well as pastoral counseling transforms lives. Pastoral counseling is not separate but is an extension of preaching. Clinton & Leaseholder, 2002) People who are in the church hurting need a pastor whose shepherding is in line of that of the Good Shepherd. In the Bible Paul appointed loving shepherds everywhere he planted a church. Specific duties for them were outlined. As pastors counsel their flock, there approach should be Christ centered ND have a strong theological structure based in love. (Chosen & Diabolism, 2007) Lay Counselors There is an ever increasing role of paraprofessional counselor. The increases have been seen both nationally and internationally.There is a significant need limitations of mental health benefits, has raised the need for paraprofessional services. Paraprofessional counselors are those counselors, who have not been formally trained in or credentialed in mental health, yet facilitate mental health care to those who are hurting. Paraprofessional counselors also known as lay counselors operate in such setting as hotness, peer counseling, client's homes, and within church-based ministries (Garà §on ; Tillie, 2009). It is increasingly difficult in today's church for a pastor to facilitate all counseling within the church.There is a pressing need today for paraprofessional counselors in the church. Within the church paraprofessional counselors are commonly referred to as lay counselors. All Christians are given the biblical mandate to care for one another. Galatians 6:2 challenges Christians to carry each other's burdens, and in doing so the law of Christ will be fulfilled. For those who have been given the spiritual gift of exhortation the call is even louder. Scripture illuminates the priesthood in all believers (2 Peter 2:5). Believers are to minister one to another.Lay counseling is a key ministry within the church. The use of lay counselors has scriptural basis, and proven effective through research. (Dry. Tan, 2013) Ther e are three models commonly used by lay counselors. The informal, spontaneous model supports in naturally occurring settings through informal relationships such as friendships. This type of lay counselor may or may not have training. The second model, the informal organized model, lay professionals help in natural settings, but they have training and are supervised. The third model is the formal organized model.With the formal organized model counseling is conducted in an official setting, the counselor is supervised, and the counselor has received training. There are hybrid models that incorporate the informal organized and formal organized models (Garà §on ; Tillie, 2009). Incorporating A Counseling Ministry Within the Church Dry. Slang-Yang Tan the editor of the Journal for Psychology and Christianity suggest our steps to follow to incorporate counseling ministries within a church. 1. Decide the appropriate model for counseling. To incorporate lay counseling as a ministry the ch oice is between informal, organized and formal, organized models.In larger churches, both models are incorporated at times. Having the ability to incorporate both models gives, different levels of care, appealing to different clients. Some cultures have a stigma against formalized counseling. Within a church where this stigma may be present the informal organized model may be deemed more appropriate. 2. Obtain support from both the pastoral staff and churches board. To be sure that the foundations for counseling are laid securely; full support from the pastoral staff and church board is a must.Counseling ministries should be viewed as an extension of pastoral care, and vital to the health and development of the church. 3. Selection and screening of persons who are gifted and qualified from the congregation. Person can be recruited openly or privately. Open recruitment involves an announcement to the congregation, and taking applicants. Closed recruitment involves the church leadersh ip nominating candidates. No matter the selection process candidates should be interviewed and trained. Selection should be done after interviewing and training is complete. 4.Establish an effective training program normally incorporate basic listening and helping skills. It is also recommended that the training program includes, Bible knowledge as it relates to people helping, counseling skills, common problems like depression and spiritual dryness. An effective training program also incorporates ethics, and addressing ethical dilemmas. Lay counselors should be given instructions on how to obtain informed consent with linens. 5. Establish ministries for using lay counselors. The specific ministries established for care using lay counselors will depend on the models chosen by the church.There should be continuous training and supervision for lay counselors. If the church has the resources the training should be conducted by licensed mental health professionals or at a minimum by an experienced pastor or church leader who has such knowledge. Some state laws may not allow the use of the term lay counselor due to licensing laws for paraprofessional counselors. In this instance other terms ay be used for example lay helpers or lay caregivers (Dry. Tan, 2013). Individual Counseling Within the church setting one on one counseling is often conducted.Using one framework, the counselor helps the client connect with God who ultimately changes the client. In this framework God is invited in and God is the one primarily changing the client. Through God the client moves closer to their goals, and deepens their relationship with God. The dynamics of individual counseling are similar when the counselor is a clinician, a pastor, or a lay counselor. (Clinton ; Leaseholder, 2002) Premarital Counseling Religious policymaking has increased opportunities for development of marriage counseling. 0% of couples that receive marriage counseling use clergy. 75 to 80% of first weddings o ccur with in a church, or other religious structure. This gives clergy access to couples, as well as the power to set minimum marriage requirements within religious institutions. Clergy having the power to set permissions to marry, have a captive audience. Couples will submit to counseling as a meaner to get married. There are few couples who voluntarily seek pre-marital counseling. (Wilhelm, 2006) Clergy have less influence over couples once they are married.About half of married couples would consider relationship education such as classes or workshops. The influence of clergy is greater, when he or she is deemed morally sound. Clergy have an unparalleled opportunity to facilitate premarital counseling. The number of organizations that actually provide premarital counseling is lacking. Less than half of the religious organizations provide premarital counseling services. (Wilhelm, 2006) The most helpful topics in premarital counseling are family of origin, finances, communication a nd conflict resolution, and sex roles and sexuality.All couples must solve or develop the skills to resolve issues relating to the aforementioned. Premarital counseling should not consist primarily of lectures. An effective program begins 6 to 12 months prior to the wedding. There should also be follow-up counseling after the wedding. (Wilhelm, 2006) Group Counseling Four out of every 10 Americans are part of small organized groups that meets it is an enriching experience. Such groups occur in settings such as treatment facilities, churches, counseling centers, schools, and in the business world.Groups are also prevalent in the field of mental health. Wenches groups are constructed there are clear specifications of guidelines, number of sessions, and cost. Churches are primary components of small groups. Churches give small group opportunities, and are meeting needs of people in a variety of ways. These groups can include Bible studies, and support group as well as lay or profession al counseling groups (Clinton ; Leaseholder, 2002). Counseling and psychotherapy groups are two types of groups that meet within churches. Counseling groups focus on interpersonal problem-solving skills.They also incorporate, support methods using a here and now framework. On the other hand psychotherapy groups are established to reduce psychological or emotional dysfunction. These groups explore antecedents to behaviors using both interpersonal and interpersonal assessment, diagnosis, and interpretation. Historical and present material also are connected. Both groups focus primarily on the needs of the individual members. There is a leader in both types of groups who facilitates, teaches or counsels (Clinton ; Leaseholder, 2002).One therapeutic model used for Christian group therapy is The Healing Cycle. This model is used in interpersonal process therapy groups. The core mechanism for change in this model is interpersonal interaction. The healing cycle is compatible with a Christi an worldview, and incorporates Scripture at each step of the process. It also includes theoretical orientation, the most prevalent of which is cognitive behavioral and interpersonal theories. The healing cycle consists of six phases which are grace, safety, vulnerability, truth, ownership, and confession.In the finals phase it further incorporates grace and the cycle continues. (Hook ; Hook, 2010) Ethical Issues The church has been infected by the societal shift to post-modernism, and post- Christianity. In today's church acts of negligence are ever present. Wrong doing is no longer accidental but intentional. Sexual misconduct, abuse of power, and other forms of exploitation are prevalent. The cause of Christ suffers, and Christianity name is slandered, because of these dreadful acts. There needs to be a renewed pursuit to uphold biblical and ethical standards within the church.Congregants still hold fast to the belief that church leadership can be trusted; therefore the standard o f excellence and integrity cannot be compromised (Clinton & Leaseholder, 2002). Ethics is defined as â€Å"the study of standards of conduct and moral Judgment and the system or code of moral conduct of a particular person, religion, group or profession† by Webster New World Dictionary. A code of ethics outlines standards of behavior for particular group. The focal group for the America Association of Christian Counselors (AC) code of ethics is Christian counselors (Clinton & Leaseholder, 2002).Ethical decision making and subsequently ethical codes are based on three views: divine revelation formulating moral absolutes, radical individualism creating oral relativism and social constructs which produces moral conscience (Clinton & Leaseholder, 2002). In the past most ethical systems were biblically based. This view undeniably viewed Gods Word as truth, therefore His statues were power to submit to this law could be obtain through a relationship with Jesus Christ (Clinton & Lea seholder, 2002). The view of the AC code of ethics is derived from biblical principles.Christian counselors ascribe to Christianity, and thus should have no problem conforming to ethical standards (Clinton & Leaseholder, 2002). Counselor faces ethical dilemmas. When ethical dilemmas arise, a standard ethical decision making process should be employed (American Counseling Association, 2005). It is important to deliberately engage is the decision making process. There is no decision making model that has been proven more effective over another. Counselors need to be familiar with at least one, or a combination of several.Ethical decision making is not always a clear cut process, but emotion effect decisions made as well. One model recommended which incorporates consideration of cultural differences, principles of altruism, and caring. 1 . Identify the problem. . Identify issues that are surrounding the problem. 3. Review ethics codes pertaining to the problem. 4. Have a working know o f laws and regulations. 5. Obtain consultation. 6. Outline possible course of action. 7. Weigh the consequence of various decisions. 8. Chose best option (Corey, Corey, & Callahan, 2011) The modern day pastor lives in controversial world.There is a rise of malpractice suits against the clergy. There needs to be clearly defined ethical accountability within the arena of church counseling. Many states do not require clergy to be licensed in the field of unseeing, as long as they are operating within a theological framework, and serve under a legitimate religious organization, body or denomination (Pain, 2010). The Practice of Pastoral Care by Carrie Doddering outlines three major ethics issues faced by clergy. These issues are prevalent within church counseling. 1. Limits of confidentiality.Clergy fall in to the group of mandated reporters. Clergy members who counsel must report sexual abuse or neglect when it involves children or the elderly. Clergy members are also required to prote ct sensitive information about clients (Doddering, 2006). 2. Sexual misconduct. There is a power dynamic within counseling. Because of this power dynamic the client cannot authenticate consent to a sexual relationship with the counselor. Without authentic consent this type of relationship is viewed as coercive in nature. (Doddering,2006) 3. Limits of expertise.Long-term counseling should not be conducted by a pastor unless they have been trained in pastoral counseling. Pastoral caregivers should only practice with in the limit of expertise. (Doddering, 2006) Four other areas of ethical concerns within church counseling are pastoral identity, referral, integrity, and boundary limit. Within all these areas malpractice can occur. In regards to clergy malpractice is negligent counseling within the realm of spiritual counseling practice. Another definition of malpractice is negligence in executing professional duties.In this definition of negligence implies the counselor not fulfilling t heir duty and subsequently harming the client. Ethics goes beyond the minimum requirement set forth by law, ethics acts as a buffer. When ethical standards are View The Bible supports counseling within the church. In Christ centered soul care theology and biblical principles are at the center. Christian counselors should consider theological perspectives while simultaneously engaging in the psychological task of counseling. Biblical understanding is essential to counseling.To be an effective Christian counselor it is important to incorporate theology, psychology, and spirituality. Came 5:16 says† confess your trespasses to one another, and pray for one another, that you may be healed. The effective, fervent prayer of a righteous man avails much† within the Bible they are are more than 60 one another Scriptures that given instructions for the care of believers. (Clinton & Leaseholder, 2002) Personal Reflection Philippians Chapter 3:3 Paul admonished believer that we the c ircumcision of God, which worship Him in spirit and have no confidence in the flesh.There are many ideas, concepts, and frameworks, ideologies, and so forth, but without a firm rooted foundation those things may pass away. The only thing that will stand is the Word of God. Through the Word lives are impacted and change can take place. I have seen demonstration of the power of God through my own life. No matter the road God leads me to on my Journey to help others, I will hold fast to the Word of God. I may acclimate care in an arena, where spirituality, and religion cannot be openly discussed.

Explaining the French Expression À tes Souhaits

The French expression À tes souhaits  (pronounced [a  tay  sweh])  is a social nicety and literally  translates to to your wishes. It has an informal  register  and is the equivalent of the English phrase bless you. Explanation  and Example You can and should use the French expression à   tes souhaits any time a friend sneezes (as long as youre not interrupting a speech or something). Unlike its English equivalent bless you, à   tes souhaits has no religious connotation whatsoever, instead offering the sneezer your hopes that his or her wishes will come true. If the person sneezes more than once, theres a more elaborate saying: After the first sneeze: A tes souhaits Second sneeze: à   tes amours Third sneeze: One of the following: avec un grand A et beaucoup de set à   tes enfantset à   ton argentet quelles durent toujoursque les tiennes durent toujoursNote: Elles and tiennes in the last two variations refer to amours. The formal equivalent à   vos souhaits can be addressed to a complete stranger with no risk of offense, but again, consider the context. On the bus: yes. During a business meeting: probably not. Souhaits is the plural of un souhait (wish), from the verb souhaiter (to wish).

Health Issues Essay - 945 Words

Health Issues 1. Physical activity Data regarding physical activity among Puerto Rican individuals are sparse. It is clear that these individuals have relatively high rates of obesity, diabetes and heart disease, all of which are often accompanied by relative physical inactivity. However, this assumption must be regarded as no more than a hypothesis. 2. Overweight and obesity Puerto Rican diet tends to be relatively high in calories, fat, complex carbohydrates, and sodium. It is somewhat deficient in calcium and vegetables. Younger individuals have abandoned the traditional diet for a more Americanized diet that includes a great deal of fast food, pizza, hot dogs, canned spaghetti,†¦show more content†¦Only 5.8% of Hispanic women report smoking during pregnancy; the reported rate among Puerto Rican women during pregnancy is higher. However, smoking among young Hispanic women, including Puerto Rican women, is lower than for White or African-American young women. Among women who smoke, Puerto Ricans were more likely to be heavy smokers than others (48.6% smoked more than 1/2 pack per day). Overall, among Hispanic men, the smoking rate is 26%, as compared with 27% for White men. It is not clear whether the same rates apply for Puerto Rican men. Tobacco use is disproportionately promoted in minority and Hispanic neighborhoods, including Puerto Rican neighborhoods. 4. Substance abuse A 1984 study of adolescent drinking in Puerto Rican communities suggested a lower rate of alcohol use and abuse in this population. However, problem drinking increased when adolescents left home. The same study found that problem drinking was substantial among mothers. 5. Responsible sexual behavior In the continental U.S., Puerto Rican adolescents have a relatively high rate of pregnancy among unmarried mothers, higher than for other Hispanic groups or for white women. These women tended to be poorly educated, and to have limited access to early pre-natal care. 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