How Nurses Can Create An Autism Friendly Emergency Room

With rates increasing of children diagnosed with Autism Spectrum Disorder (ASD), nurses have the duty to increase their awareness and knowledge about ASD. Learn in this article how as an Emergency Room nurse, you are able to make simple changes to the environment, your assessment and interactions with the patients parents, to increase the quality of care you will be able to deliver to this vulnerable population. Specialties Emergency Article

How Nurses Can Create An Autism Friendly Emergency Room

With increased rates of children being diagnosed with Autism Spectrum Disorder (ASD), it is ever so important that nurses are increasing their awareness and education about the disorder.1 According to the Centers for Disease Control, 1 in 68 children are diagnosed with ASD.1 Also, ASD is more prevalent in boys at a rate of 1 in 42, versus girls at a rate of 1 in 189.1 Given these statistics, lets dive into what ASD is defined as.

"Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less."2

What that being said, it is important to recognize that just because your patient has been diagnosed with ASD, it does not mean that every patient will present the same way with the same symptoms associated with ASD. As nurses who work in the Emergency Room, we know how chaotic of an environment it can be. Now, imagine if your patient has ASD and has an increased sensitivity to stimuli. I am sure you can imagine how this environment could be problematic for this patient. To better illustrate this, watch this video below, take note to all of the different stimuli in the home and replace those with stimuli that can be found in the Emergency Room.

Also, follow the link to learn more about all of the details that went into creating this video.

This Chaotic, Hypnotic Autism PSA Is Truly (and Literally) Sensational | Adweek

Moving right? After watching this video, I felt guilt for not knowing or being more aware of this reality. I could only think to myself, I hope that I have not dropped the ball on this if I was caring for a patient that I did not fully understand what they were going through. If I had I only been more aware, I could have been able to do my job better.

In my quest to further increase my knowledge about ASD, I was also able to find techniques to improve my assessment skills and ways to manipulate the environment to be more comfortable for my patients:

Modifications To The Exam Room

  • Use a room if available that has no medical equipment in it.3
  • Place the child in a room with a door to decreased noise from the hallway.3
  • Dim the lights.3
  • Remove all unnecessary equipment from the room.3
  • Turn off all nonessential fixed monitoring equipment in the patients room.3

Questions To Discuss With Parents

  • What is the baseline for their child's psychosocial and cognitive functioning?
  • What works as the best way to communicate with their child?3
  • Have a discussion with the parents about what helps sooth the child.3
  • Ask what has been problematic in past visits to the Emergency Room or doctors office.3

A Tailored Approach To The Physical Assessment

  • First, start your assessment away from the child.4
  • Let the child observe the conversation you are having with the child's parent.4
  • Start your assessment at the hands and feet, then progressively moving centrally.4
  • Use your medical equipment on the parent first before on the child.4
  • Let the child see and touch and equipment first before you use it.4
  • Lower yourself to the child's level so you are not towering over them.4

Moving forward, recognizing my weakness and increasing my awareness and education, it is now time to implement change. I will be doing my best to implement these changes to my practice and I hope you will as well. It is my hopes that it will get your mind churning with even more ideas that you can take to the bedside. Also, you will help with the educational process of sharing this knowledge with your fellow nurses and healthcare providers.

Also, keep in mind that when you are working with pediatric patients, we are not only caring for the child but the parents as well. All of these interventions will not only help the child but, you will be gaining trust with the parents about your ability to help their child and through this difficult time. I can only imagine the stress and anxiety parents must have about having to bring their child to the Emergency Room. This is their child, their loved one, their son or daughter, their flesh and blood. The last thing that any parent wants to see is their child struggle or in pain.

Anyone who is reading this article and is getting all fired up with excitement and motivation to get out there and make a change, run with it! Take that passion and use to it make a difference. I encourage you to make a positive change in your department that will increase the quality of care as healthcare professionals we are able to provide to the patients we serve.

Michael M. Heuninckx RN-BSN

References

  1. What Is Autism? | | Autism Speaks
  2. CDC | Facts | Autism Spectrum Disorder (ASD) | NCBDDD
  3. Caring for autistic children in emergencies | Contemporary Pediatrics
  4. Caring for autistic children in emergencies | Contemporary Pediatrics
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Michael M. Heuninckx

About Michael M. Heuninckx

Nurse Practitioner / Author
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As big sister to two men on spectrum, let me just say thank you. It's only recently been recognized what families have been saying for years, that our relatives are not disconnected, they're over stimulated. A lot of your advice is also great for children with ADD as well for simular reasons.

I'm not a nurse, at least not yet, but I do work as a caregiver in supporting adults with disabilities including ASD. The clients who are verbal will let you know that things like the TV being on can disrupt them to the point of distraction. The ones who are not, we'll you'll still see it.

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Specializes in Emergency Department.

Hello jaycam,

It is difficult for me to put in writing how appreciative that I am for your kind words. You are more than welcome, I am glad that you see the value in the article, having lived this both as a healthcare provider and sister. Keep up your hard work to get through nursing school, I have no doubt that you will be a phenomenal nurse!!!!

Michael M. Heuninckx RN-BSN

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LOVED this! I currently work as a medical scribe in a Children's Specialized Hospital and shared this with the physician I work with every day, as well as my fellow scribes. I know plenty of peers who will benefit from reading this.

Thank you, as I will definitely remember this when I eventually become a nurse!

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Specializes in Emergency Department.

Good Afternoon Tinemarie,

I am glad that you loved the article and thank you for helping get the message out there by sharing this article with your colleagues. Also keep up the strong work and keep chipping away at that nursing degree.

Michael M. Heuninckx RN-BSN

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As a former teacher, people "on the spectrum" were some of my favorite students. A common dislike of fire drills, pep rallies and school vacation may have been at the root of this affinity.

I was reading up on migraines about fMRI studies that demonstrated the brains of people who have autism (as well as migraine sufferers- my reason to dislike firedrills) are excited by patterns and thrown off by odd stuff that comes out of left field. So yes, any hospital stay or trip to the ER will be filled with random stuff and people benefit from having things predicted to them, to the greatest extent you can.

Your article does a great job of helping to illuminate the internal experience of people who may or may not have the verbal ability to let you know what is bothering them. Sensory issues can be the barrier to receiving appropriate healthcare and the nurse as an advocate has the chance to make the difference.

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Don't forget that these children with ASD grow up to be adults with ASD who may present to your office, ER, or clinic! As the mother of a young adult with ASD and a nurse who works with the ASD population, the unique needs of these individuals does not change.

Many of these "kids" have difficulty expressing their needs or that they are in pain. They can be very literal in their thinking so the language we use needs to be non threatening. We don't "take" someone's blood pressure. Not having a blood pressure can kill you. We give their arm a hug.

Anxiety is common with ASD and can be the trigger for many behaviors including perseveration on specific topics. Find out what interests your patient with ASD and use it to your advantage to build trust.

Thanks OP for starting this topic.

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If properly sterilized, it might be cool to have noise canceling headphones that you could give kids while they are there, like the kind construction workers wear, they aren't expensive, that is if the feeling of the headphones doesn't bother them.

Also, children with autism often like the feeling of pressure, they actually sell weighted blankets similar to X-ray blankets on websites that cater to ASD needs... maybe ask his/her parents if they like the weighted blanket thing and if so, offer to let him/her borrow one of the x-ray blankets if they are available.

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I'll second the weighted blankets. Many of the people I know with sensory disorders find them comforting.

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Maybe disposable ear plugs, if the person isn't bothered by the sensation and if they aren't too young/disabled that the earplugs would be a choking hazard.

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I was reading up on migraines about fMRI studies that demonstrated the brains of people who have autism (as well as migraine sufferers- my reason to dislike firedrills) are excited by patterns and thrown off by odd stuff that comes out of left field. So yes, any hospital stay or trip to the ER will be filled with random stuff and people benefit from having things predicted to them, to the greatest extent you can.

Could you post a link to the article? That sounds really interesting.

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First off, as a parent to two on the spectrum, I would just like to thank Michael for taking the time and effort to research this subject in order to make a difference. It's a long time coming and as autism prevalence continues to increase, our roles as healthcare providers will need to adjust accordingly. So again, thank you.

Michael, you put forth some wonderful approaches that are sure to have a positive effect for any RNs that apply them in dealing with a special-needs patient. As was pointed out, these individuals are rapidly entering adulthood at an alarming rate, and our approaches must be tailored accordingly. Hopefully, within a few years, we will see special-needs nursing become a sub-specialty, something I feel is desperately needed.

I would like to add that oftentimes some ASD individuals may present as non-verbal or low-verbal, which makes focused assessments more difficult and time-consuming. Many will also demonstrate self-injurious behaviors; sometimes they can be in response to external stressors like being in an ED, while other times it may simply be a baseline response to who knows what (not being flippant, our daughter pinches herself, happy or sad, day or night). Another popular complaint among ASD individuals are motility issues. While there is a great deal of conflicting (and controversial) information as to the "why", there are simply too many parents I deal with who report these issues to simply ignore them, so special attention to the GI tract is certainly prudent.

As the saying goes, "if you've met one autistic, you've met one autistic." The ASD population presents in myriad ways, with some core behaviors that are consistent. Understanding that the individualized approach we use for our patients has to be even more finely tuned when dealing with one that has an ASD will make for better patient outcomes.

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