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.
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.
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.
