What is my role in this situation?

[DorkyStudentNurse]

Hi everyone :) I'm in my second year of a four year BN program. I'm doing a rotation in the community at the moment, doing home visits (mostly respite care) to a family with a chronically ill child. I spend at least 6 hours a week for 5 weeks at their home. The child is 10 yrs old and has autism. He also has an older sibling. My instructor was specific in stating that we should maintain a nursing role and NOT a babysitting role. We have not learned about autism yet and I have little to no experience with it. The parents are the experts in this situation.

All of the other students that I've spoken to who are doing this program right now are caring for children with total care needs (enteral feedings, hygiene care, etc) and have an easy time maintaining a nursing role. The child that I am caring for is independent in basically every area. Eats independently, toilets himself, and does everything a child of his age would typically do (he just has a bit of a communication gap). I'm just required to keep an eye on him (as you would with any other child). I've made two short visits so far and I just feel really awkward. I find myself slipping more into a casual "babysitter" role because I just can't figure out how to be a "nurse" in this situation where it seems like a nurse really isn't needed very much. It just feels like babysitting in a home where the parents are still there (which makes it awkward because it feels like I spend a lot of time just sitting around). Maybe it's just because I'm new at this (I've never done any home visiting) and I'm probably looking at it in entirely the wrong way. I'm going to be making another visit tonight and my instructor is going to come see how I interact with the family and the child (she's doing this for every student). I'm sort of worried about this because of the reasons above.

So to those experienced in home visiting and respite care, how can I assume a more nursing-oriented role in a home like this? Sorry if this seems like an obvious question but it's really been bothering me.

[Daytonite, BSN, RN]

i would be looking up everything i could find on the treatment of autism. i would also keep the steps of the nursing process in mind. since you are to be providing some respite for the family, what are some of the things that the parents do with this child that you are giving them respite from? getting down and doing activities with a child, while it may look like you are babysitting, is actually part of your assessment and treatment. many therapists who work with children do just that. it doesn't necessarily mean they are babysitting them. they have a much more cognitive purpose going on. using our brains to treat is just as much a skill as doing hands on procedures.

here are some websites where you can look for information about autism. i have to go offline shortly and don't have the time to do a more extensive search for you. at medline plus, i would look, in particular, for any national organizations (they will be u.s. ones) specifically centered on autism. those organizations will usually have tons of information for consumers (and nurses!)

medline plus http://www.medlineplus.gov/

family practice notebook http://www.fpnotebook.com/index.htm

cleveland clinic disease management project http://www.clevelandclinicmeded.com/diseasemanagement/medicineindex.htm

http://www.emedicine.com/specialties.htm - listing of specialties