Hearing Aid Comparisons

Nursing people on the autistic spectrum

Current literature

In examining this issue was a motivator to draw attention to the lack of literature Current. The National Autistic Society (NAS 2008) is an information sheet on this subject, which in turn has a single reference-Kushnir.T Kagan, SW Roberts and OC Snead (2005). This is a study of the use of screening electroencephalograms (EEG) in autistic spectrum disorders and do not treat nursing problems.

Other additional reading suggested by the NAS is Fay (2004) and Shellenbarger (2004) However, these two items are not generic and not specific to the UK.

Fay (2004) is a brochure that describes some good practical advice for health professionals. It covers five key steps when a query of health care is imminent for a person with ASD. Theses are for evaluation, consultation, planning, understand and apply. What was in this leaflet was the sentence

"It essential medical equipment to be creative, keep your sense of humor and whenever possible to prepare in advance. "(Fay 2004)

  Shellenbarger (2004) is a case study that brings some of the issues to life. There are some facts about Asperger's syndrome, some strategies for intervention, dealing with stressors and drug administration.

  The only book that has been discovered by Alison Morton-Cooper (2004) analyzing some of the issues for consideration of appointments for screening and check ups.

Aylott (2001) is an excellent article which is to treat to put in the position of a person with autism. She says,

". The lack of positive awareness of autism has led people with autism oppressed within environments that can cause harm, anxiety and distress "

Jill Aylott clearly understands the world of people on the spectrum and may refer to this quote to health environments such as hospitals, health centers and community services. A table of items to consider for staff working with people with autism of some literature by Peeters (1999). This is generic advice but it applies to nursing staff.

Autism Spectrum Disorders / Conditions

  Autism Spectrum Disorders / Conditions (or known as autism) was described in 1943 by Leo Kanner and Hans Asperger (Asperger syndrome) in 1944.

  "The National Autistic Society estimates a prevalence rate of 91 per 10,000 population for an autistic spectrum condition. With an average list of doctors 2000 people, each family physician is therefore likely to have a maximum of 18 people with autism on their list "

  Society ( 1999 National Autism).

  Autism Spectrum Conditions (ASC), which includes autism, is receiving a profile greater than it has for many years due mainly to the MMR (Measles, Mumps and Rubella) vaccine controversy in the early 2000s. The link of these jabs to the development of ASC has led many parents to investigate what this condition. On the other hand, what are the risks associated with them? To date, ASC claims that MMR causes have not been substantiated, the launching of hits has been poor. So what is this terrible disease and how affects nursing.

Autism Spectrum Disorders / Conditions is a term used to describe a developmental disorder that has a whole range (or spectrum) of features that include autism and Asperger syndrome. (National Autistic Society 2006). All people with ASC and are diagnosed by the experience of three areas main difficulty known as the "triad of impairments' –

Social-interaction (eg, social relationships, indifferent, distant and understand others points of view)

Social-Communication (eg, understanding verbal and nonverbal)

-Social Imagination and flexibility (eg, play, imagination copied rigidity and repetition)

(Ala, 1996, NAS 2008)

Social Interaction

People on the autistic spectrum often presented as self-centered and lacking in empathy. This self-centered and demanding behavior can be problematic.

There is often social isolation among peers, regarded as odd or eccentric may result in the behavior of children in their private sitting on the edge of a group or playground. There is also tension when the social demands are placed on or approaches the person with ASC. Anxiety in social situations, crowds, birthday parties and Christmas is common.

It is not collected on social cues and unwritten guidelines and inappropriate behaviors such as talking, not in context, there are no turns, excessive talking or not talking with the choice to move can happen.

Often there is an improper use of social language in the wrong context or situation inappropriate for example, laughing – One example, as saying "Scoring a goal" means that they are happy.

Social Communication

People on ASD can be 'superficially' perfect spoken language. They may have an understanding of the words instead of their meanings. Rote script and language that is monotonous and repetitive may occur. People can voice expression missing or have particular characteristics as the copy of the terms, videos, commercials that can be talked out of context. There can be a very literal interpretation of the language and jokes with innuendo and the irony is strong with problems. One example is the phrase " curtains "which can be interpreted in two ways.

There are difficulties in understanding and expression of nonverbal communication such as gestures. Sometimes people with ASD may have flat facial expressions or eye glass resulting in a lifeless face.

Social Imagination / Flexibility

People in field of autism spectrum may have unusual absorb all the interest and the use of computers, spinning objects, even order! They may have a strict adherence to routines (In a certain order and time, can not change) and will be inflexible with limited development these.Often play and creative thinking and the difficulty of imagining one and the other thing – to display this.There can cause problems in the generalization of skills that can perform a task in an environment and not in another.

The difficulties sensory

Many people suffer in the spectrum of sensory processing difficulties such as hyper (over) or hypoglycemia (low) sensitivities. The effects of these can be deep and be very distressing for a person with ASC. Some examples are-

Hearing "People who are hypersensitive to different shades of noise," high " pitch for example, pipes, etc whistle or not to be seen almost hypo sensitive.

Odor-People who have an acute reaction to, for example, certain odors or perfumes, having a great sense of smell at all.

Vision – People who have a reaction to certain colors, patterns, lights and increasingly stimulated or disturbed by them.

Touch – People who are sensitive to textures (clothes, surfaces, food) can cause great distress. Touch can be underdeveloped and can not be a high threshold of pain.

The taste, people on the autistic spectrum may be seen as "picky" because they liked intolerable. They may be particular, for textures Colors eating inedible materials or prefer sharp flavors, like spices.

Bogdashina (2003)

stas sensory difficulties are very important when creating an autism friendly environment for any patient needing nursing care.

Persons with an autism spectrum condition may also show a behavior that challenges the service.

Some examples of behavior are -

Operating distance, the problems of transition, destruction

Indiscriminate excitement

Lack of motivation

The aggression, feeding problems,

Sleep problems

Depression,

Rituals / Obsessions

Withdrawal, Self-injury, fear, panic, anxiety and phobias.

To combat these behaviors of a preventive approach is the best and must include an understanding of the sources of behavioral difficulties in the Asc and structuring the environment for prevention. Best practices should include providing an effective means of communication and be clear verbal / written / pictorial rules. Perhaps importantly, an approach should include the creation of positive lives.Some with his people ASC have severe learning difficulties, while others such as those with Asperger syndrome have average intelligence or above average.

Jordan (1999) estimates

  "… Up to 75% of all people with autism may have learning difficulties generally is, with an IQ below 70 "

  It is worth noting that it is very rare for people with ASC to have special skills such as those portrayed in the film "Rain Man." Many people have never been diagnosed as disabled may be something hidden.

The eccentric man often "difficult" strange that it was a nightmare to care because I would love to talk about his interest (or computers or Star Trek their libraries) may in the spectrum.

Some famous people in history have thought that perhaps ASC characteristics as Albert Einstein and Bill Gates (Head of Informatics Microsoft). The condition is predominantly male with a ratio of 4 out of 5. The exact cause is still unknown National Autistic Society (2006) estimated to affect the lives of more than 500,000 families in the UK. With that kind of figure, it is inevitable that most nurses have some contact with a person with a autistic spectrum condition.

The impact of nursing care

The impact of nursing care must be taken into account and how could improve patient care of what we now know about autism spectrum conditions. The challenges and possible solutions as an individual and / or part of a team may include Training, Planning After care / discharge and multi-agency working.

Morton-Cooper (2004) devotes a chapter his book that addresses issues of nursing care. She suggests skill and sensitivity in the observation of the patient is required to see if the person with ASC vulnerabilities lie. She goes on to suggest Roper Logan and Tierney (1996) model of nursing activities of life to support this. The activities are-

• Keep a safe environment
• Communication
• Breathing
• Eating & Drinking
• Elimination
• Personal Care
• The control of body temperature
• Mobility
• Work and play
• Expressing Sexuality
• Sleep
• Dying

"People with autism may have contributed factors that make care decisions more complicated. Sleep disorders and hyperactivity or, conversely, the extreme slowness of movement to the point of catatonia may have implications for the care and treatment of doctors "

  (Morton Cooper, 2004)

Nursing Major issues include the management of health problems personal, personal care, patient safety, nutrition, eating difficulties, wound care, sleep and the night wandering and dying.

Difficulties Personal Hygiene with washing and maintenance of personal hygiene is responsible for qualified nurses to ensure any kind of infection or cross contamination. Some people with ASC can not even recognize different aspects of their bodies. The management of menstruation may need specific attention.

Safety- boundaries must be clear to the person with ASC. This could be the physical parameter of a room rules about what should not.

Nutrition: autism spectrum people may have specific dietary needs and preferences. The textures and colors of food and eating the usual order may limit the diet. Therefore, you can be sure of nutritional deficiencies in patients. Specific recommendations should be sought.

Wound care, if you have the sensitivity Touch priest who can not tolerate and / or scratch wounds.

people expect / Night wanderer, many in the spectrum of problems with sleep. The difficulties may beds include intolerance, sensitivities to sound, not being able to relax and motivation is limited to sleep.

Die-The concept of death can be confusing for many people. The person with ASC can not always respond with a common emotional response and may even seem distant. There is little literature on this topic.

Quality for aftercare and discharge planning must be thorough to avoid readmissions and effective participation of various agencies is essential.

Awareness

There are some pieces of work, the articles are written about ASC and nursing, which is vital for raising awareness of this problem. There are also limited training that nurses received to address disability issues, let alone Autism Spectrum Conditions. Most nurses say none or "not much." Depending on where you trained, how much of the country where you live (eg if there are specialized services provided ASC in your area) or what branch of nursing you are in, the experience will be different. Mental Health and Learning Disability nurses perhaps more aware of the problems ASC and the recognized incidence of people with Asperger syndrome in the prison population forensic / prison nurses are becoming more knowledgeable. Another issue has been the treatment of patients with ASC, as to which service should be accessed. Depending on the confidence of the NHS or area served in May to determine this. This can be mental health, learning difficulties, generic or a combination of these services.

Discussion and implications for practice

For people with a diagnosis of Asperger syndrome that has an intellectual capacity above average or it can be confusing. Some people think it could be like ASC considered a social disability and people on the autistic spectrum should be treated in disability services but many people with Asperger syndrome reflect on this as a difference rather than any shortfall.

Those ASC NHS trusts no clear policy or service that could lead to many nurses receive referral or admission of any person with an autism spectrum condition. Many will not be prepared due to lack of knowledge and training is under stress for all, a poor patient experience (see case study)

People with autism spectrum conditions continue to have access to the mainstream services, whether that be an accident and emergency, community health centers or facilities for hospital patients. Some will be treated by professionals with knowledge but most will not. The NHS, including the nursing profession must take steps to

• Including training ASC for all basic nursing students

• Any nurse working in any community or outpatient should reflect on their knowledge of the ASC and update their practice.

• All nurses need to consider how friendly ASC health care environment is, taking into account that the most suitable, the better the service and experience.

• Recognizing people with ASC can not be excluded from health care, this population growth will continue because there is no cure for autism spectrum disorders.

The consequence for the NHS, if this group of people continue to have difficulty accessing health care is undoubtedly a huge financial burden. Without adequate access to programs screening people continue to develop poor health than could have been avoided.

There are a number of suggestions to help if you are presented with a person with an autism spectrum condition in your care. Son-

Get a complete history of the person or someone who knows the person with an autistic spectrum condition.

Take note of the person with ASC s likes and dislikes including sensory difficulties, routines and obsessions. These are very important to them!

Note: The patient may be hypersensitive or hypo sensitivity to pain. Conduct a comprehensive assessment of pain.

Examine the environment of care. Use a environmental checklist to identify any potential problems if possible.

People on the autism spectrum may have problems with the interpretation of language. Sometimes phrases are interpreted literally so, avoid jargon, such sayings as good as gold, as light as a kite

Play and get help from specialized professionals.

Allow extra time for appointments and keep the person with ASC minimum waiting times.

People with ASC often find change difficult therefore need to plan transitions. Even moving a patient across a neighborhood can be problematic.

(National Autistic Society 2008)

Below is a case study illustrating the practical difficulties that exist in real situations.

Peter (name dummy) is 17 and lives in a big city in the UK. Have a diagnosis of autism spectrum condition and moderate learning disabilities. He is a permanent resident at the Children's Home run by Social Services. Due to not being able to communicate their needs articulated through verbal expression was sometimes show some challenging behaviors.

Six months ago, the staff of the home became increasingly concerned about developing Pedro self-harm behavior. This was pounding his fist in the face and hitting his head against the wall. The occurrence of this seemed to be "from scratch" and increased in intensity and frequency in a short period.

In the crisis, the staff were not trained ASC immediately referred to Learning Disabilities Nursing and CAMHS (Child and Adolescent Mental Health Service) psychology and psychiatry. Peter was diagnosed as experiencing a severe psychotic episode specialized and needed help from hospital.

He was quickly sent to ER for treatment of injuries that Peter had horrible self-inflicted same. Unfortunately A & E staff untrained ASC and Peter already in a distressed state failed to recognize how their actions can have an impact someone on the autistic spectrum.

Factors such as-

• Too much noise
• Many people also
• Improper communication
• Touch sensitivity

to make the situation more traumatic.

 

After finally getting completed Peters dressings for their wounds, is now needed to be transferred to a mental health facility as an inpatient. In this city, without But there were no children Learning Disabilities Mental Health provision and could not access adult services, as it was 18 years or accessing Mental Health Services of Children. Peter finished in generic adult mental health flag.

There continued to be Pedro increasingly anxious. Staff admitted that they had ASC training. Peter was sedated most of the week, to adult learning disability services agreed to try it.

Would you know what to do if Peter ended up in his care?

 

Conclusion

This article examines the current literature on nursing and autism. Although no specific nursing articles had some very good information for health professionals from other countries. For these pieces work together is valuable to see the full image of nursing is faced with challenge.

Care of the person with an autism spectrum condition is a test for the nursing profession. It is one that has to be embraced rather than feared. There is an obligation to provide equitable quality service to all users of the NHS.

The patient with an autism spectrum condition is something that the nursing profession has to reach deal. This may go unnoticed and undiagnosed. effective communication skills and knowledge are essential both in the implementation of quality care.

The issues most important to remember "

Lack of knowledge and subsequent training for nurses in this area

The United Nations poor clinical areas friendly for people with autism

However, the most important of the major health inequalities that exist in this group of patients.

Stephen Simpson RNLD B.phil (Autism)

References-

Attwood.T (1998) – Asperger Syndrome: A Guide for Parents and Professionals. Jessica Kingsley Publishers. London.

Aylott.J (2001) – Understanding and listening to people with autism. British Journal of Nursing Vol.10 (3) 166-172

Aylott, J (2004)-The Autism: developing a strategy for nursing to prevent discrimination. British Journal of Nursing vol.13 (14) 828-833

Bogdashina . O - (2003)-Sensory Perception Problems in Autism: Different sensory experiences – different perceptual worlds, Kingsley Publishers Jessica. London

Clements, J. and Zarkowska, E. (2000) – refers to the behavior and autism spectrum disorders: explanations and strategies for change. London, Jessica Kingsley Publishers

Fay. J – (2004) "Autism Board, the North Coast Long Island Jewish Health System "Your next patient has autism. Bethpage NY, Linder Center for Autism.

www.northshorelij.com/body.cfm?id=2851 (Accessed 09/02/2005)

Jordan.R (1999) – Autism Spectrum Disorders: An Introductory Manual for Professionals, London, David Fulton.

Kagan-Kushnir.T, SW Roberts and OC Snead (2005)-Screening electroencephalograms in spectrum disorders: guidance based Evidence Journal of Child Neurology (2005) Vol 20 (3) pp 197-206.

Morton Cooper. A (2004) – Health Care and Spectrum Autism: A guide for health professionals, parents and caregivers. Jessica Kingsley Publishers. London

National Autistic Society (1999)-Sheet technical Autism Spectrum Disorders-An introduction for physicians. National Autistic Society. London.

National Autistic Society (2006 a) – Fact Sheet: What is autism? National Autistic Society. London.

National Autistic Society (2006 b) – Fact Sheet: What is Asperger syndrome? National Autistic Society, London

National Autistic Society (2008) datasheets: Patients with autism spectrum disorders: information for health professionals.

Ngugen.A (2006) Creating an autism friendly environment, The National Autistic Society, London.

Peeters. T (1999) – Training professionals and parents in autism. In Peeters T, C Gilberg eds. Autism: Medical and Educational Aspects. Whurr publishers. London.

Roper N., Logan, WW and Tierney, AJ (1996)-The Elements of Nursing: A Model for Nursing Based on a model of life (4th Ed.) Edinburgh: Churchill Livingstone.

Shellenbarger. T (2004) - General information and tips for the care of emergency patients with Asperger syndrome. Daily Emergency Medicine 30 (3), pp278-280

Wing.L (1996) - The autistic spectrum, a guide for parents and professionals. Constable and Robinson. London.

Stephen Simpson 2009

About the Author

Stephen has his own ASC consultancy in the UK