Oct 09
17
Autism Cure 2009
People nursing Autism Spectrum
Current Literature
When examining this single issue of motivation has been to attract attention to the lack of current literature. The National Autistic Society (NAS 2008) has a fact sheet on this subject, which in turn has a Kagan-only reference Kushnir.T, SW Roberts and OC Snead (2005). This is a study of the use of screening electroencephalograms (EEG) in autism spectrum disorders and does not address nursing issues.
Other supplementary readings suggested by the NAS Fay (2004) and Shellenbarger (2004) However, these two items are not generic and not specific to the United Kingdom.
Fay (2004) is a brochure that describes Here are some tips for good practice for health practitioners. It covers five key stages during a visit to health care is imminent for someone with ASD. Theses are the evaluation, consultation, planning, knowledge and implementation. What was in this leaflet was the phrase
"It is essential to the health care team to be creative, keep their sense of humor and if possible to prepare in advance. "(Fay 2004)
Shellenbarger (2004) is a case study that brings together some of the questions life. There are some facts about Asperger syndrome, some intervention strategies, dealing with stress and drug administration.
The only book was discovered by Alison Morton-Cooper (2004) which addresses some issues to consider from medical appointments, screening and assessments.
Aylott (2001) is an excellent article that is like trying to put you in the position of a person autism. She argues
". Lack of awareness of autism has led to positive people with autism oppressed in environments that can cause damage, distress and anxiety "
Jill Aylott understands the world of people on the spectrum and citation can easily relate to healthcare environments such as hospitals, health centers and community facilities. It includes a table of questions to be considered for staff working with people with autism of certain documents by Peeters (1999). This is general advice, but applies nurses.
Autism Spectrum Disorder / Conditions
Autism spectrum disorders and conditions (or referred such as autism) were first described by Leo Kanner and Hans Asperger in 1943 (Asperger Syndrome) in 1944.
"The National Autistic Society estimates a prevalence rate of 91 per 10,000 of population for an autism spectrum condition. With a list of GPs average of 2,000 people, every family physician is likely to have a maximum of 18 people with autism on their list "
(National Autistic Society 1999).
Autism Spectrum Conditions (ASC), which includes autism, receives greater visibility it has for many years due mainly to the MMR (measles, mumps and rubella) vaccine controversy early 2000s. The relationship of these JABs for the development of CSA led to many parents of instruction what is this condition. Also, what are the risks associated with them? To date, claims that MMR causes CSA have not been much more motivated and the adoption of JAB has been poor. Therefore, what is this fear "condition and how it affects nursing.
Autism Disorders Spectrum / conditions is a term used to describe a developmental disorder that has life has a range (or spectrum) of features, including autism and Asperger. (National Autistic Society 2006). All persons are diagnosed by CSA and experience three main areas of difficulty called "triad of impairments –
-Social Interactions (eg social relationships, indifferent, aloof and do not understand other points of view)
-Social communication (eg, verbal and non verbal agreements)
-Social Imagination and flexibility ( example, play, imagination copied rigidity and repetition)
(Wing 1996, NAS 2008)
Social interaction
People on the autistic spectrum often have to be selfish or lack of empathy. The center of self and demanding behavior can be problematic.
It is often social isolation among peers, considered bizarre or eccentric behavior may lead children sitting on their own at the edge of a group or a playground. There is also tension when the social demands and approaches are placed on the person with ASC. Anxiety in social situations, crowds, birthday parties and Christmas is common.
There is lack of return on social cues and unwritten rules and behaviors such as talking to wrong and not in context, without waiting his turn to talk too much or not talking, choosing to remain silent can happen.
Often it is inappropriate social use of language in the wrong context or situation of inappropriate laughter, for example – an example as saying: "mark purposes "means they are excited.
Social Communication
People on the autism spectrum may have "superficial" language Spoken perfect. They may have the understanding of words rather than their meaning. Rote script and the language is monotonous and repetitive may occur. A voice of expression people may not have or have special features such as copying phrases, videos, commercials that can be spoken out context. There may be a very literal understanding of language and jokes using innuendo and irony are strong with problems. Example is the expression "pull the curtains", which can be interpreted in two ways.
It is difficult to understand and express nonverbal communication such as gestures. Sometimes, people with ASD may have flat facial expressions or eye resulting in a glazed lifeless face.
Imaginary Social Flexibility
People on the autism spectrum may have to absorb all unusual interests such as the use of computers, objects spinning even cleaning! They may have a certain strict routines (in a certain order and time, unable to change) and be inflexible with these.Often there will be a limited development of play and creative thinking and hard to imagine that something else – View this.There may be problems in generalizing skills that they can perform a task in an environment and not in another.
Sensory
Many people on the spectrum suffer from sensory processing difficulties such as hyper (more) or hypo (under) sensitivities. The effects of these can be deep and very painful for a person with ASC. Some examples are
-Hearing People are too sensitive to different locations of noise, "high" for example, not a whistle, bagpipes etc. hardly hear or be hypo-sensitive.
Those who feel an acute reaction to / for example certain odors or perfumes do not have much sense of smell at all.
Sight – The people having a reaction to certain colors, patterns, lights and become stimulated or disturbed by them.
Touch – People are sensitive to textures (clothing, surfaces, food) can cause great distress. Touch can be underdeveloped and it can be a high pain threshold.
Taste-People on the autism spectrum may be considered "fussy eaters" because they find intolerable taste. They may include more textures and colors to eat inedible or prefer the taste as sharp spices.
Bogdashina (2003)
sensory difficulties are very important in creating a friendly environment for all autistic patient who needs care nurses.
People with autism spectrum condition can also display a behavior that services challenges.
Examples of behavior are -
How then, transition problems, destructiveness,
excitement Indiscriminate Effects,
Lack of motivation
Aggression, eating problems,
Sleep problems
Depression
Rituals / obsessions
Withdrawal, self-injury, fear, panic, anxiety and phobias.
To address these behaviors a preventive approach is preferable and must include understanding the sources of behavioral problems in ASC and structuring the environment for prevention. Good practice in particular provide an effective means of communication and clear verbal / written / rules pictorial. Perhaps most importantly, an approach should include the construction of positives to their people with ASC lives.Some have severe learning difficulties while others such as those with Asperger syndrome have an intelligence above average or average.
Jordan (1999) estimates
"… Up to 75% of all people with autism may have general learning difficulties is with an IQ below 70 "
It is interesting to note that it is very rare for people with ASC have special abilities such as those represented on the film "Rain Man". Many people have also never been diagnosed as disabled may be a bit hidden.
The "Difficult" Odd Man often eccentric, who has been a nightmare for treatment because he kept not to speak of his interest (or Star Trek Collectibles Computers or) maybe on the spectrum.
Some celebrities throughout history thought to perhaps have characteristics such as AUC Albert Einstein and Bill Gates (Microsoft Chief computers). The condition is predominantly Men with a ratio of 4 to 5. The exact cause is still unknown but the National Autistic Society (2006) estimates that it affects the lives of more than 500,000 families in the UK alone. With that kind of number, it is inevitable that most nurses are in contact with a person with an autism spectrum condition.
Impact Nursing
The impact on nursing must be considered and how patient care could improve what you know now on autism spectrum conditions. The challenges and possible solutions to individual and / or part-team may include training, planning of care after / Discharge and multi-agency working.
Morton-Cooper (2004) devotes a chapter in his book review of nursing issues. She suggests skills and sensitivity to the observation of the patient is required to see where the person whose vulnerability is ASC. She goes on to suggest Roper Logan and Tierney (1996) activities model of nursing who live support. Are activities
- Maintaining a safe
- Communication
- Respiration
- Eating and Drinking
- Elimination
- Care Personal
- Body temperature control
- Mobility
- Work and Play
- Expressing Sexuality
- Asleep
- Dying
"People on the autism spectrum may have contributed factors that make the care decisions more complicated. Sleep disorders and hyperactivity or, conversely, the extreme slowness of movement at the point of catatonia may have implications for the care and treatment of medical problems "
(Morton-Cooper 2004)
Significant nursing issues include the management of problems of personal hygiene, personal care, patient safety, nutrition, food difficulties, wound care, sleep and night time to wander and die.
Health Problems-washing and maintenance of hygiene personal care specialist nurses will to ensure any infection or cross contamination. Some people with ASC can not even recognize various aspects of their bodies. The management of menstruation may require special care.
Safety limits should be clearly the person with ASC. This could be the physical parameter from one neighborhood to the rules on what not to touch.
People on Nutrition spectrum of autism may have specific dietary needs / preferences. The textures and colors of food and the usual order of eating can restricted diet. There may be some nutritional deficiencies in patients. Specific advice should be sought.
Care wounds, if the person has sensitivities touch they can not tolerate the bandages and / or injuries to zero.
People sleep / night-time wandering from several on the spectrum of sleep problems. Difficulties may include intolerance of bedding, her sensibilities, not to relax and lack motivation to sleep.
Dying-The concept of death can be confusing for many people. The person with ASC can not always respond with an answer Common emotional and may seem aloof. There is little literature on this subject.
The quality of monitoring and discharge planning needs be thorough to avoid admissions of new and effective multi-agency response is essential.
Consciousness
There are some workpieces, the articles are written on AUC and nursing, as well, it is essential to raise awareness of this issue. There is also a training limited that nurses have to deal with issues of disability and even less of autism spectrum conditions. Most nurses would say no or "Not much". Depending on where you were trained, what part of the country where you live (eg if there are specialized services CSA established in your area) or the Directorate of Nursing you are, the experience will be different. Mental health and learning Nurses may be more aware of issues of SAC and recognized the impact of people with Asperger syndrome with the legal population prison nurses prison / are becoming more sophisticated. Another issue was the case for treating patients with ACS, in respect of this service, they should have access. Depending on the NHS or service area you can find out. It may be mental health, learning disabilities, generic or a combination of these services.
Discussion and implications for practice
For those diagnosed with Asperger syndrome who has an intellect of average or above what can be confusing. Some people think that CSA may be considered a disability Social and people on the autism spectrum should be dealt disability services, however, many people with Asperger reflect that difference rather than any deficiency.
Those without a clear service NHS AUC or policy that could lead to many Nurses receive communications or admissions of any person having an autism spectrum condition. Many will be prepared due to a lack of knowledge and training due to stress for all, including experience of poor patients (see Case Study)
People with autism Conditions Spectrum continue to access mainstream services if they are accidents and emergencies, community health centers or hospitals. Some will be handled by professionals with knowledge, however, most will not. The NHS, including the nursing profession must take steps per-
- Including basic training on CSA for all nursing students
- All Nurse working in all forms of community or outpatient should reflect on their knowledge of the CSA and update their practice.
- All nurses need to consider how their CSA friendly health care environment, taking into account the fact that the most suitable, the better the service and experience.
- Recognizing people CSA can not be excluded health care, this population will continue to increase, as there is no cure for autism spectrum disorders.
The consequences for the NHS, if this group of people continue to have difficulties accessing health care is undoubtedly an enormous financial burden. Without adequate access to screening programs, people continue to develop ill health that could have been avoided.
There a number of suggestions to help you if you are presented with a person with an autism spectrum condition in your care. They are
Capture a complete person or someone who knows someone with an autism spectrum condition as well.
Take note of the person with CSA s likes and dislikes not including sensory difficulties, routines and obsessions. They are very important for them!
Note: The patient may be hypersensitive or hypo sensitive to pain. Perform a thorough assessment of pain.
Consider the care environment. Use a checklist of environmental recognize potential problems if possible.
People on the autism spectrum may have problems with the interpretation of language. They interpret words literally, therefore sometimes avoid jargon, sayings, such as good as gold, light as a kite
Listen to help physicians and specialists.
Allow sufficient time for appointments and avoid the person with the minimum CSA latency.
People with ASC often difficult to change, you need to plan the transition. Even moving a patient the other side of a neighborhood can be problematic.
(National Autistic Society 2008)
Below is a study case that illustrates the practical difficulties that exist in real situations.
Peter (not his real name) is 17 and lives in a big city in the United Kingdom. It has diagnosis of an autism spectrum condition and learning disabilities. It is a permanent resident on the run for children at home with the services social. Due to not being able to communicate their needs with articulate verbal expression he had displayed during behavior difficult.
Six months ago, the staff of the home has become increasingly concerned by Peter developing some self-destructive behaviors. Was himself struck with his fist in the face and banging his head on the wall. The presence of what appeared to be "out of nowhere and increased in intensity and in frequency over a short period.
In the crisis, the staff were not trained immediately referred to the CSA Learning disability nursing and CAMHS (Child and Youth Mental Health Service), psychology and psychiatry. Peter was diagnosed as suffered a severe psychotic episode and need help in a specialized hospital.
It was sent quickly to accidents and emergency to deal with horrific injuries that Peter had inflicted himself. Unfortunately A & E staff had no training on ASC and Peter already in a state of distress have been unable to recognize how their actions could have an impact on the person of the autism spectrum.
Factors such as-
- Too much noise
- Too many people
- inappropriate communication
- sensitivities tactile
all made the situation more traumatic.
After eventually making dressings Peters filled in for his injuries, he must now be transferred to a mental health hospital. In this city, but there was not children's learning and mental health provision could not access services to adults, because it was not 18 years or access child mental health services. Peter met on generic adult mental health ward.
Here, Peter has continued to become increasingly distressed. Staff acknowledged that they had no training in CAD. Peter was sedated most of the next two weeks, until Adult Learning Disability Services has decided to treat him.
Would you know what to do if Peter ended up in your care?
Conclusion
This article examines the current literature on nursing and the autism spectrum. Although there are no articles of specific treatments, there was very good information for healthcare professionals from other countries. To put these pieces of work whole is valuable to see the image of the entire nursing challenge.
The care of the person with an autism spectrum condition is a test for the nursing profession. It is a question that should be adopted rather than fear. There is an obligation to provide quality service equitably to all users of the NHS.
The achievement of a disease autism spectrum is something of nursing needs to become familiar with. It may go unnoticed and undiagnosed. effective communication skills and knowledge are essential therefore the implementation of quality care.
The most important issues are noted,
Lack of knowledge and further training for nurses in this area
The one poor clinical areas friendly to people on the autism spectrum
However, more importantly the major health inequalities that exist in this group of patients.
Stephen Simpson RNLD B.phil (autism)
References-
Attwood.T (1998) – The 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), Autism: developing a strategy for nursing to prevent discrimination. British Journal of Nursing Vol.13 (14) 828-833
Bogdashina . O - (2003) Sensory-perceptual problems in autism: different sensory experiences – Different Worlds perception Jessica Kingsley Publishers. London
Clements, J. and Zarkowska, E. (2000) – Concerns the behavior and spectrum disorders Autism: explanations and strategies for change. Jessica Kingsley Publishers London
Fay . J – (2004), Committee Director of Autism, North Shore-Long Island Jewish Health System, your next patient is diagnosed with autism. NY Bethpage, Linder Center for Autism.
href = "http://www.northshorelij.com/body.cfm?id=2851"> www.northshorelij.com/body.cfm?id=2851 (accessed 02/09/2005)
Jordan.R (1999) – Autism Spectrum Disorders: An introductory manual for professionals in London, David Fulton.
Kagan-Kushnir.T, SW Roberts and OC Snead (2005)-spectrum disorder screening electroencephalograms in: evidence-based guideline Journal of Child Neurology (2005) Vol 20 (3) pp 197-206.
Morton Cooper. A (2004) – Health Care and the Autism Spectrum: A guide for health professionals, parents and caregivers. Jessica Kingsley Publishers. London
National Autistic Society (1999), technical specifications, ASD-An Introduction for GPs. National Autistic Society. London.
National Autistic Society (2006) - Fact Sheet: What is autism? National Autistic Society. London.
National Autistic Society (2006b) – Fact Sheet: What is Asperger syndrome? National Autistic Society, London
National Autistic Society (2008) Fact Sheet: The patients with autism spectrum disorders: information for health professionals.
Ngugen.A (2006) Create an environment conducive to autism, National Autistic Society, London.
Peeters. T (1999) – Training of professionals and parents in autism. In Peeters T, Gilberg C eds. Autism: medical and educational. 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) – Overview and tips to treat patients with ED of Asperger syndrome. Journal of Emergency Medicine 30 (3), pp278-280
Wing.L (1996) – The Autism Spectrum: a guide for parents and professionals. Constable and Robinson. London.
2009 Stephen Simpson
About the Author
Stephen is an ASC Specialist in the UK
Autism Mothers … Update March 2009
