CNE: Handle with Care: Top Ten Tips a Nurse Should Know Before Caring For a Hospitalized Child with Autism Spectrum Disorder

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Abstract

Case Scenario

JJ is a green-eyed, blond-haired, freckle-faced seven-year-old nonverbal boy with autism who needs to be admitted to the inpatient unit for colonic washes secondary to prolonged constipation. He walks onto the unit holding his mother's hand but upon arrival becomes agitated and stops, looks down, then starts alternately flapping his arms and chewing on his finger. Unit hospital personnel had been informed that a child with autism was being admitted and are waiting near the entrance. Multiple staff members approach the boy at once, all talking to him, calling his name, leaning down to try to make eye contact and direct him toward his room. When he does not respond, one staff member takes his shoulders and tries to gently guide him toward the room. This causes JJ to scream loudly, shrug away from those near him, and start swinging his arms wildly. He ends up grazing one of the staff members in the face with his hand.

Case Scenario

During this encounter, JJ's mom has been standing at his side telling the staff to please back up and not touch him. However, security has been called. Once they arrive, the hospital personnel and security agents decide to physically carry JJ to his room with his mom close behind them and close the door. JJ begins banging his head on the door. His mother approaches JJ in his room but appears very distraught and is unable to comfort him. A physician is called and after confirming with the mother that JJ has no allergies, a stat dose of risperidone is ordered. Three staff members hold JJ down and administer the dose of IM risperidone. JJ calms down enough to lie on the bed, and the admission to the hospital is able to continue.

Case Scenario

The diagnosis of autism spectrum disorder is on the rise in the United States. More children with this disorder are requiring hospitalization and have an extended length of stay once hospitalized. The pediatric nurse is often unaware of or unprepared to offer the care that this special population requires. Sharing information obtained through repeated encounters with this population may lead to a less stressful and safer hospital stay for the child with autism, the family, and the pediatric nurse. Items about which the nurse should be aware when caring for a child with autism include the symptoms of autism spectrum disorder, the importance of family involvement, identifying the best way to communicate with the child, minimizing change, incorporating the child's home routine into the stay, creating a safe environment, identifying emotional disturbances, involving a multi-disciplinary team of experts on admission, listening to the family, and creating a record of this information to be shared among staff members.

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