In 2006, one in every 110 children was classified as having an autism spectrum disorder (ASD). The CDC claims that the incidence of ASD is rising.

Transcription

1

2 In 2006, one in every 110 children was classified as having an autism spectrum disorder (ASD). The CDC claims that the incidence of ASD is rising. People with developmental disabilities, including ASD, are living longer. More adults with developmental disabilities, including ASD, are being seen in the hospital.

3 The hospital environment can be an overwhelming place for those with sensory issues. In the Intensive Care Unit(s) (ICU), these issues are magnified. ICUs are not prepared to meet the unique needs of people with ASD. Research is needed to determine what the current knowledge about ASD care needs is among health care professionals.

4

5 Sensory issues

6 From the literature it is evident that people with ASD have unique needs and require individualized treatment plans to address those needs. It is also evident that parental or caregiver involvement in those treatment plans is essential. The involvement of parents in the care of people with ASD is in keeping with the current movement in health care toward family-centered care.

7 Among other things, family-centered care has been shown in literature to improve family outcomes, increase satisfaction among patients and families, increase professional satisfaction, and lead to more effective use of health care resources. One of the principles of family-centered care is ensuring flexibility in organizational policies, procedures, and provider practices so services can be tailored to the needs, beliefs, and cultural values of each child and family (CHC, 2003).

8 The goal is to conduct a need assessment of the gaps in knowledge about ASD care needs among professionals in one hospital s ICUs in Connecticut. Gap analysis directly informs the development of learning objectives for educational activities (Greene, L. & Prostko, C., 2008).

9 Invite all health professionals working in the ICUs, including physicians, physician assistants, nurse practitioners, respiratory therapists, social workers, speech, physical and occupational therapists, to participate in a survey about their knowledge of ASD care needs, including familycentered care.

10 The first section of the survey was meant to elicit the professionals : frequency of contact with people with an Autism Spectrum Disorder (ASD), type of relationship with a person with an ASD, frequency that they cared for someone in the ICU with an ASD, and their feelings on whether their were necessary policies and procedures in place to care for people with an ASD.

11 The second section was meant to ascertain whether the professionals: felt their training had prepared them to care for people with an ASD, felt it was important in their profession to know how to care for a person with an ASD, felt comfortable caring for a person with an ASD, and finally, felt parents and caregivers should always be welcome in the ICU and/or during change of shifts and during treatments.

12 A comments section allowed the respondents to provide additional information about caring for people with an ASD in the ICU. Each person was also asked to report their age, sex, race, specific profession, and number of years in that profession.

13 Discipline ICU staff Responses Attending resident physicians PAs NPs Nurses Social workers 5 2 Respiratory therapists PT OT speech therapist NP=nurse practitioner PA= physician s assistant 1 respondent skipped the demographics section Number of surveys sent out = 391; number of responses = 73 Response rate = 18.7%

14 At least: 80% of respondents were female (2 people skipped this question). 48.6% of the respondents were nurses (1 person skipped this question). 50% of respondents had worked in their current profession for over 10 years (1 person skipped this question).

15 Number of respondents

16 number of respondents

17 Number of respondents

18 number of respondents

19 76.7% 16.4% 6.8%

20 30 number of respondents Strongly disagree Moderately disagree Somewhat disagree Somewhat agree Moderately agree Strongly agree 0 My training has prepared me to care for a person with an ASD In my profession, it is important for me to know how to care for a person with ASD

21 35 number of respondents I know enough about ASDs to feel I think that caregivers of people with ASDs comfortable taking care of a patient with it. who are in the ICU should always be welcome to be with the patient and not be seen as visitors. Strongly disagree Moderately disagree Somewhat disagree Somewhat agree Moderately agree Strongly agree

22 40 number of respondents Strongly disagree Moderately disagree Somewhat disagree Somewhat agree Moderately agree Strongly agree 0 I think parents or caregivers of people with an ASDs should be allowed to remain with the patient during nurse change of shft, in accordance with patient preference. I think parents and caregivers of people with ASD should be present during treatments in accordance with patient preference.

23 help staff familiarize with patient population and provide evidence based practice. the noise level and lack of education about this population is paramount an in service on autism would be helpful. other than in school never had any info on patient with autism. tips on communication

24 more education for staff about the disorder and associated special needs would be most helpful. Like any diagnosis that one is unfamiliar with should necessitate information on how to best care for patient with There are Healthstream presentations on several other types of patients with unique needs. We should have one on ASD as a minimum

25 each case should be looked at individually changes in visitation policies. information about specialized strategies to provide care in the best manner to maintain independence and pt-centered care. Policies that allow continuity of pre-hospital care.

26 early psychiatry consult more to assist the staff in education for appropriate and expected interactions. dedicated speech/pt/ot specialists Psych consults are an important part of our team and will utilize their skills if certain behaviors are a challenge for the staff.

27 this comes up infrequently a large population of our patients are sedated, unconscious or confused. NONE!! DO NOT confuse policy and procedures with PROPER TRAINING!! Autism spectrum disorder is the psych. flavor-of-the-decade. There is not a large older population because the diagnosis was not in vogue decades ago!...

28 The small number of people who responded The fact that all the participants were from one hospital The possible deficiencies of the survey to elicit desired information about health professionals current knowledge about ASD and familycentered care Giving the participants so much information in the background piece of the informed assent section probably steered some people s thinking as it gave them ideas on some of the issues people with ASD might have in the ICUs.

29 The results are an important addition to literature as they provide some information about the knowledge of ASD care needs (or lack of) among professionals in the ICU. From this need assessment it is unclear whether or not training among ICU professionals about the care needs of people with ASD is important at this time. Although people want to be prepared to care for people with ASD, they are probably not seeing enough people with ASD in the ICUs to justify the cost of providing training for all the staff in the ICUs. However, it would be most reasonable to create some sort of informational pamphlet that staff could access at their will.

30 This need assessment may show very different results in years to come. Hospitals that wish to be leaders in the future should begin to plan how they will prepare their staff to best care for people with an ASD and their families. Family-centered care is key and will not only benefit people with ASD and their families, but all people.

31 Allison, K.P. & Smith, G. (1998). Burn management in a patient with autism. BURNS 24, Aulagnier, M., Verger, P., Ravaud, J.F., Souville, M., Lussault, P.Y., Garnier, J.P., and Paraponaris, A. (2005). General practitioners attitudes towards patients with disabilities: the need for training and support. Disabil Rehabil. Nov. 30; 27(22): Bakare, M.O., Ebigbo, P.O., Agomoh, A.O. & Menkiti, N.C. (2008). Knowledge about childhood autism among health workers- (KCHW) questionnaire description, reliability and internal consistency. Clinical Practice and Epidemiology in Mental Health 4 (17). Barraban-Gil, K., Rapin, I., Tucman, R., Shinnar, S. (1996). Longitudinal examination of the behavioural, language, and social changes in a population of adolescents and young adults with autistic disorder. Paediatric Neurology, 15 (3), Beard-Pfeuffer, M. (2008). Understanding the world of children with autism. RN, February, Centers for Disease Control and Prevention (2009). Autism information center. Prevalence of ASDs. Retrieved December 20, 2010, from Committee on Hospital Care (CHC); Policy Statement (2003). Family-Centered Care and the Pediatrician s Role. Pediatrics, 112(3): Dell, D.D., Feleccia, M., Hicks, L., Longstreth-Papsun, E., Politsky, S. & Trommer, C. (2008). Care of Patients With Autism Spectrum Disorder Undergoing Surgery for Cancer. Oncology Nursing Forum 35(2), Greene, L. & Prostko, C., (2008). Educational Needs Assessment, Activity Development, and Outcomes Assessment at PRIME: Applications of Established Conceptual Frameworks and Principles of Adult Learning. Retrieved December 24, 2010 from: Institute for Family-Centered Care-Tools for change. Available at Institute of Medicine (IOM). (1999). To Err Is Human: Building a Safer Health System, Washington, DC: National Academics Press

32 Kuzin, J.K., Yborra, J.G., Taylor, M.D., Chang, A.C., Altman, C.A., Whitney, G.M., and Mott, A.R. (2007). Family-member presence during interventions in the intensive care unit: perceptions of pediatric cardiac intensive care providers. Pediatrics, Oct., 120(4):e KW, Au & DW, Man (2006). Attitudes toward people with disabilities: a comparison between health professionals and students. Int. J Rehahabil Res. Jun. 29(2): National Autistic Society. (1990). Parent and professional partnership in caring for adults with autism. Retrieved December 20, 2010, from Nelson, D. & Amplo, K. (2009). Care of the Autistic Patient in the Perioperative Area. AORN Journal 89(2), O Malley, P.J., Brown, K., Krug, S.E., and the Committee on Pediatric Emergency Medicine. (2008). Patient- and Family- Centered Care of Children in the Emergency Department. Pediatrics, 122(2): e O Regan, P. & Drummond, E. (2008). Cancer information needs of people with Intellectual disability: a review of the literature. Eur J Oncol Nurs. Apr, 12(2): Pajares, F. The Elements of a Proposal. Retrieved December 24, 2010 from: Silver, I.L. & Leslie, K. (2009). Faculty development for continuing interprofessional education and collaborative practice. J Contin. Educ. Health Prof. Summer, 29(3): Stevens, A. & Gillam, S. (1998). Needs assessment: from theory to practice. BMJ, May, 316:1448 Tervo, R.C. & Palmer, G. (2004). Health professional student attitudes towards people with disabilities. Clin. Rehabil., Aug.,18(8): Tracy, J. & Iacono, T. (2008). People with developmental disabilities teaching medical students Does it make a difference? Journal of Intellectual and Developmental Disability, 33(4), Van der Walt, J.H. & Moran, C. (2001). An audit of perioperative management of autistic children. Paediatric Anaesthesia, 11(4),

33