So what are some of the nursing diagnoses that we are going to look at for ASD? Of
course safety. I may come back to that. I want to start with impaired social interaction,
impaired verbal communication, risk of self-harm and injury, and of course safety.
We want to make sure we keep this child safe. How do we maintain a safe environment
for the child with ASD? Well, we could remove objects that would cause any injury,
we can reduce stimuli in the room. We also want to make sure that we start developing
a relationship with the child and the child's family, develop the therapeutic trusting
relationship. How does that occur? That occurs because we take the time, number 1,
to identify strengths. What can this child do? And then to explain everything that we're
going to do slowly and carefully and remember silence is a very very good communication
to all. And so if you explain something, wait a minute notice if the child is listening.
The child may not have eye contact with you. Do not insist "Look at me. Do you hear me?
Look at me." If the child is uncomfortable with eye contact, forcing a child to look at you
will not allow that child to engage the prefrontal cortex and hear you because now all
of their being is on "I have to look." So we want to make sure that we are respecting the
abilities of that child, recognizing where those abilities and not forcing that child past
what is a comfort zone. We can do reflective listening. The child can let us know. If
they are letting us know thru non-verbal mechanisms, you can say "I see that you are
anxious. I wanna make this better. I wanna help. I'm just gonna sit here and I'm gonna
make sure that you stay safe." We want to maintain consistency in all of our interactions
so we would limit how many people are going to go in and work with this child. We're
going to use familiar objects with this child. We won't walk in every single time with
something new. And we're going to anticipate what their needs are since they can't
verbally let us know. And we're going to make sure that those needs are met. So,
one of the nursing interventions that we use with kids with ASD is positive reinforcement
and that means that we recognize those actions that they are doing that are going to
help them to advance emotionally and physically. So, how do we do that? We approach
them with acceptance. We maintain a supportive attitude for them and then we use
positive reinforcement, for example, sometimes it might be a sticker. So if we ask everyone
to brush their teeth and we see the child with ASD is brushing his or her teeth, we put
a little sticker on the calendar saying "This was a great day." And we say, "This was a
great day, I noticed you brushing your teeth. That is so good." This kind of positive
reinforcement is very effective with children with ASD. One of our most important
nursing interventions for children with autism spectrum disorder as well as adults, but
today we're focused on the children, is to assess them for actual as well as risk of
self-mutilation. And what do we mean by self-mutilation? It could be scratching, it could
be cutting, it could be hair pulling, it could be anything that causes mutilation of the skin
or the body. Oftentimes this occurs, this kind of behaviors occur at times where there is
increased anxiety and so we want to determine what might the cause of that increased
anxiety be for this person. And if we notice that anxiety is beginning to build, we can
involve the patient with some sort of diversions or perhaps a replacement activity.
An example of that is, say for example, one of the children doesn't like showers. The idea
of showers, the way the shower feels on the skin the child is afraid and when they hear
the shower go on on the unit they become very anxious and we can take them aside away
from the shower and we can explain to them that there's a bath tub or they can also
have a small tub where they can wash themselves. And we can also do diversion, we can
move them in and have them watch TV while other people are taking the shower if that
is the time where their anxiety goes up. It's important to consider working one on one,
not surrounding the child with a lot of people which only would increase that level
of anxiety.