Camelot RNs Care for Autistic, Behavior-Challenged Kids
Monday March 10, 2008
Print This- Select Text Size:
Comments
No matter how severe a patient's condition, an autistic child's treatment team — Camelot physicians, nurses, psychiatrists, teachers, staff caretakers, and parents — strive to bring about progress.
More Info
Treating an Autistic Child
Although treating a child or adult with the developmental disability can present challenges, understanding how the illness affects patients is the first step toward meeting their healthcare needs.
“It can be very intimidating treating a child with autism. You don’t know what to say, who to say it to, what to do,” says Susie Smith, RN, BSN, MSN, CPNP, staff nurse at Camelot Residential Treatment Center in Des Plaines, Ill., and mother of a son with Asperger’s syndrome. “Just don’t be afraid to ask questions of the parent because parents of kids on the autistic spectrum are going to be more uncomfortable if you don’t ask them about treating their child.”
At the same time, it’s critical nurses talk to the patient about his or her treatment, says Smith, adding, “Don’t assume they can’t understand you.”
In fact, keeping the patient well informed ahead of time might make a smoother examination, says Stacey Ruskin, RN, BA, CCM, director of nursing at Camelot.
“Very often they need lead time to the next thing so they don’t get upset or frightened,” Ruskin says. “So you have to prepare them for anything that might change. If you’re a nurse, you can move slowly and give them lead time by saying, ‘In five minutes, we’re going to go into the doctor’s office’ and ‘In a couple of minutes the doctor’s going to come in’ or ‘In a few minutes, mom is going to leave the room.’”
Because most autistic children are highly sensitive to sound, light, and touch, minimizing environmental stimuli also will improve the experience.
“Don’t leave a child in the waiting room for a really long time because the longer they’re sitting in a strange, busy place wondering where they’re at and what’s going on, the more their senses are going to be keyed up by the time they get to the exam room,” Smith says. “So when you know a child on the autistic spectrum’s coming in, maybe arrangements can be made to take the child back sooner.
“Back in the room, you don’t want a lot of noise and sudden movements, so you want to talk calmly and quietly about whatever procedure,” Smith says. “And involve the caregiver as much as possible because they’re with the child all the time and know what’s going to be difficult for the child and what isn’t.”
advertisement
At times doting aunt, cheerful friend, soothing school nurse, and concerned counselor, Smith and her six nursing colleagues must morph into a variety of personas to effectively treat the 60 children whose acute conditions require intensive, around-the-clock treatment.
"Your focus has to be on enhancing the gifts they do have and helping them cope with the things that are difficult for them. You have to really love them wherever they're at," says Smith, whose experience caring for children in the autism spectrum began nine years ago with the birth of her son, Ty. "We have the trust of their parents with the tremendous responsibility of caring for their kids, and you have to take care of them in the same way you'd take care of your own. That calls for compassion and understanding, and you have to enjoy them."
A passion for treating children failed by the traditional system was stirred in Smith when her own son was diagnosed with Asperger's syndrome, which is an autism spectrum disorder.
"You can read books about autism and watch TV shows and even meet autistic people, but until you live with it every day, really love a child on the autistic spectrum, speak his language, and live on his planet, you can't really understand it," Smith says. "The fact that I'm a nurse and the mother of an autistic child means there are some things, while others might be able to learn, that I just get."
It's a combination of compassion, empathy, patience, and know-how ingrained in Stacey Ruskin, RN, BA, CCM, director of nursing at the residential treatment facility, which provides psychiatric care, schooling, behavioral therapy, medical care, and a multitude of other services to the 5- to 18-year-old residents.
"People either love it or hate it. There are people I've hired who start work and just can't handle the kids because it's too upsetting," says Ruskin, who has worked in behavior and psychological nursing environments for the past 15 years. "So you have to have a lot of empathy because a lot of cases are extremely sad. Some of the children have self-harming behaviors. We have a couple who can't stop from hitting themselves and one who keeps biting off the end of her tongue; children who are schizo-affective and mentally retarded.
"But we're helping the young people who need it the most, who are not able to live with their parents because their lives are too difficult and require too much care," says Ruskin. "They're the neediest in our society and in my mind are the children who in the olden days would've been left abandoned on the hill."
And progress differs from child to child, says Randy Yager, LPN, BS, assistant vice president for Camelot, which, in addition to its Des Plaines facility, operates therapeutic day schools in DeKalb, Naperville, and Hoffman Estates. Camelot also maintains residential treatment facilities in Kansas, New Jersey, Oklahoma, Tennessee, and Virginia.
"If a child comes in not speaking, and they're making progress toward communication by using a picture identification system and starting to communicate or you increase the level of emotional behavior in an oppositional conduct child so they don't re-enter an acute care setting when they leave our program, that's success," Yager says.
While success may vary, the goal of treatment does not. Most treatment plans aim to have the majority of Camelot children reunified with their families at home in less than a year.
"Reunification with the family has to be the priority," Yager says. "We work with the family and teach them the different aspect of what we did in residential care that will work at home."
That, too, varies wildly from child to child but from the nursing end typically involves months of administering and changing medications, monitoring effects and side effects, watching growth, treating day-to-day injuries, and performing a variety of other health-related tasks.
"You have to be prepared for pretty much anything and have to think outside the box to find ways to make things work," Ruskin says. "You have to be very creative with giving meds. For example, we have one child who doesn't like medicine so we put it in a piece of bread and ball it up and the caretaker will say, 'Look, food!' In other cases, you have to remember not to get too close because you'll get your finger bit."
But thinking outside the box doesn't work for every child, and where creativity ends, awareness and tenacity take over.
"You have to know what works for each child, how to speak to them, sometimes how to convince them," Smith says. "With Asperger's, there is a certain amount of rigidity with kids, so you might always have to stand in the same place to give a medication."
It's a mind-set that extends through all areas of care, no matter how great or small the interaction.
"If they're rigid about something, it's not that they're being naughty, and that's a very important part of it," Smith says. "When things happen at Camelot, we don't see behaviors as bad or naughtiness, it's just the way their mind works."
Which is not to say that dealing with the behaviors is without its challenges, Smith adds.
"For whatever reason, one of the autistic girls wants to whack me upside the head when she sees me, so one of the challenges is being comfortable moving among the kids and projecting love and acceptance, but also protecting yourself from getting whacked upside the head," Smith says. "You have to remember not to take it personally and have a strong sense of self to realize it's not about me and realizing that you have to pick your battles."
Sometimes the battle can't be avoided, such as when patients react poorly to a new medication, destabilize mentally and physically, and become safety threats to themselves and those around them.
"In any kind of physical situation, it's very stressful because no one knows if the child is going to turn around or get worse and you're going to have to call for help," Ruskin says. "In those situations, we try to talk them through it and calm them down, but sometimes you can't and have to restrain them to administer emergency medicine."
But when the effort produces results — a child is able to regain control, finds a way to show affection besides hitting, takes medication willingly — the impact is tremendous.
"With the more severely autistic kids, I've seen counselors and staff members who are jubilant over small gains in social reciprocity," Smith says. "Like pushing a child on a swing, at first the child might be sitting there, but she might learn to encourage the staff member to push again. Even that is a big deal because you feel like you've broken into their world a little bit."
Robin Huiras is a freelance writer. To comment, e-mail editorIL@nursingspectrum.com.
Reader Comments
Login
Be the first to comment!