Kathleen Stimpfle, RN, emergency department nurse at Sacred Heart Medical Center in Spokane, Wash., parent of a young man with autism, and board member of the Spokane Autism Cooperative, says nurses should keep a resource notebook for parents that contains contact information for autism centers in the region, as well as other services.

Organized parents will call a medical facility ahead of time to let staff know what would make the visit easier, Stimpfle says. By the same token, she adds, nurses should gather information about autistic patients before their first visit by asking the caretaker what should be done to reduce the patient’s anxiety.

People with autism need a quiet, structured environment with as little distraction as possible. Nurses should take vital signs with a sense of calmness, even if they do it quickly, says Karen Clemmer, RN, BSN, PHN, a resident of Sebastopol, Calif., who is the mother of two boys with autism and an MSN candidate at the University of Washington at Tacoma.

Because it takes longer for autistic patients to process information, Stimpfle says, nurses should give them one instruction at a time and give them an extra 30 seconds to respond. In fact, she recommends tacking an extra 10 or 15 minutes onto an appointment. Lack of familiarity is stressful for autistic patients, she says, and rushing them would be one of the biggest mistakes a nurse could make. She adds that it helps to talk in a soft, low voice.

Parents and nurses should make things as predictable as possible, Bullen says, by having the patient see the same nurse during routine visits, always taking the same route to the appointment, and letting the patient know the routine ahead of time.

James Adams, PhD, president of the Greater Phoenix Chapter of the ASA, director of the Autism/Asperger’s Research Program at Arizona State University, and the father of a 12-year-old girl with autism, says that having the parent present during the appointment often helps the child stay calm, and that nurses and parents should remain composed even when the child is screaming.

Autistic children’s behaviors, such as hiding under tables, can look like the children are misbehaving, but the last thing they need is discipline. The children are acting out because they don’t feel safe, Clemmer says, and need reassurance.

Caroline Wilson, RN, BSN, PHN, president of the Los Angeles Chapter of the ASA and autism advocate, educational consultant, and coordinator, advises against touching patients who are hypersensitive to touch. Nurses shouldn’t try to engage patients in eye contact either, Clemmer says, because they will cower more.

When drawing blood, nurses can use EMLA Cream to numb the puncture site. Adams also recommends showing videos to children during long waits.

Wilson says nurses should tell autistic patients what to expect and use simple explanations. They should also find out how patients learn best and observe their behavior to make sure they’re not in pain.

Wilson believes that nurses can be the biggest advocates for autistic patients, whether by affecting policy or simply listening to parents and providing sources.

“Nurses get it,” she says.

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Rebecca Ray is an editor and writer for NurseWeek.

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