What should be the focus of a practice where the pediatric nurse uses a developmental approach?

What should be the focus of a practice where the pediatric nurse uses a developmental approach?

Current treatments for autism spectrum disorder (ASD) seek to reduce symptoms that interfere with daily functioning and quality of life.1 ASD affects each person differently, meaning that people with ASD have unique strengths and challenges and different treatment needs.1 Therefore, treatment plans usually involve multiple professionals and are catered toward the individual.

Treatments can be given in education, health, community, or home settings, or a combination of settings. It is important that providers communicate with each other and the person with ASD and their family to ensure that treatment goals and progress are meeting expectations.

As individuals with ASD exit from high school and grow into adulthood, additional services can help improve health and daily functioning, and facilitate social and community engagement. For some, supports to continue education, complete job training, find employment, and secure housing and transportation may be needed.

Types of Treatments

There are many types of treatments available. These treatments generally can be broken down into the following categories, although some treatments involve more than one approach:

Behavioral Approaches

Behavioral approaches focus on changing behaviors by understanding what happens before and after the behavior. Behavioral approaches have the most evidence for treating symptoms of ASD. They have become widely accepted among educators and healthcare professionals and are used in many schools and treatment clinics. A notable behavioral treatment for people with ASD is called Applied Behavior Analysis (ABA). ABA encourages desired behaviors and discourages undesired behaviors to improve a variety of skills. Progress is tracked and measured.

Two ABA teaching styles are Discrete Trial Training (DTT) and Pivotal Response Training (PRT).

  • DTT uses step-by-step instructions to teach a desired behavior or response. Lessons are broken down into their simplest parts, and desired answers and behaviors are rewarded. Undesired answers and behaviors are ignored.
  • PRT takes place in a natural setting rather than clinic setting. The goal of PRT is to improve a few “pivotal skills” that will help the person learn many other skills. One example of a pivotal skill is to initiate communication with others.

Developmental Approaches

Developmental approaches focus on improving specific developmental skills, such as language skills or physical skills, or a broader range of interconnected developmental abilities. Developmental approaches are often combined with behavioral approaches.

The most common developmental therapy for people with ASD is Speech and Language Therapy. Speech and Language Therapy helps to improve the person’s understanding and use of speech and language. Some people with ASD communicate verbally. Others may communicate through the use of signs, gestures, pictures, or an electronic communication device.

Occupational Therapy teaches skills that help the person live as independently as possible. Skills may include dressing, eating, bathing, and relating to people. Occupational therapy can also include:

  • Sensory Integration Therapy to help improve responses to sensory input that may be restrictive or overwhelming.
  • Physical Therapy can help improve physical skills, such as fine movements of the fingers or larger movements of the trunk and body.

The Early Start Denver Model (ESDM) is a broad developmental approach based on the principles of Applied Behavior Analysis. It is used with children 12-48 months of age. Parents and therapists use play, social exchanges, and shared attention in natural settings to improve language, social, and learning skills.

Educational Approaches

Educational treatments are given in a classroom setting. One type of educational approach is the Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) approach. TEACCH is based on the idea that people with autism thrive on consistency and visual learning. It provides teachers with ways to adjust the classroom structure and improve academic and other outcomes. For example, daily routines can be written or drawn and placed in clear sight. Boundaries can be set around learning stations. Verbal instructions can be complimented with visual instructions or physical demonstrations.

Social-Relational Approaches

Social-relational treatments focus on improving social skills and building emotional bonds. Some social-relational approaches involve parents or peer mentors.

  • The Developmental, Individual Differences, Relationship-Based model (also called “Floor time”) encourages parents and therapists to follow the interests of the individual to expand opportunities for communication.
  • The Relationship Development Intervention (RDI) model involves activities that increase motivation, interest, and abilities to participate in shared social interactions.
  • Social Stories provide simple descriptions of what to expect in a social situation.
  • Social Skills Groups provide opportunities for people with ASD to practice social skills in a structured environment.

Pharmacological Approaches

There are no medications that treat the core symptoms of ASD. Some medications treat co-occurring symptoms that can help people with ASD function better. For example, medication might help manage high energy levels, inability to focus, or self-harming behavior, such as head banging or hand biting. Medication can also help manage co-occurring psychological conditions, such as anxiety or depression, in addition to medical conditions such as seizures, sleep problems, or stomach or other gastrointestinal problems.

It is important to work with a doctor who has experience in treating people with ASD when considering the use of medication. This applies to both prescription medication and over-the-counter medication. Individuals, families, and doctors must work together to monitor progress and reactions to be sure that negative side effects of the medication do not outweigh the benefits.

Psychological Approaches

Psychological approaches can help people with ASD cope with anxiety, depression, and other mental health issues. Cognitive-Behavior Therapy (CBT) is one psychological approach that focuses on learning the connections between thoughts, feelings, and behaviors. During CBT, a therapist and the individual work together to identify goals and then change how the person thinks about a situation to change how they react to the situation.

Complementary and Alternative Treatments

Some individuals and parents use treatments that do not fit into any of the other categories. These treatments are known as Complementary and Alternative treatments. Complementary and alternative treatments are often used to supplement more traditional approaches. They might include special diets, herbal supplements, chiropractic care, animal therapy, arts therapy, mindfulness, or relaxation therapies. Individuals and families should always talk to their doctor before starting a complementary and alternative treatment.

There may be other treatments available for individuals with ASD. Talk to a doctor or healthcare provider to learn more.

For more information you can visit:

American Academy of Pediatrics Council on Children with Disabilities: https://pediatrics.aappublications.org/content/145/1/e20193447external icon

Autism Society: https://www.autism-society.org/living-with-autism/treatment-options/external icon

Autism Speaks: https://www.autismspeaks.org/treatments-autismexternal icon

Interagency Autism Coordinating Committee: https://iacc.hhs.gov/publications/publications-analysis/2012/treatments.shtmlexternal icon

National Institute on Child Health and Human Development: https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatmentsexternal icon

References

  1. Hyman, S.L., Levy, S.E., Myers, S.M., & AAP Council on Children with Disabilities, Section on developmental and behavioral pediatrics. (2020). Identification, evaluation, and  management of children with autism spectrum disorder. Pediatrics, 145(1), e20193447.

What should be the focus of a practice where the pediatric nurse uses a developmental approach?

Health practitioners promote service satisfaction and self-assurance by maintaining a familial bond during pediatric treatment with a value system called family centered care. Providers and organizations adopting this philosophy promote emotional, physical, and psychological health among children during treatment. Family centered care has evolved from literary works penned by practicing nurses over the last seven decades. Nurses practice the method as a means to build a rapport that facilitates fulfillment of the needs of all stakeholders.

This once prohibited practice now receives increased acceptance, bolstered by highly compelling empirical evidence. Using this approach, nursing professionals create an environment that recognizes parents as critical information sources and part of the caregiving team. While many pediatric practitioners have accepted family centered care as an effective value system, many more have yet to incorporate it into their repertoire.

Pediatric practitioners who adopt family centered care techniques recognize how important it is to include family members in the evaluation, delivery, and planning of treatment and incorporate that ideology into assessments, facility design, policies, programs, and routine interactions. [1]These care providers understand the important role that family members play in children’s wellness.

Pediatric care providers who follow family centered service principles treat each child as an individual and support family values and strengths to promote positive patient outcomes. These professionals also engage families in a way that supports emotional development and reassures family members that they are an important component in their child’s treatment.

The fact and views presented by the patient and their family members comprise important influences in clinical decision-making. Confident and informed family members reinforce children’s strength and courage. Bearing this in mind, the following five innovative practices can help pediatric care providers improve patient outcomes.

1. Open Communication with Family Members

Open communication in pediatric and neonatal wards lead to improved patient and familial satisfaction. These outcomes improve patient safety and stakeholder candidness. When clinical errors occur, a relationship built with open communication plays a critical role in how stakeholders perceive the event.

Family centered pediatric practitioners share information and encourage patient participation during treatment while maintaining privacy rights, especially among disabled children, and respect children’s ability to make appropriate decisions. When conducting research, family centered pediatricians defer to patient and family member views on project participation and information sharing. Communication also improves performance among medical personnel.

2. Recognizing Familial Importance

Patient and family centered care started to emerge in the 1950’s. The practice holds special relevance for families raising children with special needs, as well as low-income, minority, and uninsured families.

The doctrine reduces incurred costs and improves the experience realized by patients and family members. By keeping family members present during treatment, pediatricians decrease stakeholder apprehension and create a supportive setting for family members, while encouraging patient interaction and promoting a healing environment.

3. Family and Organizational Collaboration

At family centered practices, family members serve as the patient’s advisors, committee, and task force for promoting the best possible treatment outcome. [2] A supportive environment encourages family members to participate in value added groups, such as peer networks, quality improvement initiatives, and safety committees. Family centered value adoption starts at the executive level with appropriate guidance and resource allocation and then proliferates throughout the organization.

As it pertains to family centered care, collaboration encompasses complementary patient engagement, or if necessary, a guiding voice that encourages patient and family participation in the treatment process. New mothers commonly seek this kind of professional interaction.

Collaboration streamlines treatment and produces optimal health experiences. By combining their assets, beliefs, and capabilities, family members and care providers make enhanced decisions that best serve the needs of the patient.

4. Enabling Family Members to Support Treatment

Professional perceptions and attitudes can delineate the effectiveness of family centered care. To deploy the philosophy successfully, pediatric nurses must relinquish some, but not all, control to family members. To facilitate this, nurses must guide family members in caring, protecting, and making decisions for pediatric patients.

Most nurses are aware of the family centered practice concept. Entry-level nursing staff members may have difficulty relinquishing partial control to family members. However, experienced nurses typically feel more at ease with the idea, which empowers parents and guardians by enhancing their ability to play an active role in their child’s treatment.

5. Encouraging Cultural Literacy

The best methods to deliver care can change with cultural identity. Respect and honor for cultural differences represents a primary tenant in promoting family centered pediatric care. [6] Staff members who belong to various cultures can help their peers understand intercultural needs.

Each family unit also shares distinct cultural beliefs. Children learn their characteristics, heritage, and spirituality from their family members. Pediatric practitioners must identify and learn to relate to other cultures to understand the factors that contribute to patient health.

High-quality family centered care improves wellness among pediatric patients. When family members provide strong support during treatment, children feel calmer and more relaxed and require less medication to recover from painful injuries.

Family centered treatment promotes winning outcomes for patients, family members and care providers. For that reason, pediatricians should promote a family centered agenda in all aspects of their practices.

Learn More

Family nurse practitioners play a major role in today’s health care field. The responsibilities of FNPs have evolved alongside that of physicians, which means additional opportunities, autonomy, and authority. At Regis, our online Master of Science in Nursing FNP degree can help you develop the specialized skill set you need to practice at the advanced level.

Pediatric NP Job Roles and Responsibilities
Career Outlook: Family Nurse Practitioner

Sources:

[1] American Academy of Pediatrics
[2] US National Library of Medicine National Institutes of Health – Family Centered Pediatric Nursing Care
[3] US National Library of Medicine National Institutes of Health