Emergency Department Visit: Reducing Anxiety and stress in the Emergency Department

By Lisa M. Monge, MSN, RN

April showers bring May flowers! It also brings us Autism Awareness Month! In fact, the fourteenth annual World Autism Awareness Day is April 2, 2021. On this day, you can expect the international community to ‘Light It Up Blue’, in recognition of people living with Autism Spectrum Disorder (ASD) and those who love and support them. What happens when the person living with Autism isn’t feeling well, or is feeling a little blue? An emergency department (ED) is often a place of stress and overwhelming for a patient living on the spectrum and their caregiver.

Research suggests the average number of emergency department encounters is approximately 30% higher for children with ASD, 70% higher for teens with ASD from ages 15 to 18, and twice as high for adults with ASD. Given the data, it is likely the person with ASD and their family will inevitably visit an emergency department at some time in their life. The ED is busy, loud, unpredictable and has many bright lights. This environment is overwhelming for a neurotypical patient, but for the person living with Autism, this can quickly amplify an adverse behavior due to heightened sensory input or stimulations. Autism Spectrum Disorder is a neurological disorder that has an effect on communication and with the heightened sensory stimulations, the stress can be so overwhelming, it quickly can undermine their ability to tolerate the treatment they need. In the event a person with autism may require an ED visit, there may be a few things the person living with Autism Spectrum Disorder or their loved one can do to reduce anxiety and stress for both of them.

Each and every person with autism is unique and each face a different set of challenges. If at all possible, call ahead to the ED and notify staff you are en route. Staff may be able to accommodate a private room or reduce waiting time. It is important to educate staff on whether the patient is verbal or non-verbal, hyper- or hypo-sensitive, and any triggers that may cause negative behaviors. Open communication with between the patient and healthcare team will allow for customized health care in an effort to reduce stress and anxiety.

Wait times can be long in an emergency department. With the overwhelming environment, it is important the loved one remain positive and remember their mood can impact stress levels. Preparing a “fun bag” of items can be helpful! Dressing in preferred clothes instead of hospital gown can reduce sensory issues from clothing. Any items from home that are familiar that can allow for a less foreign experience are also helpful in reducing stress.

It is vital loved ones be the voice for their family with ASD if receiving care in the ED or any healthcare setting. They know the patient and it is vital to notify staff of triggers as well as techniques to cope with difficult situations. Be involved with care as much as possible! For example, administer the medication to your loved on with ASD, if allowed, if it reduces stress. It is also beneficial minimize encounters and cluster care. For example, instead of having an assistant get the vital signs and the nurse provide care, have the nurse obtain both the vital signs and provide essential care only.

Autism Spectrum Disorder is a life-long neurodevelopmental disorder. ASD has a substantial impact on the health and well-being of the affective individual and their family. Visits to the ED, or any medical setting, can cause stress and anxiety. Being prepared for the encounter can optimize the patient and family experience; resulting in appropriate medical interventions and interactions, and ultimately allow the patient to receive the highest quality of care.

**a personal note from the author** While in graduate school, I began taking courses to learn about ASD and other developmental disabilities. I chose to create a personal philosophy regarding persons with developmental disabilities and how nursing staff and healthcare personnel should integrate disciplines to optimize healthcare potentials for all. I am reaching out to all providers in every setting to please come together as a community to reduce health disparities and improve the life for this unique population. Thank you, Nurse Lisa

We, as nurses, must advocate for the family, community, teachers and healthcare providers to treat the patient and family as an entity and ensure care is integrated. All nurses, novice to expert, have a duty to acquire the knowledge, skills and attitude necessary to provide compassionate and appropriate care for this unique population. Nurses, or any healthcare provider who may encounter a patient with ASD, or any developmental disability, please consider advocating for the following

• Nurse educators to introduce ASD and developmental disabilities to students through academia and clinical settings

• Clinical nurse educators to incorporate care of the patient with ASD into hospital orientation, individual training dependent on area of practice and enforce continuing education

• Nurse navigators to assist all patients with ASD and their families in any aspect of care, through the whole process from beginning to end, throughout the lifespan of the individual

• Nurse navigators to oversee military children with ASD with relocation to new states, to prevent long waitlist to establish care with providers, specialist, referrals, etc.

• Nurse Autism Advocates to be appointed to each state to collaborate with elected officials to oversee federal funds allocated specifically to ASD, differentiated from the Medicaid Waiver

We have an obligation and an ethical duty to advocate for this unique population. Increasing education to ourselves and each other, integrating care and giving a voice to the silent will result in positive health care outcomes.

“Not really ER but before my 10-year-old son had to go in for heart monitor and sleep study, I got him accustomed to the wires and tube by playing robot with him – we hooked him up with wires and tube and bought a dryer vent used to put over his arms and legs taped wires all over him told him it was to practice being a robot before we go to the hospital to make him a real robot... kinda silly but worked great.” – Colette, mom of 8-year-old Mikey

“My son is 8. We explain everything that is going to happen before it does. We also make sure to pack a few toys to help keep him entertained. Waiting can be very stressful.” – Amanda, mom of Mason

“When I take my son to the ER, I always explain that he is non-verbal. That he has a very high pain tolerance.

I encourage nurses and doctors to talk to him with a calm voice just like they would a person his chronological age. Moderate not shout or talk slowly because you think he can’t hear. He can hear very well. He just can’t speak.

Explain everything that you are going to do. Just like you would with any other patient.

Please please be kind to us parents. We are already running on an empty tank.

A smile or understanding look goes a long way.

My son is 16 years old and has Angelman Syndrome.

He is hospitalized two to three times a year.

We have had some amazing doctors and nurses that have been our Angels and others that we pray for. We pray that they would have more compassion.

We moved to Indianapolis for our son’s medical care eight years ago” – Marisa, mom of J.R., age 16