Wood Elyssa B, Halverson Allyson, Harrison Gina, Rosenkranz Amanda
J Emerg Nurs. 2019 Jul;45(4):415-424. doi: 10.1016/j.jen.2018.12.002. Epub 2019 Jan 21.
For children with autism spectrum disorder (ASD) and sensory-processing disorder (SPD), an unexpected visit to the emergency department can be an overwhelming experience that creates intensifying behaviors and an unsafe clinical interaction for the child, nurses, and providers. Although resources exist to help nurses work with this specialized group, there are limited examples of the challenges and opportunities of modifying an emergency department to be a place where nurses can provide sensory-informed care.
Guided by Watson's Theory of Caring, nurses and child life specialists in our pediatric emergency department initiated a practice improvement (PI) project to create a sensory-friendly emergency department. The nurses (1) engaged with community members and families, (2) examined current practices, (3) modified the patient care environment, (4) collaborated in an interprofessional educational session, and (5) created a shared vision for the modified patient-care environment.
This article describes the nurse-initiated PI process and the journey to create an evidence-based sensory-friendly pediatric emergency department. A model is presented so that other facilities can embark on their own initiative, and case studies are used to evaluate project outcomes.
Integrating current evidence, staff suggestions, community input, and expert advice allowed us to find creative solutions to the unique sensory needs of children who visit our emergency department. Modifying both the patient-care environment and the patient-flow process to accommodate for the needs of children with ASD/SPD created a more peaceful and healing environment for children and their families and gave nurses the support they needed to provide sensory-informed care.
对于患有自闭症谱系障碍（ASD）和感觉统合失调（SPD）的儿童来说，意外前往急诊科就诊可能是一次压倒性的经历，会引发其行为加剧，对儿童、护士和医护人员而言，临床互动也不安全。尽管有资源可帮助护士与这个特殊群体打交道，但关于如何改造急诊科，使其成为护士能够提供感官知情护理的场所，这方面所面临的挑战和机遇的实例却很有限。
在沃森关怀理论的指导下，我们儿科急诊科的护士和儿童生活专家发起了一项实践改进（PI）项目，以创建一个对感官友好的急诊科。护士们（1）与社区成员和家庭进行互动，（2）审视当前的做法，（3）改造患者护理环境，（4）在跨专业教育会议中开展协作，以及（5）为改造后的患者护理环境创建共同愿景。
本文描述了由护士发起的PI过程以及创建一个基于证据的对感官友好的儿科急诊科的历程。文中呈现了一个模型，以便其他机构能够自主开展相关工作，并通过案例研究来评估项目成果。
整合当前的证据、工作人员的建议、社区的意见和专家的建议，使我们能够找到创造性的解决方案，以满足前来我们急诊科就诊的儿童独特的感官需求。改造患者护理环境和患者流程以适应患有ASD/SPD儿童的需求，为儿童及其家庭创造了一个更安宁且有助于康复的环境，并为护士提供了提供感官知情护理所需的支持。
