LEARNING DISABILITY PRACTICEApril 2009 | Volume 12 | Number 324
Feature
waiting because the individual with autism tend to
process visual information more easily than auditory
information (howlin and rutter 1989). By holding
the cards he can also process the information in
his own time. i have used a set of three different
coloured cards to represent the passage of time. This
is because Wing (1996) argues that the passage of
short periods of time can be marked by cues and the
autistic child can be helped to wait if the end of the
waiting period is marked in some way.
Ben should be praised if he is waiting
appropriately because the child with autism will
respond better if positive behaviour is acknowledged
(Marshall 2006). The positive phrases should be
repeated at intervals to give Ben the chance to take
the words in (Marshall 2006), thereby reinforcing
good behaviour. Ben should also be told why he has
to wait because he is unable to visualise this himself
due to his impaired imagination. he should also be
told why he can then go, so the abstract concept
becomes more concrete.
To make the care plan more person-centred,
i discussed these care decisions with Ben through a
social story, which is a short story that describes
a situation, concept or social skill. The use of
different methods of communication improves
accessibility and gives the individual control and
ownership of the information (cambridge and
carnaby 2005). The story also helped explain to
Ben how to behave while waiting, assisting him
in the development of effective coping strategies
(howlin 1998). The National autistic society (2008)
argues that social stories also improve the autistic
individual's understanding of the situation, assists
with sequencing and provides structure, thereby
reducing anxiety when the situation occurs.
Outcome of the intervention
The use of the social story appeared to be
an effective starting point to introducing the
intervention to Ben. The use of photographs of Ben
and things he had to wait for enabled him to relate
to the story and held his interest. The intervention
was first used at what used to be a challenging
time of the day � break time � when Ben would
become very agitated while having to wait for
his turn on the swing. When Ben had to wait the
actions stated in the care plan were carried out. all
staff members were aware of the plan and were
committed to offering their support, which proved
to be an essential component in providing Ben with
consistent and effective care.
This consistency meant that Ben's acceptance
of waiting had already begun to develop when the
intervention was first used in the community. it was
noticeable that in this less predictable environment
positive results took longer to achieve than in the
more routine confines of the school.
Conclusion
as nursing students in contemporary learning
disability services, we often find ourselves in
placements that may not have a nursing focus.
however, it is important to recognise that nursing
care for people with a learning disability transcends
the medical model, and that we need to become
skilled at delivering care based on a biopsychosocial
approach.
Through working with Ben in an educational
setting, not only have i crossed an important theory-
practice bridge, but i have been able to demonstrate
to myself and colleagues the breadth of the skill
base of learning disability nurses. i have learnt
valuable skills from the classroom team in terms of
providing an environment that is safe and secure
to the individual with autism, while passing on to
them skills in planning care interventions that can be
evaluated and assessed in a methodological way.
i am now keen to share the knowledge and
experience i have acquired, and have great respect
for the different perspectives of those working in the
field of learning disabilities.
Joanne Hammond is a nursing
student at the University of
Nottingham
Cambridge P, Carnaby S (2005) Person
Centred Planning and Care Management with
People with Learning Disabilities. Jessica
Kingsley, london.
Department of Health (2001) Valuing People:
A New Strategy for Learning Disability for the
21st Century. Dh, london.
Firth U (2003) Autism: Explaining the Enigma.
second edition. Blackwell, Oxford.
Gates B (2006) Care Planning and Delivery
in Intellectual Disability Nursing. Blackwell,
Oxford.
Howlin P (1998) Children with Autism and
Asperger Syndrome: A Guide for Parents and
Carers. Wiley, chichester.
Howlin P, Rutter M (1989) Treatment of
Autistic Children. Wiley, chichester.
Marshall F (2006) Living with Autism.
sheldon Press, london.
National Autistic Society (2008) Social Stories
and Comic Strip Conversations. www.nas.org.
uk/nas/jsp/polopoly.jsp?d=1574&a=15543
(last accessed: March 11 2009.)
Roper N, Logan W, Tierney A (1980) The
Elements of a Model for Nursing Based on
a Model of Living. churchill livingstone,
edinburgh.
Turkington C, Anan R (2007) Autism
Spectrum Disorders. Facts On File, New York.
Williams C, Wright B (2004) How to Live with
Autism and Asperger Syndrome: Practical
Strategies for Parents and Professionals.
Jessica Kingsley, london.
Wing L (1996) The Autistic Spectrum.
robinson, london.
References
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This article has been
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