In the Spring 2009 issue of Minority Nurse, we published a Second Opinion column written by Estela Dimes, BSN, RN, who is the mother of two special needs children. Her article, “Culture and Autism,” shared her personal experience of how family members from two different cultures—Dimes is Filipino American and her husband is Jordanian American— had different ways of responding to her young son’s diagnosis of autism. “In our struggle to deal with my son’s disorder,” she wrote, “my husband and I have learned firsthand that culture affects the way people think about, cope with and adapt to autism.”

In response, we received this letter from Zenora Thompson, MSN, RN, an instructor in the nursing program at Kent State University’s Ashtabula Campus in Ashtabula, Ohio, and the mother of a 22-year-old with autism.

“The article emphasized how problematic the acceptance of autism can be for families of different cultures,” she writes. “However, acceptance of autism, mental retardation and other developmental disorders is not just an issue for different cultures of people but also for us as nurses seeking to provide culturally competent care.

“Nurses are challenged in the pursuit of cultural diversity to educate ourselves about how to provide care to these special needs populations—and especially to adult special needs patients. Today, life expectancies for people with developmental disorders have increased, thanks to early medical diagnosis and treatment. As a result, we health care providers must re-evaluate our ability to care for this population.

“In the past, adults with more severe forms of autism or other developmental disorders who were admitted to the hospital for a medical condition were often placed in pediatric units because of their lack of communication skills and their adverse behaviors, such as head banging, hitting themselves or objects, yelling and abnormal sleep patterns. But today, as the population of older special needs patients increases, some of them are now being admitted to adult medical-surgical units, where nurses may not have been trained to understand and accommodate these behaviors.

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“Culturally competent care for special needs patients must first start with nurses’ self-evaluation of our own willingness and ability to serve this difficult population,” Thompson continues. “Today, many magnet hospitals and other medical facilities have begun to focus on providing care to culturally diverse patients. But the special needs population is often not considered as a culture. Most health care personnel think of the term ‘cultural diversity’ as applying to patients of different races, religions and ethnicities. However, ‘culture’ is defined in Webster’s New International Dictionary as ‘the sum total of the attainments and activities of any specific period, race or people.’ The special needs population fits this definition. The goal of nurses is to provide culturally competent care, and the special needs population must be included under that umbrella.

“Nurses on adult medsurg units must develop the skills to address the communication, behavior management and developmental needs of these patients,” Thompson emphasizes. “Our ability to communicate with them more effectively will promote continuity in the patient’s current medical regime. Nurses who are trained in managing adverse behaviors will foster patient cooperation and trust, eliminating the need for [physical] restraint and the administration of medications not normally used by the patient. Nurses’ use of equipment designed for people with developmental disorders—such as ‘talking books’ with pictures that patients who lack verbal communication skills can point at to indicate their needs—can enhance our ability to provide care.

“When I was working as a staff nurse on a medical unit at MetroHealth Medical Center in Cleveland, Ohio [before moving on to her teaching career at Kent State], nurses practicing under these conditions identified the need for skills training to ensure the successful care of the special needs patient,” she concludes. “The numbers of these patients have expanded beyond the pediatric units and are now challenging nurses on adult units to become culturally competent caregivers for this diverse population.”

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