Thu 20 Sep 2018

Mental Health awareness

The School of Nursing has a formal contract with Supporting Families in Mental Illness, Taranaki, to provide learning experiences based on the sharing of narratives by those who have experience with mental health and/or addiction issues, on five separate occasions, during the second year of study in the Bachelor of Nursing programme.

Participants share their lived experience in relation to the mental health case study topics, which include depression, psychosis, bipolar affective disorder, alcohol and others drugs and suicide. An array of issues are discussed, including the qualities and attributes of what makes a good nurse, from the perspective of a person receiving care and navigating the ‘system’.

This learning style is unique to the WITT nursing degree and allows us to continuously develop the students’ holistic thinking, as opposed to delivering a segregated mental health paper; this fits with the WITT BN graduate being ‘work ready’, regardless of the context of future employment.

One of the assessments for year 2 students is to write an essay that answers the question, “Is stigma and discrimination still part of society’s behaviour?”; a selection of essays are then forwarded to the Supporting Families team, who award a special prize to the winning essay, which is presented at Graduation.

In the build-up to celebrating Mental Health Awareness week on 8th October, a selection of these essays will be shared each week.

We start with essays written by Kirsty Wesner and Hine-Rotu Taylor.

 


By Kirsty Wesner

This discussion will consider the question of whether stigma and discrimination are still part of society, in relation to post-traumatic stress disorder (PTSD) as a result of domestic violence (DV). By considering the macro and micro level impacts of these issues and how this has developed historically. To understand the impacts of DV and PTSD, the science of these issues will be analysed, to determine the effects and how these impact on stigma and discrimination. In identifying the answer to the aim of this topic the concepts of what influences nursing practice will be compared. To both personal attitudes and the impact of therapeutic relationships. This will highlight key legal, professional, cultural and ethical considerations, which are factors in reducing stigma and discrimination.

Stigma is defined as marginalisation of individuals through negative beliefs and judgements. There are various forms including, self-stigma where individuals hold negative beliefs about themselves. Societal stigma is the prejudice which is placed on individuals from a societal perspective, this can include healthcare professionals. Lastly there is structural stigma which comes from the stigma placed on individuals by law, policies and procedures. The effects of stigma can lead to discrimination which can be defined as negative actions or treatment of individuals based on stigmatised views (Crowe & Murray, 2015).

The act of DV is defined as repetitive behaviour to attain power or control over an intimate partner. The power is attained through violent acts or sexual coercion which cause injury, either physically, emotionally or financially. DV is non discriminate of population however, the prevalence is disproportionate within low-income families (Davis, 2013). The World Health Organisation has indicated that the prevalence of DV is an epidemic health issue. The study suggested that the rate of DV is 35% of women worldwide (Gulland, 2013). Another study of prevalence in Aotearoa indicated that these figures are disproportionate to the population, in that Māori women experienced 53.5% which was almost twice the rate of non-Māori (Pihama et al., 2016).

The impact of DV is a leading cause of PTSD for women in Aotearoa, with one study identifying that the likelihood of PTSD is 50% to 95% (Carretta, 2008). There are strong associations amongst DV and poor health, especially in long-term mental health (Gulland, 2013). Davis (2013), suggests that the rate of increased health concerns are 60% higher for women who have experienced DV. PTSD is a mental health disorder which is a psychological response to a traumatic experience, it can develop immediately or years following. The characteristic features of PTSD include anxiety, depression, hypervigilance and arousal, cognitive alterations, insomnia, immune system dysfunction and physical pain (Griffin, Charron, & Al-Daccak, 2014).

During a traumatic experience, several neurobiological systems are activated. These include the hypothalamic-pituitary-adrenal axis, which promotes the release of cortisol to maintain homeostasis. Chronic PTSD causes a dysregulation of cortisol receptors and lymphocytes resulting in depressed stress response and increased inflammatory responses. Glucocorticoids cause destruction of the neurons within the hippocampus and amygdala. The progressive effects result in atrophy of the brain tissue (Griffin et al., 2014).

The noradrenergic system causes norepinephrine and epinephrine to be released by the sympathetic nervous system. This causes cytokine secretion, therefore, affecting the immune response. The hyperadrenergic effects can result in impaired prefrontal cortex function and dopamine reuptake regulation, which can lead to emotional dysregulation, depressive and behavioural symptoms (Bailey, Cordell, Sobin, & Neumeister, 2013). The serotonergic system is responsible for regulation of gamma-aminobutyric acid, noradrenaline, acetylcholine, glutamate and dopamine. PTSD dysregulates the binding potential, resulting in the clinical features and chronic effects on neurological, behavioural and psychological functioning (Bailey et al., 2013).

The opioid receptor system includes the encephalin (D), dynorphin (J) and morphine (I) preferring receptors which are responsible in stress inducive behaviour. The overactivity of these receptor signals benefit in acute threat situations however, chronic activation leads to anxious and depressive symptoms. These have direct correlation with DV initiated PTSD in chronic pain conditions developing. Endogenous cannabinoids develop and maintain the stress response circuit in PTSD which reduces signalling. This degradation of signalling compromises the endogenous buffering of stress within the brain (Bailey et al., 2013). The combined effects of these responses can lead to epigenetic alterations like DNA methylation. This can cause altered gene transcriptions and protein translations. This therefore, predisposes genetic risk to generations for PTSD (Pape & Binder, 2016).

The resultant epigenetic effects present in society today have been an accumulation of trauma and predisposition to PTSD. The colonisation process in Aotearoa caused intergenerational trauma and incidence of DV. DV was not seen in Māori culture prior to colonisation, and has become a deeply entrenched intergenerational behaviour (Pihama et al., 2016). The loss of Māori values and practices have impacted whānau units, language, land ownership and income. This has long term implications on support within the community, access to healthcare, cultural practices and living situations. These are all known to increase the risk factors of DV and therefore, PTSD (Pihama et al., 2016).

One study identifies the perpetual cycle of DV and PTSD in recognising the increased risk of childhood trauma, the resultant PTSD and adulthood aggression potentially leading to DV. This cycle supports the evidence of epigenetic factors and the ongoing, increasing prevalence. Other perpetuating factors maintaining this cycle include poverty, legal, social status, gender role beliefs, cognitive and emotional development dysfunction as well as physical injuries and disabilities (Pintrijel, 2012). This cycle and the ongoing effects of the trauma create stigma and discrimination at all levels. The effects of this stigma and discrimination prevent this cycle being broken and can be further divided into micro and macro issues.

Micro implications begin with the individual. The stigma experienced within society about DV leads to reduced support being sought. This is further complicated by institutional stigma which supports these views by limited financial, emotional and safety support available. Legal stigma is placed onto the victim by poorly trained police, legal and healthcare professionals. This is then reiterated by the justice system with few arrests or convictions being made. Despite the victim being required to repeatedly disclose the traumatic experiences and subsequent impacts, such as employment, custodial agreements, personal safety and housing (Hand & Betsan, 2011). Women with a history of DV experience an increased emotional, physical and psychological risk. This can affect employment which further perpetuates the risk of future DV. It also impacts on increased healthcare needs, further stigmatising the woman from seeking medical support or creating negative experiences of healthcare (Hand & Betsan, 2011).

Self-stigma can prevent help being sought or isolation from professionals, friends and family. The use of the label “victim” can have a stigma causing effect due to the negative beliefs around DV. Childhood trauma can result from witnessing DV even if the child is not directly involved. This trauma can cause PTSD, depression and are at greater risk of perpetrating violence later in life (Davis, 2013). The effects of DV on a child are multidimensional, in leaving the home or remaining within the environment. Often poverty is a factor or can be a result of leaving the violent home. This poses a risk to children in itself as poverty is well known to impede healthcare accessibility, nutrition, social environment, healthy accommodation and education. These can all play a vital role in healthy brain development and is essential in a child with a predisposition to DV and PTSD (Hand & Betsan, 2011).

These micro implications have a direct correlation to macro and the cost of DV and PTSD. The increased health implications contribute to a large economical cost within healthcare. Increased physical and psychological treatment comes at a large cost to the government and individual. Economic factors associated with impacts on employment have a great effect on the use of social welfare, criminal justice, and community services. The estimated cost in Aotearoa of this is $4 billion dollars annually. This economic cost causes organisational stigma and discrimination by reducing access, complicating processes and procedures to access support and impacting professional services beliefs about the service users (Hand & Betsan, 2011). The combination of these micro and macro level issues perpetuate the stigma of DV and PTSD further preventing the reduction of, or supportive measures required to end this cycle (Davis, 2013).

The progressive impact of these issues has created potential for stigma and discrimination within nursing practice. Many healthcare professionals are hesitant or ineffective in screening or treating DV and PTSD patients. This in turn further fuels the perpetuating cycle. An American study has resulted in the development of an evidence-based management of DV tool. It includes screening and assessment processes, training for healthcare professionals, intervention plans, and the support required for patients (Carretta, 2008). The stigma and potential for discrimination often causes under-reporting of DV and many services do not routinely screen for it. Effective training and communication skills can promote more effective disclosure and enable support (Howard et al., 2010).

Developing an effective therapeutic relationship is required to enable a disclosure and provide advocacy for the individual. This can be achieved through motivational interviewing techniques, effective communication and active listening (Stein-Parbury, 2006). The inclusion of cultural safety is essential in building a therapeutic relationship, by being able to understand and incorporate their values, beliefs and experiences into care. Principle four of the guidelines discuss the importance of reducing the power imbalance. This is also a significant requirement to enable patients to develop a rapport and feel comfortable making disclosures of DV (Nursing Council of New Zealand, 2011).

Providing advocacy, support and a safe environment support therapeutic relationships. As many women will be fearful of disclosing DV and PTSD due to stigma and discrimination beliefs, it is essential to ensure a safe, reassuring environment. This also includes initiating actions appropriate to prevent compromise to their safety or wellbeing, as outlined in the nursing competencies (Nursing Council of New Zealand, 2012b). By advocating for the patient and supporting the needs for treatment upholds the ethical requirements of a nurse. In particular, non-maleficence must be forefront as the client’s safety is essential in competent nursing practice. The guidelines also outline the importance of advocating for vulnerable patients, ensuring protection and minimising and preventing harm (New Zealand Nurses Organisation, 2010).

The implementation of the Violence Intervention Plan (VIP) throughout the district health boards has been integrated to identify DV and provide early interventions. The data shows that of the sample studied there were a significant number of women screened and approximately 6% gave disclosures. This data identifies an issue in the disclosure rate, given the drop from the previous year. As well as the significant difference from other statistical data available. The sample size was small and did not include all incidents of DV. The data was collected by quantitative study and analysed using credible resources. The data is within 10 years although, more up-to-date information would be beneficial. The evidence of this document is strong given the data identified and the implications to practice (McLean, Kozoil- McLain, & Garret, 2016).

Having a lived experience of both DV and PTSD has altered perceptions and beliefs around these issues. The stigma and discrimination which is associated with these have been personally experienced from all aspects and further adapted beliefs and values. The negative implications of DV have been experienced, physically, psychologically and psychosocially. The experiences have developed a deep empathy for patients experiencing these issues and has supported the growth of emotional intelligence in responding to others needs. Experiencing the process of reporting, medical intervention, ongoing treatment and recovery as well as the practical actions such as financial recovery, custodial issues, safety management and legal processes, provided invaluable first-hand experience which can be utilised to better support patients through identification, support, education and advocacy in a nursing setting (Stein-Parbury, 2006).

The potential for professional issues to arise as a result are high and must remain consciously avoided. As Stein-Parbury (2006) explains, information sharing can be a highly effective communication tool. When used effectively it can support the patient in feeling safe, validated and reassured. However, there is a risk of transgressing the boundaries. When the focus on the patient becomes instead on the nurse. This can impact on the power imbalance further which may increase the patient’s vulnerability and nurse objectivity. The Code of Conduct outlines this boundary transgression is at risk of occurring if a nurse discloses aspects of their life (Nursing Council of New Zealand, 2012a).

In conclusion, identifying the prevalence of PTSD and DV, and the micro and macro level issues which arise from these, indicate a significant issue within Aotearoa. The ongoing healthcare implications demonstrate a need to improve interventions and treatments in a way which reduce stigma and discrimination. The stigma by healthcare professionals can further impact the issues. This is often a result of lack of training, lack of time and a perceived lack of understanding (Crowe & Murray, 2015). Recognising the enormous cost to society also underlines the increased potential for stigma and discrimination. Considering the progression of historical events and epigenetics this only exacerbates the issues which then have a perpetuating effect on seeking support or treatment and reduction. Therefore, it is evident that stigma and discrimination are prevalent in society currently, in relation to DV and PTSD.

 

Reference list:

 

Bailey, C., Cordell, E., Sobin, S., & Neumeister, A. (2013). Recent progress in understanding the pathophysiology of post-traumatic stress disorder: Implications for targeted pharmacological treatment. CNS Drugs; Auckland, 27(3), 221–232. doi:10.1007/s40263-013-0051-4

Carretta, C. (2008). Domestic Violence: A worldwide exploration. Journal of Psychosocial Nursing and Mental Health Services, 46(3), 26–35. doi:10.3928/02793695-20080301-02

Crowe, A., & Murray, C. (2015). Stigma from professional helpers toward survivors of intimate partner violence. Partner Abuse, 6(2), 157–179. doi:10.1177/0886260512441253

Davis, D. (2013). Rehabilitation counselling master’s students: Beliefs and attitudes about domestic violence toward women. Graduate College: The University of Iowa, 1–167.

Griffin, G., Charron, D., & Al-Daccak, R. (2014). Post-traumatic stress disorder: Revisiting adrenergics, glucocorticoids, immune system effects and homeostasis. Clinical and Translational Immunology, 3(11), 27–33. doi:10.1038/cti.2014.26

Gulland, A. (2013). A third of world’s women have been sexually or physically abused by a partner, says WHO. Best Practice Medical Journal, 346(2), 4077–4077. doi:10.1136/bmj.f4077

Hand, J., & Betsan, M. (2011). Community responsibility for freedom from abuse (2006): The view from 2011. Women’s Studies Journal, 22(2), 11–13.

Retrieved from http://wsanz.org.nz/journal.htm

Howard, L., Trevillion, K., Khalifeh, H., Woodall, A., Agnew-Davies, R., & Feder,G. (2010). Domestic violence and severe psychiatric disorders: Prevalence and interventions. Psychological Medicine, 40(06), 881–893. doi:10.1017/S0033291709991589

McLean, C., Kozoil-McLain, J., & Garret, N. (2016). Health response to family violence: 2015 violence intervention programme evaluation. Centre for interdisciplinary trauma research. Retrieved from https://niphmhr.aut.ac.nz/ data/assets/pdf_file/0010/79183/2015-VIP-Evaluation-Report- CITR-Report-15_WEB.pdf

New Zealand Nurses Organisation. (2010). New Zealand Nurses Organisation code of ethics. Wellington. New Zealand: New Zealand Nurses Organisation. Retrieved from http://www.nzno.org.nz/Portals/0/publications/Guideline%20-%20Code%20of%20Ethics%20 (2010%202013).pdf

Nursing Council of New Zealand. (2011). Guidelines for Cultural Safety, the Treaty of Waitangi and Maori Health in Nursing Education and Practice. Wellington, New Zealand: 

Nursing Council of New Zealand. (2012a). Code of Conduct: For Nurses.

Nursing Council of New Zealand. (2012b). Competencies for Registered Nurses.

Nursing Council of New Zealand. Retrieved from http://www.nursingcouncil.org.nz/Nurses

Pape, J., & Binder, E. (2016). The role of genetics and epigenetics in the pathogenesis of posttraumatic stress disorder. Psychiatric Annals, 46(9), 510–518. doi:10.3928/00485713-20160729-02

Pihama, L., Nana, R., Cameron, N., Smith, C., Reid, J., & Southey, K. (2016). Māori cultural definitions of sexual violence. Sexual Abuse in Australia and New Zealand, 7(1), 43–51. Retrieved from https://www.anzatsa.org/saanz-journal/

Pintrijel, O. (2012). The child: At the border between abusive family and quality of human life. Revista de Asistenta Sociala, (4), 51–66. Retrieved from http://www.revistadeasistentasociala.ro/

Stein-Parbury, J. (2006). Patient and person: Interpersonal skills in nursing (3rd ed.). Marrickville, Australia: Churchhill Livingstone.

 


 

By Hine-Rotu Taylor

“It seems that for success in science or art, a dash of autism is essential" (James, 2003). Autism spectrum disorder (ASD) is termed as a neurological disorder with a broad range of conditions and symptoms, the most distinctive of these being social intercourse deficits, eccentric interests, sensory hypersensitivity and compulsive behaviours (Autism speaks, 2018). Despite the estimation of one in every sixty-six people having some form of Autism, there is still a prevalent air of stigma and discrimination held towards ASD (Silberman, 2015). Stigma is the disapproving beliefs held towards a particular group, while discrimination is the act of unfairly treating people in accordance to their grouping (Bevan-Brown & Dharan, 2016).

The following essay will explore micro and macro perspectives of autism, history that has contributed to its negative stereotypes, legal professional and ethical issues, underpinning science as well as personal beliefs in an attempt to answer the question; is stigma and discrimination still part of society’s behaviour?

Kanner defined autism as childhood psychosis, a sub-set of schizophrenia with key features including a profound obsession with self and inability to possess or understand human emotion (Kanner & Eisenberg, 1944). Kanner believed that autism was extremely rare, debilitating and the result of neglectful parenting. His theory led to the derogatory term refrigerator parents which to this day stigmatizes parents of ASD children (Silberman, 2015). The second model was proposed by German paediatrician Hans Asperges who theorized that autism was not rare and had many presentations existing across a spectrum. Due to increased awareness and restructured diagnoses criteria, the known prevalence of autism has skyrocketed in recent decades (Autism speaks, 2018). Although Han’s model was influential in separating ASD from schizophrenia in the diagnostic statistical manual of mental disorders, Kanner’s model maintained notoriety for the majority of Autism’s recorded history (Silberman, 2015).

Despite the gradual increase of awareness, a globally infamous controversy pinned ASD negatively in society, with its after effects still pertinent and stigmatizing today (Silberman, 2015). An article published in the Lancet journal proposed a causal link between the measles mumps and rubella (MMR) vaccine to developing autism (Sathyanarayana Rao & Andrade, 2011). Although this study was found to be fraudulent, the widespread media coverage sparked fears amongst parents with the marked ignorance surrounding both MMR and ASD creating an extreme stigma around children developing autism (Amanna & Slifka, 2005). To this day distrust continues to be harboured, centre-staging autism as a worst-case scenario for parents (Silberman, 2015).

In recent years, a neurodiversity movement has emerged with the philosophy that ASD is in fact not a disorder but rather a naturally occurring variation in human genetics (Silberman, 2015). It promotes awareness and tolerance  of ASD as a different way of thinking rather than a disorder to be cured (Silberman, 2015). Within this movement, sociologist Judy Springer coined the term neurodiversity, the concept that brain function and cognition exists as a diverse plane (Silberman, 2015). Related to this concept, the term neurotypical is seeing more usage, which is the description for individuals with perceived normative cognitive function (Silberman, 2015).

In society there is a pervasive stigma against individuals with autism in that they are perceived as apathetic to human emotion (Brewer & Murphey, 2016). While individuals with ASD may not express or react to emotion in a typical manner, the idea that they lack empathy is not founded on any scholarly literature (Brewer & Murphey, 2016). Associated to this stigma, it is widely believed that autistic individuals are not able to recognize emotion in others which has also been contradicted by investigation (Brewer & Murphey, 2016).

Stigmatizing beliefs surrounding autism are also prevalent in the healthcare system which affects communication between health care and patient. This was demonstrated in a study conducted wherein stereotypes held by paediatricians were uncovered (Heidgerken, Geffken, Modi & Frakey, 2005). The results showed that the majority of doctors still subscribed to Kanner’s outdated model wherein autism was synonymous to childhood psychosis (Heidgerken et al, 2005). The belief that aberrant behaviours were purposefully undertaken in an attempt to be non-compliant rather than being a genuine symptom of a developmental disorder was also evident, increasing intolerance and impatience in their delivery of care (Heidgerken et al, 2005). Additionally, despite current studies indicating autism is largely genetic in origin, doctors maintained a belief that ASD stemmed from neglectful parenting, admitting to perceiving and even treating parents in a negative light (Heidgerken et al, 2005).

The self-stigma induced by living with autism often arises from an incessant awareness of otherness to the neurotypical population, with notable flaws such as social ineptitude, overstimulation and unsuitable responses being a part of everyday life (Clements, 2005). These challenges often leave ASD people to be fundamentally prone to significant impacts on mental health such as depression and anxiety (Clements, 2005). In particular sensory overload can often leave ASD individuals maintaining a higher baseline of anxiety and stress than a neurotypical individual (Sicile-Kira, 2006).

ASD typical behaviours can also prompt discriminatory behaviours from parents or close peers wherein the individual is prompted to isolate themselves from others both due to their perceived inconvenience, as well as a superficial adherence to the concept of independence (Clements, 2005).

A lack of understanding of ASD has also led to the vulnerability of people with autism to be the targets of bullying, particularly in schools. The prevalence of ignorance and bullying within the schooling system has contributed to the perception that autism is something to be pitied, simply tolerated and ashamed of (Sicile-Kira, 2006).

It is a professional responsibility for nurses to communicate effectively with patients to promote positive health outcomes (Levett-Jones & Bourgeois, 2014). Communication between healthcare provider and patients with autism can present challenges for a number of reasons such as sensory perception and preferred forms of communication (Bevan-Brown & Dharan, 2016). For example many people with ASD can become over-stimulated by sensory stimuli that neurotypical individuals easily ignore (Sicile-Kira, 2006). Due to this hypersensitivity ASD individuals are stigmatized by healthcare providers, being seen as slow to respond and can quickly become agitated or distressed in high stimuli environments (Sicile-Kira, 2006). Additionally, preferred communication is often not verbal in form. For example ASD individuals may prefer visual mediums such as makaton, a simplified form of sign language (Bevan-Brown & Dharan, 2016).

Since many derogatory misconceptions are held towards ASD individuals, the professional responsibility of facilitating partnership with clients is hindered (Heidgerken et al, 2005 & Wepa, 2015). For example the non-normative behaviours and communication methods commonly exhibited by Autistic people can be viewed as an annoyance by healthcare professionals (Heidgerken et al, 2005). In order to maintain the nursing role of treaty partners, communication with Autistic patients should ideally be delivered in a low-stimulus environment with whatever form of communication is most preferable to them (Levett-Jones & Bourgeois, 2014 & Wepa, 2015). This validates the patient’s needs and promotes a level of comfort that is conducive to both effective communication and positive health outcomes (Bevan-Brown & Dharan, 2016 & Tilmouth & Pavord, 2013).

In some severe cases of autism individuals may not use any form of spoken communication and are termed non-verbal (Quinn, 2006). Depending on the level of other forms of communication, this can present an issue in obtaining consent as verbal consent cannot be given (Quinn, 2006). While many healthcare delivery practices can be given with implied consent, verbal or written consent may be unavoidable, necessitating problem solving around non- verbal patient’s consent (Burgess, 2008).

With the justification of bodily autonomy, individuals with debilitating symptoms of autism have rights to make their own medical decisions (Bevan-Brown & Dharan, 2016). This raises the ethical conflict of non-maleficence wherein the depth of cognition in severe cases may not be adequate in formulating decisions or giving informed consent (Burgess, 2008). This discourse has unfortunately perpetuated the stigma that Autistic people are lesser humans, propagating the view that ASD individuals do not deserve to have bodily rights (Brewer & Murphey, 2016 & Silberman, 2015).

Although the mechanism underlying ASD is not understood, the use of psychotropic medication remains one of the most common ways to manage symptoms (Bevan-Brown & Dharan, 2016). One of the most frequently used medications is Risperidone, which is an atypical antipsychotic (McKenna & Lim, 2016). This class of drugs works by binding to dopaminergic and serotonergic receptors in the brain inhibiting the transmission of action potential through the central mesolimbic pathways and mesocortical pathways, which are thought to be structurally aberrant in ASD individuals (Kaustubh et al, 2018 & McKenna & Lim, 2016). These aberrant neurological features of the brain have contributed to nursing practice by implementing pharmacological interventions as treatment (Kaustubh et al, 2018).

From a psycho-social perspective, Autism has a distinct neurological dysfunction wherein other people’s views of reality often cannot be distinguished as separate to their own perceptions (Tager-Flusberg, 1999). This manifests socially as the assumption of ASD individuals that others will understand their thoughts without necessarily having to explain them, increasing the frequency of miscommunication (Tager-Flusberg, 1999). This has influenced nursing practice wherein investigative questioning when communication between provider and ASD individuals seems unclear becomes routine (Bevan-Brown & Dharan, 2016 & Tilmouth & Pavord, 2013). This neurological difference can negatively impact mental health, as ASD individuals often see the thoughts and behaviours of the neurotypical population as being puzzling, leading to anxiety and paranoia towards a never-ending navigation of social uncertainty (Tager-Flusberg, 1999). Related to this, ASD psychology and interpersonal behavious can be further understood by the phenomenon that structured social play such as turn-based games is feasible in contrast to reciprocal conversation, demonstrating that the uncertainty of external minds is a main contributor to the ASD’s social deficit (Lord, 1993). For this reason Makaton is an utilisable tool that is sometimes used in nursing practice, which eliminates the necessity of overly complicated verbal communication (Bevan-Brown & Dharan, 2016).

Personal attitudes, values and beliefs surrounding different groups of people impact the way healthcare is delivered in a clinical setting (Levett-Jones & Bourgeois, 2014). It is a personally held belief that Autism is not necessarily disadvantageous in nature with many of the perceived adverse aspects being mainly due to societies’ restricted parameters of acceptable ways of being. ASD from a personal perspective is a highly respectable and beneficial form of neurological being for several reasons. From personal experience ASD individuals tend to interact with others out of sincere enjoyment rather than pressure from social convention, pursue their passions and interests without compunction or reserve and are capable of expressing genuine thoughts to others without the restriction of conventional manners. On reflection this has led to the belief that ASD individuals are generally more authentic and trustworthy in their genuineness than the neurotypical population, and that communication in general would be aided by this level of intrinsic sincerity. Additionally, I respect ASD typical mindsets, as their lack of adherence to social traditions is not spawned from a petty form of defiance to neurotypical norms but is rather considered to be their default normal.

My lack of appreciation for the struggles of individuals with ASD was challenged in practice when a 56 year old European M=male was admitted with per rectal (PR) bleeds, and was non-verbally autistic. Through delivering care to this man, I noticed that my previously exalted view of ASD individuals was not extendable to this patient. After this experience I have harboured a greater appreciation of the struggles experienced by those with ASD and those around them.

An organisation founded in 2005 called Autism Speaks has undertaken a number of campaigns in an attempt to reduce stigma towards the ASD community (Autism Speaks, 2018). A prominent promotion by Autism Speaks is global autism day which promotes acceptance and raised awareness of ASD (Autism Speaks, 2018). Though this campaign has raised awareness of Autism as a condition, little evidence has been produced that demonstrates stigma towards ASD is decreasing as a result (Silberman, 2015).

When comparing literature discussing Autism there is a stark difference when considering the date of publication, namely the modern understanding of ASD in contrast to Kanner’s model (Silberman, 2015 & Kanner & Eisenberg, 1944). Modern literature has a more evidence-based and robust collection of scholarly works illustrating neurological and social differences as hallmarks of autism (Tager-Flusberg, 1999 & Bevan-Brown & Dharan, 2016). Contrastingly, Kanner’s study used a selectively bias, small population group and can therefore not be considered robust (Borbassi, 2015).

In summary, despite attempts to promote acceptance, stigma and discrimination towards ASD continues be a part of society’s behaviour (Brewer & Murphey, 2016 & Silberman, 2015). Self-stigma amongst autistic individuals continues to negatively impact their mental health, with their access to quality healthcare significantly hindered due to the outdated views still held by the healthcare workforce (Clements, 2005 & Heidgerken et al, 2005). Society’s attitudes of Autism continue to disparage their status and make them vulnerable targets for bullying (Brewer & Murphey, 2016 & Sicile-Kira, 2006). A greater awareness and understanding must be achieved in order to fulfil the nursing role of partner and protector in Aotearoa New Zealand (Autism Speaks, 2018 & Wepa, 2015).

 

Reference list:

 

Amanna, I., &Slifka, M. K. (2005). Public fear of vaccination: Separating fact from fiction. Viral Immunology, 18(2), 307-15. Retrieved from https://doi. org/10.1089/vim.2005.18.307

Autism Speaks (2018). DSM-5 diagnostic criteria. Retri eved from https://www. autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria

Autism Speaks (2018). World Autism day. Retrieved from https://www.autism speaks.org/what-autism/world-autism-awareness-day

Bevan-Brown, J., Dharan, V. (2016). Autism spectrum disorder in Aotearoa New Zealand: promising practices and interesting issues. Wellington, New Zealand: NZCER Press.

Borbasi, S., & Jackson, D. (2015). Navigating the maze of research: Enhancing nursing and midwifery practice (4th ed.). Sydney, Australia: Elsevier.

Brewer, R., & Murphy, J. (2016). People with Autism can read emotions, feel empathy. Retrieved from https://www.scientificamerican.com/article/ people-with-autism-can-read-emotions-feel-empathy1/

Burgess, M. (2008). A guide to the law for nurses and midwives (4th ed.). Auckland, New Zealand: Pearson.

Clements, J. (2005). People with Autism behaving badly. Philadelphia, PA: Jessica Kingsley Publishers.

Heidgerken, A. D., Geffken, G., Modi, A., & Frakey, L. (2005). A survey of Autism knowledge in a health care setting. Journal of Autism and Developmental Disorders, 35(3), 323–330. Retrieved from https:// doi.org/10.1007/S10803-005-3298-X

James, I. (2003). Singular scientists. Journal of the Royal Society of Medicine, 96(1), 36-9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC539373/

Kanner, L., & Eisenberg, L. (1944). Early infantile autism, 1943-1955.

Psychiatric research reports, (7), 55. Retrieved from https://www.ncbi. nlm.nih.gov/pubmed/13432078

Kaustubh, S., Kochalka, J., Shaer, M., Wakeman, H., Qin, S., Padmanabhan, A., & Menon, V. (2018). Deficits in mesolimbic reward pathway underlie social interaction impairments in children with autism. Retrieved from https://academic.oup.com/brain/advance- article/doi/10.1093/brain/awy191/5054337

Levett-Jones, T., & Bourgeois, S. (2014). The clinical placement: An essential guide for nursing students (3rd ed.). Sydney, Australia: Churchill Livingstone.

Lord, C. (1993). The complexity of social behavior in autism. In S. Baron-Cohen,

H. Tager-Flusberg, & D.J. Cohen (Eds.), Understanding other minds: Perspectives from autism Oxford: Oxford University Press.

McKenna, L. & Lim, A. G. (2014). McKenna’s pharmacology for nursing and Health Professionals (2nd ed). Sydney, Australia: Lippincott William & Wilkins.

Tager-Flusberg, H. (1999). A psychological approach to understanding the social and language impairments in autism. International Review of Psychiatry, 11(4), 325-334. doi: 10.1080/09540269974203

Tilmouth, T., Pavord, E. (2013). Mental health care a care worker handbook.Abingdon, Oxon: HODDER Education.

Sathyanarayana Rao, T., & Andrade, C. (2011). The MMR vaccine and autism: sensation, refutation, retraction, and fraud. Indian Journal of Psychiatry,53(2), 95-96. doi:10.4103/0019-5545.82529

Sicile-Kira, C (2006). Adolescents on the autism spectrum. Auckland, New Zealand: Random House.

Silberman, S. (2015). Neurotribes, the legacy of Autism and the future of neurodiversity. New York, NY: Penguin Random House.

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