Specialised nursing - Essay Example

The presentation of depression of people with autism, which is a pervasive developmental disorder, is coloured by the underlying disorder, considerably altering the manner in which it presents (Munden and Perry, 2002, 13). Nursing assessment, diagnostic process, care plan, and care delivery would thus be very complicated. The clinical presentation further complicates the already existing difficulties in communication. There is a necessity of increased nursing knowledge base to ensure people with autism receive a prompt diagnosis and appropriate treatment (Stewart et al.

, 2006, 103-116). Mr. John has been admitted to the hospital with a diagnosis of gastric cancer. Therefore, it is expected that he has presented in an advanced stage, where palliative surgery is the only means of treatment, and the outlook is poor. His understanding about his condition would be poor. The nurse who is left with his care has several challenges. Most important is his inability to communicate. The patient remains conscious about that, and as a result becomes anxious. The basis of nursing in his care would depend on social exchange between him and his nurse.

However, the social impairment is extreme, leading to situations where his well-defined needs may fail to be adequately considered. The classical triad of impairments in him would be social relationship, social understanding, and imagination and social communication. These patients are often extremely anxious in an unfamiliar environment, and from that angle, admission to a hospital is a very difficult issue to deal with. The nurse must be aware of this fact, and the problem may be further aggravated by failure to communicate (Valente, 2004, 236-243).

His advanced stage of gastric cancer needing palliative surgery places him in the need of palliative nursing care. Many autistic individuals need palliative care, and their care needs are different (Dell et al., 2008, 177-182). His palliative care need would need extra input from the nursing services. Palliative care is implemented for people with impending death, and being an autistic individual, his morbidity and mortality patterns, healthcare needs, presentation of symptoms, conceptualization of illness and death, and issues around education and training will be different.

Palliative care has been defined as active total care for patients whose disease is unresponsive to curative management. The nursing goal is to achieve the best possible quality of life for both the patient and his family. Being autistic exerts limitations in adaptive skill areas, such as, communications, home living, skills in social relations, self-care, academic skills, concepts in health and safety, and leisure and work. All these factors may influence his care (Tuffrey-Wijne, 2003, 55-57).

The associated depression in this patient is another problem. Depression frequently coexists but is very difficult to identify, since many of these patients are noncommunicative. Behaviours may escalate or patients may shut down, where the nurses must rely on their interpretations of their behaviours and the environment. The nurse must be aware about this possibility. The presentation depends on the patient's age, level of intelligence, and level of verbal skills. There may be history of crying spells, sad affect, increasing aloofness or social withdrawal, and disturbance of sleep and