Fetal Alcohol Syndrome Disorder (FASD) and Autism Spectrum Disorder (ASD) are two of the most common developmental disabilities (DD) and neurodevelopmental disorders. As stated in the DSM-5, neurodevelopmental disorders generally co-occur which will be discussed and shown amongst similarities between FASD and ASD. Children with FASD are known to exhibit symptoms similar to ASD. Despite these two developmental disorders sharing similarities, they are two separate DD’s, and need to be acknowledged as so.

Diagnostic Criteria

The DSM-5 states that for neurological disorders, the clinical presentation requires symptoms of delay, excess and deficits in achieving developmental milestones (i.e. social communication). For one to be diagnosed with ASD, they must show a deficit and delay in social communication and interaction skills. Another major diagnostic criterion for ASD would be the presentation of repetitive patterns in regard to interest, activities and behavior (American Psychiatric Association, 2013).  ASD has four severity levels: mild, moderate, severe and profound, whereas FASD has subtypes (Partial Fetal Alcohol Syndrome, Alcohol-Related Neurodevelopmental Disorder, and Alcohol-Related Birth Defects). The severity of ASD is dependent on the social communication impairments and restricted, repetitive behavioral patterns (American Psychiatric Association). Hoyme et al. (2006) state the main diagnostic criterions for FASD include facial phenotypes, central nervous system damage and dysfunctions, growth deficiency, as well as alcohol exposure before birth. They also expressed some concerns with FASD’s diagnostic criteria due to it being too vague and not assessing family and genetic history adequately. Hoyme et al. believe that diagnosing FASD would be easier if it included precisely defined diagnostic categories, operationally defined terms, as well as the emphasis of genetic and family background.

Phenotypes

Medical Phenotypes

FASD’s medical phenotypes include, but are not limited to, growth deficiencies and brain structural abnormalities. The physical phenotypes of FASD are small palpebral fissures, smooth philtrum, inner canthal distance, and a thin upper lip (Astley & Clarren, 1996). They believe that a frontal facial photograph can define FASD by acknowledging the physical phenotypes.

ASD has similar medical phenotypes in terms of brain structural abnormalities, however, when it comes to physical phenotypes; ASD does not have as specific of a list. The DSM-5 states that both individuals with FASD or ASD have a higher probability of also being diagnosed with other emotional, mental and behavioral disorders such as depressive and bipolar disorders, anxiety disorders, stereotypic movement disorder, and attention-deficit/hyperactivity disorder. It is important that professionals keep an eye out for associated medical conditions such as cerebral palsy, and seizure disorders in those with neurodevelopmental disorders (American Psychiatric Association).

Behavioral Phenotypes

Individuals with ASD are much more likely to not make friends in comparison to those without ASD (Orsmond et al. 2013). They believe that this is a result of low conversation ability, a deficit in functional skills, and having parental or community supports due to their disability. Simonoff et al. (2012) believe that the lack of mood regulation in those with ASD is another reason for their lack of relationships. Simonoff et al. describe severe mood problems as high levels of irritability which is presented through temper tantrums, as well as severe and prominent mood abnormalities, hyperarousal and increased reactivity to negative emotional stimuli. Those with FASD also face the difficulty of building and maintaining social relationships due to their similar social deficits.

Individuals with FASD and ASD share a variety of behavioral phenotypes which include, but are not limited to, social deficits, a higher risk for educational disabilities, and difficulties achieving developmental milestones (Shields, B., Wacogne, I., & Wright, C., 2012). Those with FASD are more likely to become individuals with addiction in comparison to individuals with ASD. They are also more likely to become more involved in criminal activity. Astley and Clarren stress that those who have been diagnosed with FASD will live a lifetime with physical, intellectual, cognitive and behavioral disabilities; similar to those with ASD.

Models of Service Delivery

A large piece of support for individuals with either FASD or ASD is educational assistance. This can be specific to an educational assistant in the classroom or being placed in a learning environment specific towards learning and developmental disabilities. Unfortunately, due to funding cuts in the educational field; these supports are not always available to those who need them, and then the individuals with disabilities such as FASD or ASD tend to have more difficulties within the classroom and in their social skills.

Sansosti (2013) worked as advocates for individuals with ASD and found that effective school-based services include development implementation, evaluation of instructional strategies, and constant information and assistance from school psychologists. They state that due to the growing numbers of students with ASD, these services and supports need to be more accessible and stable for students in order to achieve and promote academic success.

A common service delivery for those with FASD include prevention services and family empowerment networks. Wilton & Plane (2006) analyzed and implemented a family information, referral and support network for those affected by FASD. This network can be used by the children or families and provides educational training to those who are interested. They state that it is the responsibility of health professionals to not only recognize those at risk of FASD, but to refer families to the appropriate intervention services to ensure the safety and development for those involved. They discuss how mothers of those with FASD face a lot of shame and stigmatism, and how although those feelings are understood; they do not help the current problem, and we need to focus on the prevention measures rather than blaming.

Similar to Wilton and Plane, the Government of Yukon proposed an FASD prevention service model in 2014. This model was created and implemented due to the prevalence in Aboriginal populations. This project will assist governments and health care professionals to bridge together in hopes of preventing FASD in children, and further educating mothers, families and others in this disability. They have similar beliefs to Wilton and Plane, and state that by addressing this growing concern immediately will allow for a more understanding, helpful and supportive environment for those involved.

Evidence-Based Interventions

All patients have the right to effective treatment, and this is a core principle of behavior analysts. The Behavior Analyst Certification Board states that Applied Behavior Analysis (ABA) is one of the more effective interventions for ASD, and this is due to the direct observation, functional analysis, and measurements between behavior and environments. ABA is reliant on empirical support and is a successful correction of main deficits within ASD, and acts as an assistant for restoring abilities. This form of intervention is also effective in those with FASD due to the similarities the two disorders share in deficits. Tools such as social stories, token economies, and modeling are used to reward a client’s accelerate behavior (i.e. completing schoolwork), as well as rewarding the absence of a decelerate behavior (i.e. temper tantrums, or off-task behavior).

Conclusion

Although FASD and ASD are two separate developmental disabilities; they have similar social and educational deficits which means that they can be treated similarly depending on circumstance. Both require educational support for those involved, and through education we can support families and individuals with these disabilities. A lack of information can lead to discrimination, stigmas and ineffective treatment for those with developmental disabilities.

It is important to ensure that regardless of the disability, the client is always receiving the most effective and responsible treatment, and that if the treatment is no longer effective; it is to be eliminated immediately. Individuals with FASD and ASD will need constant support whether it is empathy from loved ones, educational assistance, or behavioral analysts.

Together, professionals can work together to assure the effectiveness and rightful treatment of clients with developmental disorders. This can be through treatment implementation, public educational workshops, support networks, and proper screening, diagnoses and referrals.

References

• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text Revision)
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The aim of this essay is the critical evaluation of adverse events in the acute environment. Adverse event (AE) can be defined as an unattended and harmful effect which is caused by healthcare management that has or may cause harm to patient/s and result in prolonged hospital stay, disability or death (Wyeth, 2014). AE impose a huge financial burden on the healthcare system HCS and question the quality of care of the patients. AE is not caused by the mistake done by a single person who is involved with the direct cares of a patient but might be the conditions in the whole system that let the AE to occur (Raftar et al., 2014). Falls, medication errors, pressure sores and infections are different types of AEs that put patients at risk and place a huge burden on the HCS to resolve these issues (Kang, Kim, & Lee, 2014). AE chosen for this essay is hospital acquired infection (HAI). This essay will also talk about the prevalence of HAIs in healthcare and how it effects the patients, their families and the HCS itself. Two strategies involving interprofessional practice to prevent HAI in the hospital setting are also going to be explained in this essay. This essay will also show light on some of the barriers in the achievements nursing strategies to prevent HAI in the hospital setting and discuss the various approaches to overcome such barriers and prompting patient safety.

HAI is also known as nosocomial infection that is the major safety concern for patients admitted in hospital and results in morbidity, increase in deaths and put health care system into financial pressure. There are approximately 200,000 HAIs occur in Australian hospitals each year that shows it is the most common complication effecting patients (Mitchell, Shaban, Macbeth, Wood, & Russo, 2017). HAI is defined as an infection acquired by a patient during the hospital stay when he/she admitted in the hospital for another reason rather than infection. These infections appear after hospital discharge and also occupational among hospital staff. (Kadri, 2014). Different types of HAIs are urinary tract infections, surgical site infections, bloodstream infections, lower respiratory infections to name a few. HAIs occur because of microorganisms transmit from an infected person to a non-infected person through personal contact, air droplets, contaminated food, medicines, equipment, water and so on (Fernando, Grey, & Gottlieb, 2017).

Patients and their families often get emotional stress caused by HAIs lead to prolonged hospital stay, disability, reduced quality of life, readmissions, loss of job and fear of death (Kadri, 2014). Medicare costs are increased by HAIs both during hospital admission and subsequent health care that leads to financial stress as Medicare may not cover when a patient has consumed a specific coverage threshold (Coomer & Kandilov, 2016). Surgical infection is one of the HAI occurs up to two years of surgery is mostly acquired during the surgery cause suffering to the patients and leave negativity impact on their lives. Devices used to drain fluid from the surgical wounds in these cases can be socially embarrassing for the patients (Moore, Blom, Whitehouse, & Gooberman-Hill, 2015). Depression and anxiety can also be seen among the patients who are on contact or isolation precautions. Patients feel neglected and discriminated when they have less contact with nurses and family members (Landelle, Pagani & Harbarth, 2014).  In the situation of loss of physical function patients become dependent on partner or family members that put burden on the caregivers that brings psychological stress to the patient like loss of dignity and independence. Loss of income because of sudden disabilities as a result of HAIs put the patients in financial difficulties (Moore et al., 2015). Antibiotic treatment of HAIs cause side effects like diarrhea, allergic reaction and vomiting may lead to social isolation due to embarrassment and humiliation (Guillemin et al., 2014).

Infection Prevention and control (PAC) is a continual struggle as medical treatment has become more invasive and ageing and immune comprised population continue to increase. There is financial burden on HCS due to allocating resources and the funds to treat patients from HAIs and to make strategies to prevent HAIs (“Australian Safety and Quality Goals for Health Care | Safety and Quality”, 2018). Surgical site infections, central venous catheter associated infections and catheter associated urinary infections are the most common infections causing financial burden on the hospitals. Different types of costs include medical service, medications, material and compensations to the patients due to the unintentional harm caused in the form of HAIs (Fernando, Gray & Gottlieb, 2017)

The role of nurses is very important in PAC of infections in their daily activities when they look after patients. It is the responsibilities of nurse to make sure that quality care is being provided to the patients by following the appropriate practices to save the patients from HAIs. According to the National Competency Standards for the Registered Nurses in Australia, a nurse should have basic competencies on skills, knowledge and attitude to provide safe and competent care (Liu, Curtis, & Crookes, 2014). Two nursing strategies involving inter-professional practice for this essay are hand hygiene (HH) and the use of Personal Protective Equipment (PPE) for PAC of HAIs. Inter-professional practice includes different healthcare professional such as physician, nurses, dieticians, pharmacists, environment physicians, physiologist, nutritionists and so on that are involved in the patient care for various reasons or care needs during their hospital stay. So, the role of their inclusion       is important for effective Infection PAC strategies (Nester, 2016).

It is recommended by the World Health Organization (WHO) that HH is the effective way to prevent HAIs. HH is defined as any action of cleaning of hands. Hands are common source of transmission of organisms and therefore HH is a significant approach to prevent infection passing from one person to another. HH is washing hands with soap and water, use of alcohol-based hand rub (ABHR), no artificial nails, trimmed fingernails with no nail polish and avoiding wearing long sleeve clothing to prevent infection transmission through hands (Mehta et al., 2014). The presence of microorganism is reduced when HH is performed correctly and it also promotes infection prevention. Five moments of HH recommended by WHO guides healthcare professionals to when, why and how to perform HH (Wyeth, 2014).

The other aspect of standard infection PAC strategies is PPE. PPE are the equipment used to protect self and to minimise the risk of transmission infectious organism in the healthcare setting. Gloves, apron, facemask, gowns, shoe covers, goggles and eye protecting items are included in PPE (Lamb, 2013). HCPs should have the knowledge about PPE items when caring patients with various health conditions to prevent infection. Nurse and other healthcare professionals are expected to follow the hospital guidelines to prevent PAC infection at the time of cleaning body fluids and blood spills, specimen collection, collecting and handling used equipment and instruments. To follow the correct sequence of putting on and removing PPE is highly important to reduce the risk of unintentional exposure to microorganism causing infection (Liu et al.,2014). Educating the staff to help assessing the risk associated to the task and select appropriate PPE wisely will save from potential exposure to the infectious agents and promote self and patient safety


(Wyeth, 2014.) Provision of PPE such as gowns, mask and gloves outside the patient’s rooms who are isolated or are under contact precautions, clear signage of using appropriate PPE on the doors of the rooms and educating visitors to use appropriate PPE like mask for the patients under droplet precautions can help in infection PAC (Barker et al., 2017). Providing education to the staff about appropriate positioning of PPE in the clean dry places and using PPE dispensers, avoid decanting PPE will save decontaminating of PPE and prompt safety (Lamb, 2014).

There are some barriers in implementing the above two chosen strategies for PAC of HAIs that includes lack of knowledge in basic infection PAC practices, inexperienced staff, incorrect use and disposal of PPE, lack of hand washing bays, language proficiency, nurse to patient ratio and so on (Barker et al, 2017). There is not enough awareness among the nurses about the standard precautions like HH and PPE. In previous study majority of nurses expressed that the use of gloves replaces hand washing. The reason of this perception could be lack of work experience and previous trainings (Kang, Kim, & Lee, 2014). Inappropriate use and disposal of PPE increase risk of infections among staff and patients. Barriers for HCPs being non-compliant in using PPE includes incorrect fitting, insufficient knowledge, availability of PPE, skin reactions, workload and so on (Wyeth, 2014). Another barrier in infection PAC strategies such as HH and PPE is language. Limited language proficiency and experience issues to understand terminology used in health care setting are seen in the HCPs from non-English speaking countries (Travers et al., 2015). Studies have shown that the terminology related to HH has been interchangeably used like hand disinfectant, hand washing, hand rub ABHR and hand sanitizer which can be confusing for the HCPs with limited language skills (Pires, Tartari, Bellissimo-Rodrigues, & Pittet, 2017). Another barrier is nurse to patient ratio that affect to carry out routine infection PAC strategies because of excessive work load (Traver et al, 2015).There are also some other barriers in infection PAC to minimise HAIs such as lack of hand washing bays and unavailability of ABHR (Mehta et al., 2014).

To overcome the above barriers there are different methods which can be helpful to infection PAC such as on job education and training to the new staff, provision of  basic knowledge about HH such as HH Australia handout explaining five moments of  HH with written and visual description and access to  infection control units to obtain required information. Another strategy is to educate hospital staff about how and when to use PPE and appropriate method to remove and disposal of gloves (Lamb, 2013).The role of hospital management staff is also very important to address the issues like provision  of more sinks and ABHR dispensers, sufficient supply of HH and PPE products, fast access to dermatologist in case of skin reaction, monitor staff work load to ensure the staff get enough time to comply with hygiene policies. Posters and signage at various locations tokens of appreciation like cups, water bottles, officials notice, and emails can help to motivate staff for HH and PPE use (White et al., 2015). Empowering patients to participate in their care can also be beneficial for infection PAC strategy. National Patient Safety Agency initiated Cleanyourhands campaign and the aim of this campaign used to encourage patients to ask healthcare professionals if they have performed HH before providing them care is a good example of patient empowerment (Seale et al., 2015). There are also other strategies such as pictures, colour coded messages clear and simpler readings and educational sessions will help HCPs from diverse cultures, languages and different educational levels to develop their knowledge about HH and the use of PPE (Travers et al., 2015).

To conclude it can be said that this essay fulfilled the aim of critically evaluating the adverse events in the acute environment. The chosen adverse event in this essay is HAI and the prevalence of HAI in Australian hospital setting is discussed as well. This is also highlighted how an AE affects the patient and their families in terms of emotional stress because of prolonged illness or disability caused by HAIs, change in physical appearance and financial burden. Besides of that, it has also been discussed how the healthcare system bear the financial burden resulted from HAIs such as facing legal complaints lodged by patients and their families, cost of prolonged treatment of patients and use of resources. Critical evaluation of the chosen two strategies of HH and PPE is also discussed in this essay. The role of the Interprofessional practice and the barriers to implement these strategies are also identified. The different strategies to overcome these barriers to promote patient safety are also presented in this essay.

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