Caring for children with autism : emergency and paediatric nurses’ and doctors’ knowledge, confidence and self-efficacy

Abstract

Background: Children with Autism Spectrum Disorder (ASD) frequently present to the emergency department with various healthcare needs and often require adapted, sensory aware and communication- sensitive care. However, evidence suggests that healthcare professionals may lack knowledge, confidence and self-efficacy required to provide optimal care. Objectives: This study examined paediatric and emergency nurses’ and doctors’ knowledge, confidence and self-efficacy in caring for children with ASD in a Maltese acute hospital. It also aimed to identify specific knowledge gaps to inform recommendations for targeted education and training. Design and Methods: A descriptive cross-sectional online survey was conducted with all nurses and doctors (n=357) working in the emergency department, paediatric emergency department and paediatric wards. Data were collected using the knowledge about Childhood Autism among Health Workers (KCAHW), the General Self-Efficacy Scale (GSES) and Self-rated Confidence. Descriptive statistics, non-parametric group comparisons and correlation analyses were performed. Results: A total of 131 participants responded giving a response rate of 36.7%. Participants reported moderate comfort with their ASD knowledge (mean 2.89/5), moderate autism knowledge (mean KCAHW 13.83/19) and confidence (mean 9.16/15), and moderate-to-high general self-efficacy (mean GSES 33.51/50). Doctors scored significantly higher than nurses on autism knowledge, while paediatric staff reported greater knowledge, comfort and confidence than emergency staff. Previous ASD-specific training and more frequent contact with autistic children were associated with higher comfort and confidence but not with general self-efficacy. Knowledge showed a moderate positive correlation with both iv comfort and confidence, whereas no meaningful association was found between knowledge and general self-efficacy. Conclusion: Emergency and paediatric staff in this Maltese hospital possess a basic understanding of ASD, but important gaps remain, particularly among emergency practitioners and those without ASD-specific training or regular exposure. It also showed that paediatric staff Structured, ASD-focused education and experiential learning opportunities are needed to strengthen competence and confidence and to support person-centred care for autistic children and their families.