How dolls can help patients with dementia - American Nurse Today

Practice Matters —
How dolls can help
patients with dementia
By Lori A. Neushotz, DNP, PMHCNS-BC, NP; Lorna V. Green, MSN, RN; and Patricia S. Matos, DNP, RN
ONE EVENING while making
rounds in the geriatric psychiatry
unit, a nurse manager heard a patient
crying in a little girl’s voice and pleading for her
mother and her doll. The patient had been admitted
from a nursing home because of physical and verbal
aggression and an inability to cooperate with care
(she had pulled out her feeding tube). The nurse
manager asked a mental health aide to make a doll,
using a pillowcase.
When the patient received the doll, she became
calmer, smiled, and hugged the doll. To the staff’s
amazement, the positive effects continued. The patient
became more cooperative during care, tests, and procedures.
Her sleep improved, as did her social interactions
with staff and peers. Shortly afterward, she was
discharged.
Baby dolls bring new life
to dementia patients.
Doll benefits
After that episode, the nurse manager kept thinking
about how to use dolls as a therapeutic intervention
with patients on the geriatric psychiatry unit. She and
her staff searched the literature and discovered several
articles supporting the use of dolls as a therapeutic
intervention to calm agitated patients. The staff then
developed and implemented a unit-based quality initiative
to comfort agitated geriatric patients by offering
them dolls. The director of nursing supported the
initiative and approved the budget to buy dolls.
In October 2007, we bought six dolls. The therapeutic
benefits for patients who accepted dolls were
immediate, and since then, we have bought many
more. Our dolls are lifelike baby dolls and reflect
the diverse, multicultural patient population at our
hospital.
The dolls have helped improve patients’ mood and
affect, increased their cooperation with feeding and
toileting, and improved their interaction with staff. To
monitor the impact of dolls on levels of agitation, the
staff began to document their observations in a log
book. The dolls have also been beneficial when used
as vehicles to explore patients’ histories.
All disciplines are now enthusiastically involved in
the doll project. The unit’s attending physician commends
the nursing staff for improving the quality of
life for patients in geriatric psychiatry.
And staff members note that
the dolls have a positive effect on
them, too. As one said, “We even have our own
dolls…they make you feel good!”
When some family members expressed concern
about using dolls to treat adult patients, the staff developed
an informational handout, describing the therapeutic
benefits. After experiencing the positive effects
the dolls have on the mood and behavior of patients
suffering from dementia and other psychiatric disorders,
many families have expressed their gratitude to
the staff. At discharge, many patients and families ask
to take their doll home.
Future of dolls
After hearing anecdotal observations of the project’s
benefits, our chief executive officer and chief nursing
officer suggested conducting research to compare rates
36 American Nurse Today Volume 4, Number 8 www.AmericanNurseToday.com

colleagues, patients, and families. The doll project
was also highlighted at our hospital’s recent Magnet
redesignation survey. And we continue to receive
requests for collaboration from general medical inpatient
and rehabilitation nurses who have heard
about the success of the project. The doll population
keeps growing and improving lives.
✯
Geriatric psychiatry unit staff at The Mount Sinai Medical Center,
New York, New York.
of p.r.n. haloperidol administration between patients
who accepted a doll and patients who didn’t. The research
proposal has been submitted to the institutional
review board and is pending approval.
For Nursing Research Day in November 2008, the
staff exhibited a poster outlining the project, and it
generated tremendous interest and enthusiasm from
Selected references
James A, Mackenzie L, Mukaetova-Ladinska E. Doll use in care homes
for people with dementia. Int J Geriatr Psychiatry. 2006;21:1093-1098.
Jeste D, Caligiuri M. Tardive dyskinesia. Schizophr Bull. 1993;19:303-315.
Miller RJ, Snowden J, Vaughan R. The use of Cohen-Mansfield agitation
inventory in the assessment of behavioral disorders in nursing
homes. J Am Geriatr Soc. 1995;43:546-549.
Remington R. Calming music and hand massage with agitated elderly.
Nurs Res. 2001;51(5):317-323.
Spira A, Edelstein B. Behavioral interventions for agitation in older adults
with dementia: an evaluative review. Int Psychogeriatr. 2006;18:195-225.
Sugarman A, Williams B, Alderstein A. Haloperidol in the psychiatric
disorders of old age. Am J Psychiatry. 1964;120:1190-1192.
Lori A. Neushotz is manager of performance improvement, education, and research;
Lorna V. Green is a clinical nurse manager; and Patricia S. Matos is director
of nursing in psychiatry. All three work in the Department of Psychiatry at The
Mount Sinai Medical Center in New York, New York. The staff thanks the Cullman
Institute for generous funding of the doll project.
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