rly 4b percent of the patient population is considered to be geriatric -age 65 or older .... To better core for their geriatric patients, GMC nurses affiliated with Nurses Improving Core for Heolthsyslem Elders (NICHE), a notional geriatric initiative to improve lhe core of older hospitalized adults, began to research the use of alternative treatment methods, nome~/ baby doll therapy."
... =. ,: = · z x=r:t==ts::=·swrr ... .-• . -,. f<"C-*<1"--00 ... •-·v.>.,~ c-r~~·~.~::.~~·*:!~,. "According to GMC nurses Tomi underhill, R.N., BSN, and Sarah Evans, R.N., this mode of therapy involves the simple oct of offering a doll to a patient in need-of soothing, The approach may seem flu tty to some, but it works wonders with their patients, according to Underhill. "II is on effective therapy for improving dementia patients' quality of life," Underhill said . '11 is also one of the easier therapies, if not the easiest. to administer." "Baby dolls perform 11miracles" for Alzheimer! s patients every day. For some they bring bock wonderful, nurturing memories and feelings of coring for a small baby, others simply find it comforting to core for another, when their days ore mostly spent being cored for by someone else."
http:l/e.com/wotch?leot ure=ployer embedded&v= I X I zPVI41ZE. "Two ladies at an . .l\.lzheimer's care facility were in the later stages of aphasia-despite the staff's best efforts, the words out of their mouths appeared to be nothing more than gibberish, ma!cingno sense whatsoever. Sentences were not sentenceS: phrases were Wltelated words were not words. atleastin.anylanguagethatthe · staff recalled. Yet these two women would sit on a bench outside \vith their baby dolls and talk to each otherforhours, seemingly Wlderstanding every word, on topics of great importance to each other .. , .. One evening while making rowtds in the geriatric psychiatry wtit, 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 physcial 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 pillow case. When the patient received the doll she became calmer, smiled and hugged the doll. To the staf!s amazement, the positive effects continued. The patient became more cooperative during care, tests, and procedures. Her sleep improved, as did her social interaction with staff and peers. Shortly afterward she was discharged (Neuschotz, Green, & Matos, 2009, P. 36)."
APPENDIX G ORIGINAL PROJECT IMPLEMENTATION GUIDELINES A.PROJECT OVERVIEW: 1. Title: Baby Doll Therapy in Dementia Residents 2. Protocol summary: The condition of dementia exhibits itself in anxiety, agitation, and sleeplessness, inability to care for oneself, wandering, defiant and sometimes violent behavior, and other unsafe actions. Chemical restraints are often used to control agitated behaviors, but are not always effective and produce untoward effects. Doll therapy has provided purposeful activity that can help dementia residents feel useful. In most instances they are less agitated, sleep better, relate to others better, and have an over-all positive affect improvement. The PICOT question for this evidence based project is: :In female residents over 65 with moderate to severe dementia (P), how does exposure to baby-doll therapy (I) compared to no baby-doll therapy exposure (C) influence behavior (O) over a one-week period (T)? The project will be implemented using the framework by Rosswurm and Larrabee (1999) “A Model for Change to Evidence-Based Practice.” It is anticipated that approximately 16 female residents will participate in the implementation of the project. These participants will be identified by Dementia care center staff, per the developed criteria.
The dolls will be offered to the dementia residents following appropriate consent. Those who accept the dolls and treat them as real will be monitored by their caretakers on their perceptions of the impact of the dolls in six areas of behavior; activity/liveliness, interaction with staff, Interaction with other residents, happier/content, Agitation, and amenable to personal care. They will be evaluated on a five-point Likert-type scale with 5 being much more change and 1 being much less change. Results will be reported in descriptive terms and in table format. Case studies will be reported. If successful in modifying untoward behaviors, the use of dolls will be considered for continued use by the Hospice staff. Evaluation of feasibility will be conducted through family and staff involved with implementation. 3. Project Lead: 1) Barbara Braden, NP-C, FNP Student, University of Toledo 4. Collaborators: 1) Nursing Director, Dementia care center 2) Staff of the Dementia care center 3) Family members/Guardians of select residents at Dementia care center 5. Team members: 1) Project Lead 2) Director of Nursing 3) Family Members/Guardians 4) Additional personnel as indicated
6. Scope: The scope of this Guideline includes elderly female dementia residents, administrative personnel, healthcare personnel, and caretakers, engaged in the care of the dementia residents. 7. Ethical/legal Issues: Even though this Project is evidence-based and does not require an Internal Review Board (IRB) it is always good practice to have the Board review and approve the Project for future efforts. An application will be made to the IRB at the University of Toledo. The literature shows little if any adverse effects of instituting baby doll therapy. Therefore, ethical/legal issues are not discussed in this Protocol. There were no safety issues related to the use of doll therapy in the literature. B. INTRODUCTION: 1. Current State of Knowledge According to Medical Subject Headings (2011), dementia is defined as, “An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness (p.1).” Groulx (1998) opines that this type of behavior may be the result of internal physical or mental problems such as pain or unmet needs, and residents will respond best to attentive and respectful care by care providers and family members.
Verity and Kuhn (2008) opine that one of the biggest needs for seniors who have led a productive life is to feel needed and useful. Higgins (2010) states that baby doll therapy can provide purposeful activity that can help dementia residents feel useful. Spenser (2009) states, “Surprisingly, an "Alzheimer's baby" helps someone with dementia feel like a functional adult (not a patronized child). And that brings feelings of satisfaction, pleasure, calm, and accomplishment. Cuddling a doll soothes and entertains, reducing aggression. Pretty good, as dementia activities go (P. 1).” Outcomes of baby doll therapy with dementia residents have shown increased activity and focus, improved communication when carrying a doll, improved attitude towards other residents and caretakers, decreased agitation during routine care, keeping the resident’s hands occupied, and they are less likely to do harm to themselves. 2. Justification for the Study: Historically, the treatment of dementia was the use of devices and techniques that restricted and restrained the movement of residents. The restraints were used to keep the resident safe from self-harm and accidental injury and to save money and staff -resources. Over time the use of restraints has increasingly been viewed both as undesirable and abusive. As a result chemical restraints to control agitated and other unsafe behavior are being used with dementia residents. Use of chemical restraints, usually in the form of anti-psychotic medications, to control behavior is not always successful and increases the possibility of adverse side effects, to include death, and furthers digression of cognitive faculties. Groulx (1998) states there are several types of agitated behaviors in individuals with dementia that are not well-managed with pharmaceutical-therapeutics. Baby doll therapy has been shown to successfully control untoward behavior in elderly residents
with dementia but is not widely accepted in the United States. There is also no literature describing use of baby doll therapy in hospice residents with dementia. 4. Questions: PICOT: In female residents over 65 with moderate to severe dementia (P), how does exposure to baby-doll therapy (I) compared to no baby-doll therapy exposure (C) influence behavior (O) over a three-week period (T)? 5. Purpose: The overall aims of this Guideline are to: 1) Prevent long-term complications in elderly residents with dementia 2) Increase the resident’s self-confidence 3) Improve the resident’s behavior during routine and special care 4) Increase the resident’s social interaction with staff, family members, and other residents 5) Improve the resident’s participation in activities of daily living 6) Improve the resident’s sense of well-being 7) Decrease agitation and assist the resident in times of stress C. PROCEDURES AND METHODS: 1. Project design/locations: The design of the study is an evidence-based longitudinal cohort project of qualified residents under the care of The Dementia care center, Toledo, Ohio. A convenience sample of caregivers, and the dementia residents for whom they care, will be given the opportunity to volunteer to participate in the study. Potential residents will be identified by staff members of The Dementia care center as meeting the inclusion criteria.
2. Audience and stakeholder participation: An in-service on baby doll therapy and its functions will be given to all staff members of The Dementia care center on an individual basis, Follow-up training both in groups and as individuals will be done as indicated. Each of the caretakers of eligible residents will receive initial training about the Project and how to use the measurement instrument. 3. Introduction of baby doll: There are three ways in which baby doll therapy can be introduced to the elderly female dementia resident: 1) Offer a baby doll to the resident by handing it to them or holding it out to them 2) Leave several dolls on a table in an area accessible to the resident and allow her to pick one up.
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