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.

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 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 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 in­-patient and rehabilitation nurses who have heard about the success of the project. The doll population keeps growing and improving lives.

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.