NURSING AT McLEAN

Understanding sensory stimulation

by Lesley Adkison, RN, MSN

'Sensory stimulation' is a term that refers to interventions designed to stimulate one or more of the five senses. Sensory stimulation interventions are designed to promote self-soothing when used by agitated or distressed individuals. Until recently, the use of sensory interventions was mainly seen in Occupational Therapy. As part of an ongoing effort to reduce restraints and seclusion, the Department of Mental Health (DMH) began to explore sensory stimulation techniques as a way to decrease agitation and stress prior to, or instead of, restraining patients in psychiatric settings. As a result, sensory stimulation has hit the mainstream, and we're all beginning to understand more about it.

Sensory therapy has been widely accepted in Europe for some time. While there are many variations on the concept of the sensory room, the prototype came from the Netherlands. A Dutch company designed Snoezelen® rooms in the mid-1970s for use with a variety of populations, including dementia clients, children with pervasive developmental disorders, and brain-injured clients. "Snoezelen®" is a term originating from two Dutch words meaning to sniff and to doze. Snoezelen® rooms use controlled, multi-sensory stimulation to help clients calm themselves. Aroma therapy, sand trays, weighted blankets, murals, and a variety of other tactile and visual objects provide sensory stimulation. Clients can choose the stimuli they find useful, and that information is recorded on sensory diet cards. That information is readily available to staff and clients in the event of emotional distress.

Getting a sensory room up and running is more difficult than you may think. Identifying space and obtaining appropriate items for the room present distinct challenges. McLean Southeast (adult inpatient unit) and South Belknap II (dementia unit) have completed the process, and each approached the task differently.

McLean Southeast uses sensory stimulation in two ways. One is a sensory room that doubles as a quiet room. The space is easily transformed from a quiet room with the help of soothing music, a bedspread, and a rocking chair. Unfortunately, sometimes patients are admitted to that room (late-night admissions, need for a single room) and may not want to leave the comfort of a room that's more tactually pleasing than others on the unit. Joan Kovach, RN, nurse director for MSE, cleverly worked around this problem by creating a sensory room on wheels that can be transported to various locations on the unit. The experience is different from the sensory room but equally valuable in that clients can choose their sensory tools and a location that feels safe and comfortable. Says Kovach, "We know there are many ways to help people get better, and everyone has different ways of learning and processing. Sensory stimulation has the potential to help people in ways that talking therapy and medication may not, using other portals to achieve self-soothing, understanding, and relief of symptoms. It's exciting to see how staff incorporate this intervention into their work with patients."

Weighted Blanket

Kareen Eka RN models the "weighted blanket". With 20 lbs. placed inside the blanket, some patients describe the experience as "grounding", "feeling safe", or "containing".

South Belknap II, the Geriatric Neuropsychiatry Unit, works exclusively with dementia patients. The unit has a dedicated sensory stimulation room with special equipment that can't be removed from the space. Patients have access to a sound machine, a soft toned lamp, a weighted blanket, a sand tray, and a lighted ball that they use under staff supervision. The room is small, seating two or three people comfortably. Intimacy is part of what makes the room work. Patients may come to the sensory stimulation room if they show signs of stress or agitation. Staff may notice a patient is unable to tolerate the milieu and offer to bring him to a quieter room where he's encouraged to engage in an activity of his choosing. If a patient has a history of escalating behavior at a certain time of day, staff may proactively take her to the sensory room and engage her in an activity until the anticipated time of disruptive behavior has passed.

Outside the sensory room, patients have access to other sensory-based experiences through: tactile equipment (e.g., balls, clay, a parachute game); an aquarium for visual stimulation; artwork that allows patients to reminisce about the past; and pets for tactile stimulation.

How does sensory stimulation work? Or for that matter, does it work? McLean Southeast and South Belknap II are currently trying to find out. We've been working with the Institutional Review Board to facilitate a study on the use of sensory rooms to obtain data on whether sensory stimulation shows a measurable effect on two populations: cognitively intact adults under 65 years of age with mood disorders and/or psychotic disturbance, and adults diagnosed with dementia.