Adult Behavioral Units Offer Multisensory Environment

Karen Hogan, DNP, RN, NE-BC, director of behavioral health and the Magnet® program at Cleveland Clinic Marymount Hospital, became interested in the utilization of multisensory environments (MSE) for adult patients with high anxiety years ago. While working for another healthcare system, she created an MSE room – a dedicated space where sensory stimulation can be controlled to reduce anxiety, promote relaxation and encourage communication – on an older adult behavioral unit. Later, she completed an evidence-based practice project on MSE rooms as part of earning her Doctorate in Nursing Practice.

When Hogan joined Marymount Hospital in 2018, the adult behavioral health (ABH) unit was undergoing renovations, providing the ideal opportunity to add MSE as a therapeutic intervention. “Because I saw improvements in patients in my previous position, I felt strongly that we should introduce a multisensory environment to our adult patients at Marymount,” she says. “If you can address and reduce a patient’s anxiety, the hope is that it won’t progress to agitation or aggression.”

With approval of hospital leadership, Hogan and clinical nurses on the ABH unit designed components for MSE rooms and worked with the construction company to modify architectural plans for their inclusion.

Calming rooms provide multisensory stimulation

Marymount Hospital has 74 beds in four ABH units, three for adults and one for geriatric patients. Three of the four now feature MSE rooms, which the hospital calls “calming rooms,” and a fourth one will be completed when the COVID-19 pandemic subsides.

Opened in the fall of 2019, the calming rooms offer the following:

• Visual Stimulation – Components include a 4-foot-long lighted tube with a moving stream of bubbles that change color and a projector that displays abstract or other soothing images on the walls.
• Tactile Stimulation – There are a variety of items for patients to hold, such as vibrating pillows, stuffed animals that vibrate with the sound of music, soft balls and gel-filled plastic shapes.
• Auditory Stimulation – Patients may listen to compact discs playing sounds from nature or soft, calming music.
• Aromatherapy – To stimulate the olfactory senses, essential oils in one of three scents – cinnamon, lavender or mint – can be placed in a diffuser.

“If a member of the caregiving team sees somebody who is pacing or showing high anxiety or early agitation, they can suggest the patient go into the calming room,” says Hogan. During the first visit, the caregiver shows the patient all of the options. Then, patients choose the stimulation mode that appeals to them.

“The caregiver’s only job is to facilitate the patient being in the room safely,” says Hogan. “This is the patient’s time, and it needs to be directed by the patient.”

One component in a comprehensive toolbox

Hogan trained clinical nurses and recreational therapists on using MSE during meetings and huddles, including information on the Brøset Violence Checklist, a violence prediction instrument. The lead recreational therapist provided individual hands-on training of the tools in the calming room. In addition, in September 2019 Hogan conducted a series of education on therapeutic programming with one session devoted to the use of MSE.

Hogan would like to conduct a study on the use of a multisensory environment for adult behavioral health patients. Her hypothesis is that MSE offers several benefits: “I see a reduction in seclusion and restraint, a reduction in PRN medication, a decrease in patient anxiety and agitation, and better patient understanding upon discharge on how to cope with anxiety.”

Anecdotally, Hogan has already witnessed how MSE has benefited patients at Marymount Hospital. Some who have difficulty expressing their feelings have been able to more calmly talk to nurses about their fears and worries while in the calming room, while others have reminisced about positive times in the lives. “One patient who had used the calming room a number of times before asked to use it again,” says Hogan. “When a patient can identify that they need a therapeutic intervention, that’s a really big victory.”

Hogan views MSE rooms as one part of comprehensive care that nurses can offer patients. “It takes a lot of creative ideas to help our patients cope with some of the trauma and fears they have,” she says. “MSE is one way of doing it, but there is no single way. It’s part of the toolbox that caregivers have to use.”