In 2019, MU Health Care started a new unit at University Hospital called Integrated Medicine. It is staffed and equipped to meet the needs of patients who require medical care and also are not thinking clearly.
Along with doctors and nurses, the unit has milieu specialists, who are trained to calm patients suffering from dementia, delirium and mental health disorders. “Milieu” is defined as a person’s social environment, and MU Health Care’s milieu specialists learn about their patients’ history and interests to find the best ways to comfort them.
“One gentleman with dementia who I worked with had done machinery work,” said Sonya Willis, who worked as a milieu specialist on the unit for nearly two years before recently taking a job in human resources at MU Health Care. “We used something called fidget tools. One was a board that had a bunch of different latches and fasteners that you would have to manipulate to keep busy. It kept him from pulling at his IVs and tubes.”
Finding the right tool to calm each patient can be a challenge, but that task was made easier in August 2020 when the unit received a $10,000 grant from the MU’s Division of Hospital Medicine to purchase new equipment and study its effect on patients. The equipment includes dolls, puzzles and art supplies.
“Delirium patients really struggle with the daytime-nighttime sleep-wake cycle, so we do a lot of sleep hygiene to help with that confusion,” said Megan Cram, RN, the clinical manager of the Integrated Medicine unit. “A lot of the dementia patients are stuck in a stage of their prior adult life, so we have baby dolls they can hold and rock so they feel like they’re taking care of a baby. We recently purchased animatronic dogs and cats that look to be moving and breathing for patients to hold and pet. They have made a notable difference in orientation and agitation in the patients we have trialed them with.”
Cram said the patients especially enjoy the animatronic cats, so her team has begun a research study on the effects of those interactions on patients with delirium.
“We’ve seen a lot of patients who are agitated on another floor can go to Integrated Medicine and within a pretty short amount of time calm down significantly,” Cram said. “We’ve been able to use these interventions, and as the patients become more oriented, we are able to discharge them to their facility or to their home.”