A quiet room and plenty of enjoyable activities have proved a safe and effective alternative to restraints and sedation for brain-injured patients who receive treatment at University Hospital in Newark, New Jersey.
Planned Activities Less Medication (PALM) is the brainchild of Linda McGinnis, RN, BSN, MA, director of Patient Care Services for the Critical Care Division, Respiratory Services, who sought a more humane solution to the challenge of overseeing patients with traumatic brain injury and dementia from drug abuse.
“Restraints, we felt, were dehumanizing,” McGinnis says. “In the past, patients would be restrained in their rooms all day, which made them even more confused, and often they required more sedation. But if we released their restraints, they became a risk for elopement or falls.”
One-on-one sitters also proved unsatisfactory because demand depleted the work force.
And the solution …
The solution, McGinnis discovered, was to create a room accented with carpeting, dim lighting, soft music, and aromatherapy, as well as a variety of activities that are entertaining and therapeutic. Two nursing assistants stay with the patients, who are able to visit the PALM room every day from 7 AM to 11 PM.
“Our objective is to provide a safe environment that will allow a continuum of care so we can decrease the length of stay for these patients,” explains McGinnis. “The patients love it. We have asked them to write down what they think about PALM, and their responses have been heartwarming.”
The staff also appreciates the program, McGinnis adds. “The nurses and assistants love it because they can see changes for the better in their patients,” she notes. “As a result, staff members encourage their patients to go.”
Benefits all around
The PALM program benefits University Hospital in many ways, McGinnis says. It has a positive financial impact by dramatically reducing the need for one-on-one sitters, which previously totaled as many as 20 each day.
The activities available to patients in the PALM room are often geared toward rehabilitation. A patient with right-sided weakness from a traumatic brain injury, for example, might be encouraged to toss a ball or play checkers with his right hand.
Other activities include orientation time, during which newspaper articles are discussed, and there are painting, puzzles, musical entertainment, pet therapy, yoga, and massages. Patients may receive their meals in the PALM room, and physicians and physical therapists also visit when necessary.
“The program promotes health, well-being, and positive energy,” observes McGinnis. “The patients are happier than just sitting in their rooms watching television. They receive socialization, form relationships, and try to help one another.”
McGinnis says she would like to see other facilities pick up the PALM program, and she has promoted it regionally through radio interviews. She would also like to see it expand within the University Hospital. “My vision would be to have a PALM room on every floor,” she says. “We’ve piloted to see how it would go, but I think it has had such a positive effect that we will continue it.”
Language has no barriers
Many of the patients who benefit from University Hospital’s PALM program do not speak English, but that has not been a barrier to their participation.
For example, a Spanish-speaking man from Honduras who suffered brain trauma and multiple orthopedic injuries in a car accident, was clearly a patient with a fall risk. In the PALM room, he received treatment for his right-sided weakness with activities such as tossing a ball or playing board games (using only his right hand), and he participated in music sessions by playing the keyboard – a skill that surprised everyone.
One patient spoke only Korean, so staff used the PALM computer to print off Korean-language newspapers for him to read. Another gentleman who was mentally challenged was found wandering around a train station. While social services searched for a group home that would accept him, he spent up to 16 hours a day in the PALM room, supervised and safe.