SENSORY RELAXATION SENSORY STIMULATION AND PLAY'

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SENSORY RELAXATIONSENSORY STIMULATIONAND PLAY.

• Anne Aspin
• Lead Nurse Neonatal Surgery
• Leeds General Infirmary.
• October 2003

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Snoezelen.

• Developed in Netherlands as a sniff and doze
  method of relaxation for handicapped children and
  adults.
• 
  Hulsegge and Verheul 1987.
• Their technique involved relaxing aromatic
  smells, listening to soft music and watching a
  variety of light sources and coloured baubles.
• Today, we have lava lamps, alternating bubble
  tubes, fibre optic shower threads and projected
  pictorial images.

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BACKGROUND.

• It was from the notion of pain management that an
  idea was generated to create a sensory and
  relaxation room for infants and their parents
  within the ward area.
• There are many sick infants who require a number
  of surgical procedures and need to stay in
  hospital for months and experience many painful
  procedures.

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Effects of pain, discomfort or distress.

• In the short term
• Apnoea
• Bradycardia
• Hiccoughing
• Vomiting
• (Pinnelli and Symington 2001)

• In the long term
• Clumsiness
• Decreased motor skills
• Sensitivity to stressful events later in life.
• (Winberg 1998)

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Parents

• Parents are encouraged to spend some quality time
  with their infants in the sensory room, to
  minimise stress for both the infant and their
  parents.
• Breast feeding
• Expressing their milk
• Bathing
• Cuddling
• Floor exercises
• Stimulating hand held toys.

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Quiet time

• The period spent in the snoezelen room is a
  special quiet time for parents so they may build
  a loving relationship out of an extremely
  stressful roller- coaster experience in an acute
  hospital environment.

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Developmental care

• Although developmental care is commonly
  recognised as interventions such as
• Positioning (Young 1994)
• Non nutritive sucking (Webster 1999, Pinnelli and
  Symmington 2000)
• Kangaroo care (Affonso et al 1993, Roberts et al
  2000)
• Positive touch (Yellott 2001)
• Sensory relaxation and stimulation are an
  innovative addition to the umbrella of
  developmental care.

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Growth and development

• Young (1994) identifies developmental care as
  specific interventions to
• facilitate and promote infant growth and
  development by optimising potential
• outcomes and minimising developmental
  impairments.
• Neonatal surgical infants who have undergone
  extensive bowel surgery
• (e.g NEC), and need long term TPN
• - growth is interrupted on numerous occasions
  due to milk intolerance.

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• Hungry infants expend vital energy reserves
  needed for growth
• by 200 through increased basal metabolic rate
  from
• crying (Pineyard 1994).
• Klaus et al (1982)
• Early interactions between parent and child are
  needed for
• emotional security and cognitive, social and
  educational
• development.
• Lupton and Fenwick (2002)
• New mothers feel overwhelming despair, grief,
  alienation
• and a sense of needing to ask permission to
  touch or care
• for their baby on a neonatal unit.

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Parent support

• Nurses encourage, teach and support parents how
  to interact with their infant and interpret
  behavioural cues such as distress, discomfort,
  hunger or quiet, alert and relaxed states.
  Although there are parents who sit by the bedside
  for hours and learn cues themselves (Sparshott
  1989).

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Nursing responsibilities

• Cerebral irritation
• Convulsions
• Neurological problems
• Drug exposed infant
• Hypersensitive infant
• -post surgery.
• Sepsis, injury or anaemia

• Swaddle/contain infant, reduce environmental
  stimulation.
• Avoid any stimulation.
• Use holding techniques
• Swaddle, rock or warm bath to relax
• Holding techniques, use of boundaries.
• Containment holds if distressed.

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Planning

• Teach parents how to recognise infant behaviour
  and
• provide some strategies to give comfort and
  reassurance.
• Develop a plan of care together with the parents
  and
• build a positive relationship.
• Between the baby and family this
• Promotes parental confidence
• Increased eye contact
• Increased weight gain
• Shorter hospital stay
• Longer duration of breastfeeding

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Textures

• Six weeks post term tactile stimulation
• Different textures
• Large shapes
• By four months, hold and move small hand toys.

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Auditory stimulation
Auditory stimulation. Auditory pathway
functional by 20 weeks gestation Rattles, bells
and chimes hold attention for 10 -15
seconds before concentration is affected.
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Sessions

• Initial session of five minutes.
• Increase as tolerated to a maximum of ten minutes
• Extensive literature searching revealed no
  evidence based guideline
• Positive touch by parents is a relaxing
  experience, no time limit is set, whilst it is
  pleasurable and induces a quiet sleep into
  periods of deep sleep.
• Personal experience has shown by giving the
  parents information they need, it provides some
  control and privacy to go into the snoezelen room
  on their own.

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preferences

• Distinguish mother from stranger by two weeks of
  age
• Fix and follow a small object by six weeks
• Babies show a preference for human faces
• Track a moving object by four weeks

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Stimulating auditory and visual toys

• Finger puppets
• Musical kaleidoscopes
• Magical mirror carousels
• Toys suspended from a floor activity arch
• Cot mobile

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Sensory relaxation

• Sensory relaxation
• Effective to relax if fretful or fussing
• Relax after sensory stimulation
• Promote quiet sleep into deep sleep
• Rocking
• Kangaroo cuddling- encourages breast milk
• Bathing
• Soft music
• Soft lighting
• Create an air of calm

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Tactile sensitivity

• Stroking the head
• Massaging hands and feet
• Limb exercises
• Lying prone over a wedge
• Re educate not all touch is painful

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Sensory stimulation

• In order for neurodevelopmental pathways to
  develop and mature, an experience of the senses
  taste, smell, hearing and vision is necessary
  first (Schultz 1992)
• A well, term infant cared for by a loving, stable
  family and environment, and their first
  encounters to stimulate their senses ex utero are
  pleasant, the potential for their development can
  be optimal.
• However, this is a different story for those sick
  and/or preterm babies who are exposed to multiple
  detrimental stimuli.

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Behavioural cues

• Behavioural cues in infants are a type of body
  language portraying how an infant is feeling
• There are many different cues that if
  misinterpreted can cause detrimental outcomes by
  over stimulation, particularly if the infant did
  not want to be disturbed.

Do not disturb
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Neonatal and nursery nurses.

• Enabling nurses to remember behavioural cues
  byAls(1986) Assessment of Preterm Infants
  Behaviour Framework.
• Physiological pattern of resp, gagging,
  hiccoughing, sneezing, yawning.
• Motor posture, pattern of moving, arching,
  saluting.
• State of sleep refers to type of sleep and
  wakefulness
• Attentiveness response to stimuli
• Self regulation the ability to respond to
  stimuli and maintain a stable state.

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responsibilities

• No clinical procedures in snoezelen room safe
  haven.
• Find out medical history plan programme with
  parents
• Aim for balance of stimulation and relaxation
• The length of time will be different for each
  occasion depending upon baby responses
• Give praise, encouragement and support to parents
  to promote self confidence in an environment that
  can be intimidating.

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continued

• Inform parents how to
• recognise baby behaviour.
• Nurse be aware of trigger
• factors, teach parents how
• to alleviate distress.
• Quick response to crying.

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Diary

• A developmental diary is a useful aid to plan
  developmental care and improve communications
  between parents and professionals.

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After episodes of stimulation, relaxation or
play the experience is documented in the nursing
kardex as to the infants response and well being.
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Adverse behaviour is highlighted so it can be
avoided in the future and alternative techniques
can be tried!!!!
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THE END
WHAT A SENSE OF ACHIEVEMENT WHEN PARENTS FIND
THE CONFIDENCE TO FINALLY TAKE THEIR BABY HOME.
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Audit

• Parental questionnaire.
• Parent satisfaction
• Safety
• Supervision

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Research

• Seek the evidence
• Clinical governance
• To do no harm
• Optimise potential.