Doll therapy, a widely used non-pharmacological intervention in dementia care, provides a way for residents to engage in nurturing behaviours that can help reduce anxiety and bring comfort.
However, in a recent case, an aged care nurse in New South Wales faced serious consequences for misusing this therapy. The nurse, Sudiksha Ahuja, had her registration cancelled after an incident involving a therapy doll led to distress for an elderly patient with dementia who believed the doll was a real baby.
Doll therapy has long been employed in aged care settings to support residents in the later stages of dementia. By engaging with dolls, residents often reminisce about their past experiences as parents or carers, finding solace and purpose.
For many, the dolls offer companionship, a chance to express care, and even a sense of responsibility. The use of life-like dolls, particularly in communal spaces, can foster social interaction, reduce challenging behaviours, and improve the overall well-being of residents.
However, doll therapy is not without its critics and challenges. Some worry that the practice may risk infantilising residents, while others believe it could be distressing if handled improperly.
Crucially, to ensure it remains therapeutic, caregivers must approach doll therapy with respect and sensitivity, understanding that residents may view the dolls as real infants.
A Distressing Incident
This understanding was severely breached in Ahuja’s case. The incident occurred at Junee hospital’s residential aged care unit in December 2021.
Ahuja, along with an assistant nurse known as AIN-B, mishandled a therapy doll in front of an 85-year-old patient, referred to as “Patient A,” who held a deep emotional attachment to the doll and regarded it as her “real” baby.
According to the tribunal, Ahuja removed the doll from its cradle and proceeded to slam it onto a dining table, laughing at Patient A’s distressed reaction.
The tribunal heard evidence that Patient A was tearful, distressed, and verbally pleading for Ahuja to stop, but her cries were ignored. Other staff members and even other residents had to intervene to stop the incident.
A progress note recorded the following day highlighted Patient A’s ongoing distress, stating that she cried, shook her head, and repeatedly referenced the “girls hurting the babies.” Her trauma was evident, as she later tried to “check if the babies were safe,” demonstrating the lasting impact of the incident.
Consequences for the Nurse
The Health Care Complaints Commission (HCCC) took action against Ahuja, leading to a tribunal ruling that described her behaviour as “callous and deplorable.”
Not only did the tribunal find her conduct to be inappropriate, but it also pointed to an alleged attempt by Ahuja to coerce AIN-B into giving false testimony about the incident. This lack of integrity compounded her culpability and resulted in the cancellation of her nursing registration, along with a 12-month ban on providing any health services.
The tribunal underscored that Ahuja’s actions were a direct violation of the codes of conduct and standards expected of aged care professionals.
For a vulnerable population with limited ability to advocate for themselves, carers are expected to exercise empathy, patience, and an understanding of dementia’s effects. The tribunal made clear that Ahuja’s actions were the “antithesis” of these requirements.
Ensuring Proper Use of Doll Therapy in Aged Care
This incident serves as a reminder of the importance of education, training, and strict guidelines in the implementation of therapies like doll therapy. Staff must be trained to handle these therapeutic tools respectfully and in a way that aligns with each resident’s understanding and emotional needs.
According to Karen Cmiel, a dementia care expert, the success of doll therapy relies on the carer’s ability to empathise with the resident’s perspective, including recognising that many may see the doll as a real child. For these individuals, mishandling or disrespecting the doll can be deeply distressing.
Facilities can take steps to reduce the risk of incidents like this by establishing clear protocols for doll therapy, ensuring that carers understand the emotional significance of the dolls to residents, and conducting regular staff training. Moreover, family members should be involved in therapeutic decisions to ensure transparency and understanding.
While doll therapy can be incredibly beneficial, its use can be complex, and ethical concerns sometimes arise. For some family members, seeing their loved ones with a doll might be unsettling, or they may feel that the practice is infantilising.
However, advocates suggest that when handled appropriately, doll therapy can be a dignified way to bring comfort to individuals with dementia.
If that nurse was so callus to that resident and obviously enjoyed terrorising her, what else has she done to others and not been caught out.
In my opinion she is unsuitable to work with people with dementia.
That aged care nurse certainly deserved de-registeration. What happened to AIN-B?
I have worked a Facilities that use Doll Therapy and have seen how it can help calm a Resident. Some Carers scoffed at one Lady who would not sit down for Dinner as Her ‘Baby’ was upset. I calmly approached Her and asked if I could hold Her ‘Baby’ while She ate. I explained She needed to keep up Her food intake in case She had an unsettled night. Resident ate well whilst I cuddle Baby and I was later given a cuddle by The Resident for getting Her ‘Baby’ to sleep. Result; happy Resident who was no longer upset.
I worked in aged care especially with dementia and I found a lot of AINs were not trained enough with doll therapy which was very important with calming dementia residents it’s heartbreaking to hear that this is still happening
No amount of “training” will help that ex RN. There obviously is a streak of nastiness within her and a distain for our elderly Australian dementia patients. If she was one of the overseas workers who came here for automatic citizenship after working 2 years in aged care, she should not get the prize. Wonder if she would have done that in her home country to her elderly relatives? Doubt it.