Mission Alliance Community Engagement Project: Exploring the Impact of COVID-19 on Social Isolation, Loneliness, Mental Health and Wellbeing in Veterans.

During the Coronavirus disease pandemic, many U.S. veterans with posttraumatic stress disorder (PTSD) experienced increased symptomology and worsened mental health and well-being due in part to social isolation and loneliness. The Mission Alliance project explored these ramifications and prioritized critical issues expressed by U.S. veterans and stakeholders (N = 182) during virtual regional meetings (N = 32). Field notes created specifically for this project were recorded and thematically analyzed. Emerging themes included: (1) social isolation: missed opportunities, collapsed social circles, work-life balance, fostering relationships, and evolving health care delivery; (2) loneliness: deteriorated mental health, suffered with PTSD together but alone, looked out for each other, ambivalence toward technology, and strained and broken systems; (3) mental health: sense of chaos, increased demand and decreased access, aggravation, implementation of tools, innovative solutions, fear and loss, and availability of resources; (4) wellbeing: sense of purpose, holistic perspective on well-being, recognition of balance, persisting stigma, redefined pressures, freedom to direct treatment, and reconnection and disconnection. A PTSD-related patient centered outcomes research (PCOR)/comparative effectiveness research (CER) agenda was developed from these themes. Establishment of a veteran and stakeholder network is suggested to support, facilitate, and promote the PTSD-related PCOR/CER agenda. Furthermore, enhancement of opportunities for veterans with PTSD and stakeholders to partner in PCOR/CER is required to develop and conduct projects that lead to PTSD-related comprehensive care of veterans affected by traumatic events with the potential to translate findings to other populations.

My Dog, My Hero: Assessing the Feasibility of a Cross-Generational Digital Storytelling Intervention for Veterans.

During the COVID-19 pandemic, social isolation had a devastating effect on well-being. Veterans were among the most vulnerable given their high rates of military trauma-related conditions. Research supports that dogs can provide veterans with a sense of purpose, social support, and stress management. Digital storytelling provided a unique perspective with focus on a recognized hero, the veteran's dog, and an opportunity for engagement with other veterans during COVID-19. The purpose of the study was to assess the feasibility of this digital storytelling intervention based on Story Theory framework and tailored to encompass components of cross-generational collaboration in combination with individual and group virtual sessions as a mechanism to promote social engagement. The research was conducted using a descriptive exploratory design. Veterans (N = 8) were paired with a trained student and grouped in sets of four. There were eight guided 1-hour weekly virtual sessions to create their digital story. Demographic and pre-post intervention survey data were also collected. Based on eight established criteria, this article systematically evaluates the feasibility of the digital storytelling intervention for veterans. The findings suggest practical considerations to ensure viability of digital storytelling as a therapeutic intervention for veterans and other populations at-risk for suboptimal well-being.

Opioid use disorder research and the Council for the Advancement of Nursing Science priority areas.

BACKGROUND: Chronic diseases, such as opioid use disorder (OUD) require a multifaceted scientific approach to address their evolving complexity. The Council for the Advancement of Nursing Science's (Council) four nursing science priority areas (precision health; global health, determinants of health, and big data/data analytics) were established to provide a framework to address current complex health problems. PURPOSE: To examine OUD research through the nursing science priority areas and evaluate the appropriateness of the priority areas as a framework for research on complex health conditions. METHOD: OUD was used as an exemplar to explore the relevance of the nursing science priorities for future research. FINDINGS: Research in the four priority areas is advancing knowledge in OUD identification, prevention, and treatment. Intersection of OUD research population focus and methodological approach was identified among the priority areas. DISCUSSION: The Council priorities provide a relevant framework for nurse scientists to address complex health problems like OUD.

A Narrative Review of Movement-Based Mind-Body Interventions: Effects of Yoga, Tai Chi, and Qigong for Back Pain Patients.

This narrative literature review evaluated the effects of movement-based mind-body interventions (MMBIs; yoga, tai chi, and qigong) on low back pain. A search of databases was conducted to identify relevant studies. Thirty-two articles met inclusion criteria and were included for this narrative review. Of the reviewed studies, the highest number focused on yoga intervention (n = 25), 4 focused on qigong, and 3 focused on tai chi in managing back pain. The selected articles showed MMBI to be effective for treatment of low back pain, reporting positive outcomes such as reduction in pain or psychological distress (eg, depression and anxiety), and improved functional ability. However, little is known about the effects of MMBI, in particular qigong and tai chi. More clinical trials are needed to determine how to reduce back pain, improve physical function, and minimize behavioral and psychological symptoms associated with low back pain. Nurse practitioners may introduce such mind-body interventions for managing pain, especially for patients at high risk for adverse effects from pharmacological treatment, and refer them to a yoga therapist, tai-chi instructor, or qigong instructor.

Examining the Effects of a Service-Trained Facility Dog on Stress in Children Undergoing Forensic Interview for Allegations of Child Sexual Abuse.

Disclosure of child sexual abuse can be a stressful experience for the child. Gaining a better understanding of how best to serve the child, while preserving the quality of their disclosure, is an ever-evolving process. The data to answer this question come from 51 children aged 4-16 (M = 9.1, SD = 3.5), who were referred to a child advocacy center in Virginia for a forensic interview (FI) following allegations of sexual abuse. A repeated measures design was conducted to examine how the presence of a service-trained facility dog (e.g. animal-assisted intervention (AAI) may serve as a mode of lowering stress levels in children during their FIs. Children were randomized to one of the two FI conditions: experimental condition (service-trained facility dog present-AAI) or control condition (service-trained facility dog not present- standard forensic interview). Stress biomarkers salivary cortisol, alpha-amylase, immunoglobulin A (IgA), heart rate, and blood pressure, and Immunoglobulin A were collected before and after the FI. Self-report data were also collected. Results supported a significant decrease in heart rate for those in the experimental condition (p = .0086) vs the control condition (p = .4986). Regression models revealed a significant decrease in systolic and diastolic blood pressure in the experimental condition (p = .03285) and (p = .04381), respectively. Statistically significant changes in alpha-amylase and IgA were also found in relation to disclosure and type of offense. The results of this study support the stress reducing effects of a service-trained facility dog for children undergoing FI for allegations of child sexual abuse.

National nursing science priorities: Creating a shared vision.

BACKGROUND: Nursing science is essential to advance population health through contributions at all phases of scientific inquiry. Multiple scientific initiatives important to nursing science overlap in aims and population focus. PURPOSE: This article focused on providing the American Academy of Nursing and nurse scientists in the Unites States with a blueprint of nursing science priorities to inform a shared vision for future collaborations, areas of scientific inquiry, and resource allocation. METHODS: The Science Committee convened four times and using Delphi methods identified priorities with empirical evidence and expert opinion for prioritization, state of the science, expert interest, and potential target stakeholders. DISCUSSION: Nursing science priorities for 2017 were categorized into four themes including: (a) precision science, (b) big data and data analytics, (c) determinants of health, and (d) global health. CONCLUSION: Nurse scientists can generate new knowledge in priority areas that advances the health of the world's populations.

Pet Therapy: Enhancing Social and Cardiovascular Wellness in Community Dwelling Older Adults.

Pet therapy can be therapeutic for older adults living in the community. A crossover design was used to examine changes in blood pressure and heart rate before and after a pet therapy visit versus a volunteer-only visit in 28 community dwelling older adults. Relationships among stress, pet attitude, social support, and health status were also examined. Study findings supported that pet therapy significantly decreased blood pressure and heart rate. Ultimately, the findings supported the notion that community health nurses should consider developing and implementing pet therapy programs in the communities they serve. Further implications for community health nurses are discussed.

Forensic Interviews for Child Sexual Abuse Allegations: An Investigation into the Effects of Animal-Assisted Intervention on Stress Biomarkers.

The use of therapy animals during forensic interviews for child sexual abuse allegations is a recommendation by the Therapy Animals Supporting Kids Program to help ease children's discomfort during the forensic interview process. Based on this recommendation, this study incorporated a certified therapy canine into the forensic interview process for child sexual abuse allegations. This study investigated changes in salivary cortisol, immunoglobulin A, blood pressure, and heart rate as a result of forensic interview phenomenon (e.g., outcry) incorporating animal-assisted intervention versus a control condition in children (N = 42) interviewed for alleged child sexual abuse. The results supported significantly greater heart rate values for the control group (n = 23) who experienced sexual contact and/or indecency than the experience of aggravated sexual assault compared to no difference in HR for the intervention group (n = 19). The results suggest that the presence of the canine in the forensic interview may have acted as a buffer or safeguard for the children when disclosing details of sexual abuse. In the intervention group, children's HR was lower at the start of the forensic interview compared to the control group. Finding an effect of having a certified handler-canine team available during the forensic interview on physiological measures of stress has real-world value for children, child welfare personnel, and clinical therapists. It is suggested that animal-assisted intervention be expanded to children facing other types of trauma and to treatment programs for child survivors of sexual abuse.

Pet ownership and older women: the relationships among loneliness, pet attachment support, human social support, and depressed mood.

Pets can play a positive role in the both the physical and psychological health of older adults. This cross sectional study investigated the relationships among loneliness, pet attachment support, human social support, and depressed mood in a convenience sample of 159 pet-owning older women residing in the community. Participants completed loneliness, pet attachment support, human social support, and depressed mood scales. The results supported significant relationships between loneliness, pet attachment support, human social support, and depressed mood. No relationship was found between human social support and depressed mood. Pet attachment support, but not human social support, influenced the relationship between loneliness and depressed mood indicating the importance of pet attachment as a greater form of support in this sample. Clinical and social implications for nurses working with the geriatric population were identified and discussed.

Factors related to type of companion pet owned by older women.

Although pets can be valuable companions for older adults, little is known about why older adults select a specific kind of pet. This study examined demographic (e.g., marital status, health status), health (i.e., well-being, loneliness), and environmental characteristics (i.e., living arrangement, type of housing) of 159 older women in terms of whether they had a companion dog or cat. Significantly more women who were married/partnered had dogs, whereas more single women had cats. Significantly more women who lived alone had cats, whereas more women who lived with someone had dogs. Women with companion dogs had significantly lower depressed mood and higher levels of general health, vitality, and total well-being than those with cats. Although loneliness was somewhat greater among women with cats, the difference was not statistically significant. More women living in 55-and-older communities had cats, whereas more women living in private homes had dogs. Practicing psychiatric nurses can use the information generated from this research to advocate for pet companionship in order to enhance well-being in older women.

Facts, fiction, and figures of the Sarcoptes scabiei infection.

Today scabies, an ectoparasitic skin disease caused by the mite Sarcoptes scabiei variety hominis, is estimated to infect over 300 million humans worldwide. Scabies most frequently occurs among children and young adults. Outbreaks in child care facilities and schools are common. Scabies affects all socioeconomic classes and races. Students presenting with a possible outbreak of scabies in the school setting must be referred by the school nurse to a medical provider for diagnosis and treatment because scabies is highly contagious and can be spread by skin contact. This article will provide school nurses with the history, etiology, mode of transmission, symptoms, and the recommended treatment of a S. scabiei infection. Implications for school nursing practice will be discussed.

Relation of post-traumatic stress disorder symptom severity to the efficacy of an animal-assisted intervention for stress reduction after military aeromedical evacuation.

Animal-assisted interventions (AAIs) have been found to decrease stress in some settings, but it is not known if AAI is feasible in an aeromedical staging facility or effective in reducing stress following aeromedical evacuation (AE) of military personnel. An experimental design was used to evaluate the efficacy of AAI at reducing stress in AE military patients (N = 120). Patients participated in a 20-min AAI (n = 60) or 20-min informational session about assistance dogs as an attention-control group (n = 60). Demographics, post-traumatic stress symptom severity (PTSSS), and stress biomarkers (cortisol, alpha-amylase, and immunoglobulin A) were collected regular intervals. AAI was found feasible and efficacious at reducing stress. Cortisol decreased significantly (p < .05) in the AAI group compared with the attention-control group. PTSSS moderated the immunoglobulin A responses to AAI as demonstrated by the interaction of PTSD Checklist-Military Version score, group, and time, F(1, 111.23) = 4.15 p = .044; effect size: d = 0.31. This research supports AAI as a stress-reducing modality in AE patients, particularly those who report higher PTSSS. Implications for future research are discussed.

Human-Animal Connections and Nursing Science: What Is the Relationship?

Human-animal relationships have been documented for centuries. Animals are used for many purposes, such as enhancing human health, wellness, and companionship, to name a few. The human-animal relationship is different for every person and requires a holistic perspective. Nurses are interested in relationships that are caring, natural, and therapeutic. Research supports the profound and multifaceted health benefits of the human-animal bond. The purpose of this paper is to discuss the relationship between the human-animal connection and nursing science.

Effects of VA Facility Dog on Hospitalized Veterans Seen by a Palliative Care Psychologist: An Innovative Approach to Impacting Stress Indicators.

The United States is home to 23 million veterans. In many instances, veterans with serious illness who seek healthcare at the VA receive care from a palliative care service. Animal-assisted intervention (AAI) is gaining attention as a therapeutic stress reducing modality; however, its effects have not been well studied in veterans receiving palliative care in an acute care setting. A crossover repeated-measures study was conducted to examine the effects of an animal-assisted intervention (AAI) in the form of a therapy dog on stress indicators in 25 veterans on the palliative care service at the VA Eastern Colorado Healthcare System in Denver, CO. Veterans had a visit from a therapy dog and the dog's handler, a clinical psychologist (experimental condition) and an unstructured visit with the clinical psychologist alone (control condition). Blood pressure, heart rate, and the salivary biomarkers cortisol, alpha-amylase, and immunoglobulin A were collected before, after, and 30-minutes after both the experimental and control conditions. Significant decreases in cortisol were found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.007) and control condition ( p = 0.036). A significant decrease in HR was also found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.0046) and control ( p = 0.0119) condition. Results of this study supported that a VA facility dog paired with a palliative care psychologist had a measurable impact on salivary cortisol levels and HR in veterans.

Military veterans and canine assistance for post-traumatic stress disorder: A narrative review of the literature.

BACKGROUND: Veterans with post-traumatic stress disorder (PTSD) are a vulnerable population at high risk for depression, isolation, and suicide. A substantial body of anecdotal evidence exists supporting the use of canines as an effective adjunct treatment for this population. However, a comprehensive review of its use based on scientific literature has thus far not been conducted. METHODS: A narrative literature review was conducted to examine the current state of the science on canine assistance for veterans diagnosed with PTSD in order to synthesize current empirical knowledge on the subject. Articles were retrieved among the small body of recent literature using computerized database searches. Inclusion criteria included peer-reviewed journal publications published through October 1st, 2015. Only originally published articles that examined the outcomes of canine assistance on veterans with PTSD were examined. Additionally, each included article was specific to veterans, dogs, and, PTSD in combination rather than article that discuss the concepts separately. Exclusion criteria included symposia and conference material, dissertations, media articles, and no mention of canines as a treatment modality. 563 articles were retrieved; 6 met the criteria. When evaluating data, information and themes were extracted into an Excel table; this table was employed in the synthesis of information into manuscript form. RESULTS: The following themes were explored within the selected publications: What is Canine Assistance; Why Use Canine Assistance for PTSD in Veterans; Concerns; and Future Directions. The literature endorsed canine assistance for PTSD in veterans as a promising modality. Authors also raised concerns about lack of protocols, cost and availability barriers, and animal welfare calling for additional, rigorous research to advance its use as a treatment for veterans with PTSD. CONCLUSIONS: PTSD continues to pose significant psychological, health, and welfare challenges to veterans and the multi-disciplinary providers who treat them. Analysis of this literature should expand knowledge and outline future directions for healthcare professions and improve health and wellness for veterans with PTSD through the use of canine assistance.

Situational factors related to loneliness and loss over time among older pet owners.

Loneliness occurs in people of all ages but can be particularly debilitating in older adults. In this population, there are many factors that enter into the loneliness-loss pathway. The purpose of this study was to examine the interrelations of situational factors, coping, and pet attachment that affect loneliness in 191 older adults who experienced loss over time. Data showed that loneliness was lower among study participants who lived in 55 and over residences than private residences, those who experienced loneliness due to loss, those who reported lower coping, and those who reported higher pet attachment. The results of this study suggest that nurses working with this population need to evaluate loneliness by means of situational factors such as living arrangements. Nurses should also examine the effects of loss over time and discuss coping mechanisms, including the benefit of pet relationships in this vulnerable population. Implications for nursing are addressed.