It has already been established that animals have various constitutional effects on humans and influence quality of life and well-being in various ways (see Nestmann 2005). For a lot of people in all stages of their life, pets are important sources of support. They are able to contribute to our health as well as to buffer stress and illness. Especially elderly and frail people take profit from the human animal bond. Pets may be seen as important agents in support and therapy of people with dementia. Besides offering emotional support in times of struggle and loneliness, pets can even have a healing influence in situations of physical or mental illness. Since the 1960s animals have been used in professional and therapeutic settings. Even retirement and nursing homes experience the psychosocial benefits of animal assisted activities and integrate animals successfully in the daily routine of the residents. The longitudinal field study “Animals at the Johanniter-Stift Nursing Home” is the first to investigate the effects of animal assisted activities on the quality of life and well-being of elderly nursing home patients with dementia. In order to systematically establish the extent to which various forms of regular contact with animals can benefit such patients, psychological and social changes in patients with and without contact to animals were examined at three intervals over a three-year period, using research instruments such as non-participant observation (MTU), questionnaires completed by nursing staff (FSAK; NPI) as well as interviews with the nursing staff to examine the human-animal-contacts between the residents and the animals in the daily routine. The study demonstrates that elderly dementia sufferers with regular contact to animals tend to show greater agility, independence, strength of social network and communication abilities compared to those without contact to animals. The study shows the psychosocial effects and the options of animal assisted activities with and care of elderly people suffering from dementia as an alternative to pharmacological treatment.

Studiens syfte var att beskriva arbetsterapeuters kliniska resonemang vid användande av hundassisterad intervention på korttidsboenden och särskilda boenden för äldre personer. Genom ett ändamålsenligt urval valdes fem arbetsterapeuter med tre till sex års erfarenhet av hundassisterad intervention ut som deltagare i studien. Deltagarna deltog i enskilda narrativa intervjuer. Den insamlade datan analyserades därefter genom en narrativ metod. Analysen av datan resulterade i tre teman som benämndes hundassisterad intervention är en mångfacetterad åtgärd, vårdhunden motiverar till delaktighet i aktivitet samt omgivande faktorer påverkar användningen av hundassisterad intervention. Hundassisterad intervention är utifrån arbetsterapeuters kliniska resonemang en mångfacetterad åtgärd som kan användas för att skapa motivation till delaktighet i aktiviteter som både rehabiliterar och ger äldre personer en känsla av meningsfullhet. Omgivande faktorer såsom resurser i form av tid och ekonomi samt den fysiska och sociala miljön kan både begränsa samt skapa möjligheter för användande av hundassisterad intervention. Utifrån studiens resultat skulle hundassisterad intervention som används i en främjande miljö kunna leda till en förbättrad livskvalité hos äldre personer som befinner sig på korttidsboenden och särskilda boenden. Det finns dock ett fortsatt behov av forskning för att stärka evidensen för användandet av hundassisterad intervention. Studiens resultat ger arbetsterapeuter ny kunskap om interventionens terapeutiska värde och hur hundassisterad intervention kan användas i den kliniska verksamheten samt vilka faktorer som påverkar dess användning. / The aim of this study was to describe the clinical reasoning of occupational therapists when using dog-assisted therapy in residental settings for older adults. Five occupational therapists with three to six years of experience in dog-assisted therapy were purposefully selected as participants in the study. Data was generated by individual narrative interviews and analysed using a narrative analysis. The analysis of the data resulted in three themes called dog-assisted therapy is a multifaceted intervention, the care dog motivates participation in activities and surrounding factors affect the use of dog-assisted therapy. Dog-assisted therapy, based on the clinical reasoning of occupational therapists, is a multifaceted intervention that can be used to create motivation for participation in activities that both rehabilitate and give older adults a sense of meaningfulness. Surrounding factors such as time and economy resources as well as the physical and social environment can both limit and create opportunities for using dogassisted therapy. Based on the results of this study, dog-assisted therapy used in a promotional environment could lead to an improved quality of life for older adults in residential settings. However, there is a continuing need for research to strengthen the evidence for the use of dogassisted therapy. The result of the study give occupational therapists new knowledge about the therapeutic value of the intervention and how dog-assisted therapy can be used in the clinical setting and what factors affects its use.

Bakgrund: Medellivslängden i Sverige har aldrig varit så hög som de senaste åren vilket kommer ställa höga krav på äldreomsorgen. Situationen är komplex och påverkar framförallt patienterna i den kliniska vården. Tidigare studier visar att patienter inom äldreomsorgen löper större risk för ensamhet, depression och understimulans av olika anledningar. För att kunna möta dessa behov som sjuksköterskor i den kliniska vården, vill vi undersöka om alternativa metoder kan fungera som ett komplement till den vård som bedrivs inom äldreomsorgen. Alternativa metoder har blivit ett alternativ de senaste åren där bland annat djur kan användas i ett terapeutiskt syfte. Vi vill därför belysa faktorer för välbefinnandet hos dessa patienter som får djurassisterad intervention som ett komplement i vården. Syfte: Syftet var att belysa faktorer för välbefinnandet hos patienter inom äldreomsorgen som får djurassisterad intervention som ett komplement i vården. Metod: I denna studie tillämpas en litteraturöversikt där elva vetenskapliga artiklar från 2008 till 2018 ligger till grund för resultatet. De vetenskapliga artiklarna som inkluderades var nationella eller internationella. Datainsamlingen har gjorts i tre olika databaser; CINAHL Complete, PsycINFO och PubMed. Resultat: Efter analys av resultatet framkom fyra faktorer för välbefinnandet; fysiska, psykiska, sociala och existentiella. Resultatet visade att djurassisterade interventioner kan ha positiva, negativa och/eller inga effekter överhuvudtaget på äldre personers välbefinnande. Denna typ av intervention kan fungera som ett komplement i vården främst vid behandling för främjande av psykiska symtom och social påverkan/interaktion. Diskussion: Patienter inom äldreomsorgen är en riskgrupp för nedsatt välbefinnande och där farmakologiska behandlingar är vanligt förekommande. Djurassisterad intervention kan ses som en icke farmakologisk behandlingsform, där välbefinnandet kan främjas ur ett holistiskt perspektiv för den äldre patienten i vården. Mer forskning krävs för hur djurassisterad intervention kan ersätta viss farmakologisk behandling. Callista Roys adaptionsmodell stödjer sjuksköterskans arbete för förståelse av patienters strategier för att anpassa sig efter miljön och påverka miljön på ett självhävdande sätt. / Background: Life expectancy in Sweden has never been as high as in recent years, which will have a big influence on the care of the elderly. The situation is complex and affects primarily the patients in the clinical care. Previous studies show that the elderly patients are at greater risk of loneliness, depression and lack of stimulation for various reasons. In order to meet these needs as nurses in clinical care, we want to investigate whether alternative methods can serve as a complement to the care provided. Alternative methods have become more common in recent years, an example is using animals for therapeutic purposes. We therefore want to illuminate the factors of well-being in patients affected by animal-assisted intervention as a complement to health care. Aim: The aim was to illuminate the factors of well-being in patients of the geriatric nursing who receive animal-assisted intervention as a complement to standard care.    Method: A literature review has been done, where eleven scientific articles from 2008 to 2018 form the results. The articles that were included were national or international. The data collection has been made in three different databases; CINAHL Complete, PsycINFO and PubMed. Results: After analysis of the result, four factors emerged for the well-being; physical, mental, social and existential. The result showed that animal-assisted interventions may have positive, negative and / or no effects at all for the well-being of older patients. This type of intervention can serve as a supplement in the care of primary care in the treatment of mental and social interaction. Discussion: Patients in elderly care are a risk group for impaired well-being and where pharmacological treatments are commonplace. Animal-assisted intervention can be seen as a non-pharmacological treatment, where well-being can be promoted from a holistic perspective to the elderly patient in standard care. More research is needed on how animal-assisted intervention can replace certain pharmacological treatment. Callista Roys adaptation model supports the nurse's work for understanding patients' ability to adapt to the environment and influence the environment in a self-assertive manner.

Les symptômes psychologiques et comportementaux de la démence (SPCD) sont fréquents et peuvent concerner jusqu’à 90 % des patients atteints de la maladie d’Alzheimer. Considérant l’efficacité limitée et l’ampleur des effets secondaires observés avec les traitements psychotropes en France, la majorité des directives existantes soulignent l’importance de la recherche clinique sur la maladie d’Alzheimer et une amélioration de l’évaluation des approches non pharmacologiques (ANP). En 2016, Le recours à la médiation animale, comme prise en soins, en établissements d’hébergement pour personnes âgées dépendantes (EHPAD) est de plus en plus fréquent. Nous avions montré les bienfaits de cette ANP sur l'apathie dans la maladie d'Alzheimer et avons souhaité en démontrer son efficacité. Notre étude évalue et mesure, principalement à l’aide de l’Inventaire Neuropsychiatrique version Equipe soignante (NPI-ES), comment la présence du chien dans la psychothérapie des malades Alzheimer est associée à des niveaux de SPCD chez des femmes et des hommes, âgés en moyenne de 85 ans qui vivent en institution. Nous nous sommes concentrés sur le bien-être et la construction d’émotions positives de la personne âgée démente, en particulier sur la revalorisation de l’estime de soi, la stimulation, la remobilisation et le maintien des capacités cognitives préservées, comme base thérapeutique possible dans l’association de la présence du chien avec la diminution significative des SPCD. / Today, the use of animal mediation as a form of treatment in nursing homes has become more and more common. Our study assesses and measures, largely through the use of the Neuropsychiatric Inventory for Nursing Home (NPI-NH), how the presence of a dog in Alzheimer’s patient psychotherapy affects psycho-behavioral disorder (BPSD) levels in French men and women with a mean age of 85 years living in an institution. Our study focuses on well-being and on building positive emotion in the elderly with dementia, particularly through regaining self-esteem, stimulation, remobilization and maintenance of preserved cognitive abilities. This therapeutic basis is made possible through exposure to a dog with the goal of decreasing BPSD.

Bakgrund: En fungerande vardag bygger på att individen klarar av sin egenvård. Depressiva symtom kan vara paralyserande och till följd av det skapa egenvårdsbrist. Den huvudsakliga behandlingen idag är farmakologisk och tillgången på psykologisk behandling motsvarar inte behovet som finns. Syfte: Syftet var att belysa hur individer med depressiva symtom kunde stärka sin egenvårdsförmåga med hjälp av djur. Metod: En litteraturstudie med induktiv ansats utfördes. Samtliga valda vetenskapliga original artiklar kvalitetsgranskades. Två teman valdes utifrån utskiljningar som gjorts vid granskning av artiklarna mellan gårdsdjur och husdjur. Artiklarna delades in i två teman: Husdjurens förmåga att stärka individen och Gårdsdjurens förmåga att stärka individen. Resultat: Resultatet visade hur individer med depressiva symtom kunde stärkas med hjälp av husdjur eller gårdsdjur i djurassisterad terapi eller aktivitet. Samtliga studier i resultatet påvisade olika positiva egenskaper och känslor som kom utav djur. Positiva saker som påvisades i resultatet var bland många: ett ökat självförtroende, en förbättrad självkänsla och sinnesstämning samt ökade känslor av hopp. Konklusion: Utmärkande var att depressiva symptom kunde reduceras med hjälp av djur samt att djuren stärkte individen utifrån en ökad kompetens kring hur att hantera sitt hälsotillstånd. / Background: A functioning everyday life is based on the individual being able to take care of their own care. Depressive symptoms can be paralyzing and as a result create a lack of self-care. The main treatment today is pharmacological and the availability of psychological treatment does not correspond to the need that exists. Aim: The aim was to shed light on how individuals with depressive symptoms could strengthen their self-care ability with the help of animals. Method: A literature study with an inductive approach was performed. All selected scientific original articles were quality reviewed. Two themes were selected based on differentiates made when reviewing the articles between farm animals and pets. The articles were divided into two themes: The ability of pets to strengthen the individual and the ability of farm animals to strengthen the individual. Results: The results showed how individuals with depressive symptoms could be strengthened with the help of pets or farm animals in animal-assisted therapy or activity. All studies in the results showed different positive qualities and feelings that came from animals. Positive things that were demonstrated in the results were among many: an increased self-confidence, an improved self-esteem and mood and increased feelings of hope. Conclusion: Characteristic was that depressive symptoms could be reduced with the help of animals and that the animals strengthened the individual based on an increased competence in how to manage their health condition.

Symptom severity among veteran survivors with partial or full posttraumatic stress disorder (PTSD) continues to increase, with approximately 40% of U.S. veterans reporting significant symptomology 10 years after initial onset of the condition. Veteran survivors often struggle to find therapeutic interventions that meet their specific needs and have a difficult time maintaining a therapy that is both equitable and evidenced based. Grounded in the Rogerian, client-centered theory, the purpose of this qualitative collective exploratory case study was to explore the effects of equine-facilitated psychotherapy with 3 veteran survivors with partial or full PTSD. A 4-stage process was used to collect data, including initial semistructured interviews, observations, photo-interviews, and researcher interpretations of photo-interviews. Data were transcribed, analyzed, and coded into within-case themes and cross case-themes. The principle findings revealed that veteran survivors with partial or full PTSD engaged in an equine-facilitated psychotherapy program had both here-and-now experiences and relational connection experiences with the horse. Many other significant details provided insight into the veteran participants' experiences with equine-facilitated psychotherapy, such as trust, connection, nonverbal communication, awareness, peace, decompression, communication, empathic reflection, congruence, reciprocity, concern, respect, and selflessness. These findings provide social change implications that may inform mental health professionals and counselor educators about the benefits of equine-facilitated psychotherapy with veteran survivors with partial or full posttraumatic stress disorder; the findings also provide structure to the use of equine-facilitated psychotherapy as an adjunct and/or alternative to traditional posttraumatic stress disorder treatments.

The aim of this phenomenological qualitative study was to capture and understand the essence of the lived experiences of individuals after participating in equine facilitated psychotherapy (EFP). In that the experiences of participants after exposure to EFP have not previously been examined, this study adds to the literature on this innovative therapy. Theoretical viewpoints on animal assisted therapy and solution-focused brief therapy (SFBT) were explored, as well as how the SFBT methodology compares to techniques used in EFP. Using interviews, the study involved capturing participants' experiences by collecting their descriptions of their involvement with EFP, identifying the specific experiences they noted, ascertaining what the participants did with these experiences, and discerning themes or patterns in the interview data. A purposive sample of 10 adults who had participated in EFP participated in interviews, the data from which were analyzed by hand coding. Analysis showed improved quality of life with improvements in overall well-being and in participants' relationships. The findings of this research study may lead to additional research in this area and may promote the establishment of consistent techniques in EFP, proper credentialing of those who use EFP, and applicable regulatory standards. By exploring the lived experiences of individuals who have participated in EFP, providers may be able to delve more deeply into the curative factors that may be at work with this type of therapy.

The purpose of this qualitative study was to investigate the experience and knowledge from the implementation of animal-assisted therapy as a health-promoting method in nursing homes. This study used a qualitative method with an inductive approach. To collect data, four semi-structured interviews were conducted. The respondents of this study were selected by a meaningful sampling method. The inclusion criteria were that the nursing homes currently used or had used therapeutic animals. The collected data was analyzed with a content analysis. The results were presented in continues text with quotes from the respondents to validate the findings. The main findings of the study displayed that the reasoning behind the respondent’s willingness to implement animal-assisted therapy in nursing homes was that they had previous positive experience with the effects of therapeutic animals. The respondents highlighted that they experienced that the implementation of therapeutic animals was met with few difficulties.  The conclusion of the study was that nursing homes were dependent on receiving therapeutic animals in form of donations to implement them. Lack of funding may be an underlying factor why therapeutic animals have not been implemented to a greater extent in other nursing homes, despite the health-promoting effects previous studies show. / Syftet med denna kvalitativa studie var att undersöka upplevelser och erfarenheter av implementering av terapidjur som en hälsofrämjande metod på äldreboenden. En kvalitativ metod med en induktiv ansats användes för studien. För att samla in data genomfördes fyra individuella semistrukturerade intervjuer. Urvalet av respondenter till studien gjordes genom ett meningsfullt urval. Inklusionskriteriet för urvalet var att respondenterna hade använt eller använde sig av terapidjur på äldreboendet. För att analysera data genomfördes en innehållsanalys där ett kodningsschema tillämpades. I innehållsanalysen identifierades sex kategorier vilka formades utifrån respondenternas svar. Resultatet presenterades i flytande text med stärkande citat från respondenterna. Resultatet visade att respondenterna hade erfarenheter av en variation av terapidjur; mjukis- och robotdjur, terapihundar, höns, marsvin, kaniner, häst och orm. Huvudresultatet för studien visade att bakgrunden till respondenternas vilja att implementera terapidjur på äldreboenden var att de erhöll kunskap och erfarenheter av de effekter som terapidjur kan ge. Att det ansågs som att något saknades på äldreboenden när det inte fanns terapidjur samt att det bedömdes vara ett behov hos de boende. Möjligheterna för att implementera terapidjur var tack vare bidragande ekonomiska resurser. I sin helhet upplevdes få svårigheter av respondenterna om att implementera terapidjur. Slutsatsen för studien var att äldreboendena var i stor utsträckning beroende av att få terapidjur i form av bidrag för att implementera dem. Brist på bidrag kan vara en bakomliggande faktor till att terapidjur inte har implementerats i större utsträckning på andra äldreboenden, trots de hälsofrämjande effekterna tidigare forskning visar. Denna studie belyser de fördelar som kan upplevas i samband med terapidjur och hur en implementering av terapidjur kan antas. I takt med en ökad livslängd bland befolkningen finns det ett behov av ytterligare hälsofrämjande metoder, där terapidjur är en väl anpassad hälsofrämjande metod för äldres hälsa och ett hälsosamt åldrande.

This pilot study examined the effect of participation in an equine-assisted activities (EAA) program on the social functioning of participants with autism spectrum disorder (ASD). Pre- and post-assessments via the Naples Equestrian Challenge Participant Initial Evaluation were completed by a trained Certified Therapeutic Riding Instructor prior to and at the conclusion of a 12 week EAA program. 12 individuals (75% male; M age = 10.8; age range 5 – 20 years) participated. Paired-sample t-tests were conducted to examine the impact of EAA on social functioning. Analyses revealed that involvement in the EAA program resulted in a significant improvement in social functioning, but when grouped by age (5 – 10 years old, 10 – 20 years old) the effects were not significant. Lastly, individual analyses indicated that 75% of the sample had improved social functioning scores after participation in the EAA program. Results support EAA as an effective therapy for persons with ASD.

Bakgrund: Hästunderstödd terapi, HUT, är en sedan länge existerande vårdform för allehanda besvär. Evidensen för HUT som vårdverktyg har framtill nyligen dock varit svag, men allt fler studier har visat att HUT är en effektiv träningsform för balans och gångförmåga hos barn och ungdomar med CP-skador, förmågor som är tätt förknippade med människors livskvalitet. En diagnos som är lik CP och ofta ger liknande symtom är stroke. Trots likheterna mellan stroke och CP finns inte alls samma mängd evidens för effekten av HUT vid stroke som vid CP. Samtidigt råder det brist på effektiv strokerehabilitering i vissa delar av Sverige. Det är därför av intresse att utvärdera huruvida HUT kan vara ännu ett verktyg att använda vid just strokerehabilitering. Syfte: Att systematiskt granska forskningen och gradera evidensen för effekten av HUT på balans, gångförmåga och livskvalitet hos patienter som tidigare drabbats av en stroke. Metod: Systematisk litteraturstudie av randomiserade kontrollerade studier Resultat: Åtta studier hittades och de visade en förbättrande effekt av HUT på de undersökta områdena. Fem av studierna var av tillräckligt hög kvalitet för att graderas via GRADEstud. Graderingen visade att evidensvärdet var mycket låg för effekt av HUT på gångförmåga, låg för effekt av HUT på livskvalitet, och måttligt hög för effekt av HUT på balans.  Konklusion: På grund av begränsat antal studier och begränsade mätmetoder i dem kan ingen fast slutats dras, mer forskning behövs för att svara på frågeställningarna. / Background: Horse-Assisted Therapy, HAT, has since a long time been used as a health-care-tool for an assorted group of problems. The evidence for HAT as a health-care-tool has until recently been weak, however an increasing number of studies has shown HAT to be an effective way to train balance and gait in children and youths with cerebral palsy, abilities that are closely linked to a persons quality of life. A diagnosis that is similar to CP and often gives similar symptoms is stroke. Despite the similarities between stroke and CP there is far less evidence for the effects of HAT on stroke than there is for that on CP. At the same time some parts of Sweden are lacking in0 ways to rehabilitation-train after a stroke, therefore it is of interest to evaluate whether HAT can be yet another tool to use in stroke-rehabilitation.  Purpose: To systematically review and evaluate the evidence for the effect of Horse-Assisted Therapy on balance, gait and quality of life in patients who earlier has suffered a stroke.  Result: Eight studies were found and showed that HAT has an enhancing effect on the examined values. Five studies were of high enough quality to be graded using GRADEstud. The evidence grading showed a very low evidence grade for the effect of HAT on gait, low for the effect on quality of life, and moderately high for the effect on balance.  Conclusion: Due to a limited number of studies, and limitations in the ways to measure the effect no conclusion can be drawn, more research is needed in order to answer the issues in question.