Substance use disorder (SUD) is a disease that continues to affect the lives of millions of Americans. Access to adequate treatment also continues to be a challenge for many of those suffering from substance use disorder. To better understand the barriers to treatment as well as the social challenges people face in seeking care for their substance use, we designed an observational study to capture demographic data, perceptions of stigma, and self esteem levels at a medication assisted treatment (MAT) facility in Northeast Tennessee. A robust survey was administered to patients at the MAT facility to quantify and analyze these metrics. Results from the survey showed when it came to stigma, respondents felt the highest level of internalized stigma compared to the other two types of measured stigma (enacted and anticipated). This was still the case even after stratifying based on gender. Regarding self esteem, survey results showed that as a whole, most respondents were within the normal range for self esteem, however, differences were appreciated when the data was categorized based on age. Finally, some of the most common reasons respondents selected for not seeking treatment previously were the thought that the problem could be handled alone, the lack of health insurance, and the fact that they were not ready to quit. A greater understanding of these issues is crucial for providers to better serve their patient population and tailor their services to the pertinent issues of the area.

Studiens syfte var att undersöka terapeuters erfarenheter av att arbeta med hundassisterad terapi med kvalitativ metod. Studien bygger på intervjuer med sex yrkesutövare som inkluderade terapihund i sitt klientarbete. Datainsamlingen bearbetades med en tematisk analys vilken gav fyra huvudteman. Kontextuella terapifaktorer, Terapiprocess, Påverkan på terapeutroll och verksamhet och Terapihunden som terapeutisk agent. Resultatet visar att terapihund kan användas som en icke-verbal terapiingrediens, den erbjuder en brygga vid terapialliansbyggande och den inkluderar beröring. Terapeuterna uppfattas ha ett utvidgat ansvar som terapihundförare, och de förefaller ta hand om terapihundarna med stor lyhördhet, vilket ger intrycket att djurens välfärd kan påverkas positivt. Terapihundarna väljs ut och tränas utifrån lämplighet och deras beteenden bygger på väl utvecklade sinnen och ett eget känsloregister. I analysen tolkas terapirelationen som inte bara dyadisk utan också triadisk. I diskussionen konceptualiseras terapihunden från en tvåpersonspsykologisk position. Denna modell föreslår att terapihunden bör erkännas som ett tredje subjekt i den terapeutiska triaden med sin egen subjektivitet, snarare än som endast ett verktyg som kan användas i en terapimetod. Resultatet kopplas till tidigare forskning och framtida forskningsområden diskuteras. / The aim of this study was to investigate how therapists experience their use of dog-assisted therapy with qualitative method. The study is built on interviews with six professionals who included therapy dogs in their work with clients. The empirical data was analyzed thematically and four main themes emerged: Contextual therapy factors, Therapy process, Impact on the therapist role and on the working place and The therapy dog as a therapeutic agent. The results showed that therapy dogs can be utilized as a non-verbal ingredience and as a bridge building alliance and they can offer tactile stimulation. The therapists are perceived to have an expanded responsibility as dog instructors and they seem to care for their therapy dogs with high sensitivity, which gives the impression that it may affect the animals’ welfare positively. The therapy dogs are selected and trained by criteria of suitability and their behaviours are built on their perceptual abilitys and their own emotional range. In the analysis the therapeutic relationship is interpreted as not only dyadic but also triadic. In the discussion the therapy dog is conceptualized from a two-person psychological position. Such a model proposes that the therapy dog should be recognized as a third subject in the therapeutic triad with its’ own subjectivity, rather than only as a tool to be used in a therapeutic method. The findings of the study are related to previous research and future topics of research are discussed.

Background: Evidence-based complementary treatment options for multiple sclerosis (MS) are limited. Objective: To investigate the effect of hippotherapy plus standard care versus standard care alone in MS patients. Methods: A total of 70 adults with MS were recruited in five German centers and randomly allocated to the intervention group (12 weeks of hippotherapy) or the control group. Primary outcome was the change in the Berg Balance Scale (BBS) after 12 weeks, and further outcome measures included fatigue, pain, quality of life, and spasticity. Results: Covariance analysis of the primary endpoint resulted in a mean difference in BBS change of 2.33 (95% confidence interval (CI): 0.03–4.63, p = 0.047) between intervention (n = 32) and control (n = 38) groups. Benefit on BBS was largest for the subgroup with an Expanded Disability Status Scale (EDSS) ⩾ 5 (5.1, p = 0.001). Fatigue (−6.8, p = 0.02) and spasticity (−0.9, p = 0.03) improved in the intervention group. The mean difference in change between groups was 12.0 (p < 0.001) in physical health score and 14.4 (p < 0.001) in mental health score of Multiple Sclerosis Quality of Life-54 (MSQoL-54). Conclusion: Hippotherapy plus standard care, while below the threshold of a minimal clinically important difference, significantly improved balance and also fatigue, spasticity, and quality of life in MS patients.

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.

A sizeable number of U.S. veterans of all ages experience post-traumatic stress disorder (PTSD) which can impact their quality of life; physically, mentally and socially. Consequences of PTSD are associated with physical and emotional disabilities, including ideation of self-harm and even suicide. Increasingly, animal-assisted therapies (AAT) are used to treat PTSD and other physical and behavioral conditions in veterans. Over the decades, AATs have used dogs, cats, horses, and dolphins among other animals. The purpose of this integrative review is to examine the use of AAT focusing on canine assisted therapy (CAT) among veterans diagnosed with PTSD. The methodology involved database searches, including MEDLINE, PubMed, PsychInfo, EBSCOhost, along with textbooks and popular media published from 2000 to 2016. Associated with the lack of more recent research, relevant articles published before 2000 were included in the review. Search terms included, ‘veterans,’ ‘service dogs,’ ‘service animals,’ ‘animal-assisted therapy,’ ‘canine therapy,’ ‘PTSD,’ ‘post-traumatic stress disorder,’ ‘psychiatric,’ ‘U.S. veterans,’ ‘equine therapy,’ ‘horse therapy,’ ‘pet therapy,’ and ‘military veterans.’ A total of ten relevant studies were identified which focused on the use of AAT among veterans diagnosed with PTSD. Different populations diagnosed with PTSD and other behavioral and psychiatric health conditions using AAT were examined as well. These articles were read, analyzed, and synthesized. Results of the review offer some support that AAT has psychological, physiological and psychosocial benefits for some populations across the lifespan with various diagnoses. Consistent and conflicting findings along with gaps in the literature are highlighted. Limitations and implications for nursing practice, research, policy and education also are noted in this thesis.

No description available.

Sjuksköterskan ansvarar för att främja hälsa, förebygga sjukdom, återställa hälsa och lindra lidande hos patienten. Djur har genom historien haft stor betydelse för människans välbefinnande och hälsa så väl i arbetet och som sällskap i hemmet. Forskning har visat att djur bidrar med positiva effekter inom äldrevård, skola och sjukvård vilket benämns som djurunderstödda insatser. Djurunderstödda insatser syftar till att uppnå terapeutiska fördelar hos människor inom bland annat hälso- och sjukvård. I Sverige är dock användningen av djur inom vården mycket begränsad jämfört med andra länder. Syftet med studien är att undersöka patientens upplevelse av djurunderstödda insatser i relation till välbefinnande och hälsa. För att besvara syftet valdes en allmän litteraturöversikt som metod, de artiklar som valdes i översikten var sex kvalitativa och två mixade. Resultatet presenteras i fem teman, 1. Upplevelse av närvaro och distraktion - djuren i centrum, 2. Ökat deltagande, motivation och välbefinnande - interaktion med djuren, 3. Att uppleva tillhörighet och gemenskap - bygga relationer, 4. Stärkt självförtroende och självkänsla - omsorg om djuren och 5. Upplevelse av både trygghet och oro - djurens närvaro. I diskussionen diskuteras djurens påverkan på hälsa och välbefinnande, hur sjuksköterskan kan ta lärdom och inspireras av djuren samt synen på djurunderstödda insatser och andra kompletterande behandlingar. / The Nurse responsibility is promoting Health, preventing disease, restoring health and ease suffering in patients. Animals have played a significant role throughout history contributing to human well-being and health, both in work and as companions in the home. Research has shown that animals have had positive effects in elderly homes, education and healthcare, referred to as animal assisted interventions. Animal assisted interventions aim to achieve therapeutic benefits for people in healthcare settings. However, in Sweden the use of animal assisted interventions in the healthcare department is very limited compared to other countries. The aim of this study is to investigate patients' experiences of animal assisted interventions in relation to wellbeing and health. To address this aim, a general literature review was chosen as the method, including six qualitative and two mixed-method articles. The result is presented in five themes: 1. Experience, presence and distraction - the animals in the center, 2. Increased participation, motivation and well-being -Interaction with the animals, 3. Experiencing belonging and community - building relationships, 4. Strengthened self-confidence and self-esteem - caring for the animals and 5. Experience of feeling safe and worry - the presence of animals. The discussion discusses the impact of animals on health and well-being, how the nurse can learn from and be inspired by animals, as well as the view on animal-assisted interventions and other complementary treatments.