Background: Animals have been shown to have a positive effect on people. The nursing science approach says that a person can experience well-being despite illness. The positive attributes of animals can be used in health care to help ill people experience well-being. An animal-assisted intervention can be a form of activity or therapy involving pets (AAA / AAT) or horses (EAT). Aim: The purpose of this study was to elucidate how animals in health care promote well-being for people with long-term illness. Methods: Literature review based on fourteen original scientific articles, with both qualitative and quantitative approach. Results: The compilation of the results led to four main categories with two subcategories respectively. These were: Physical aspects with subcategories Physical well-being and Bodily functions; Psychic aspects with subcategories Psychic well-being and Reduced psychiatric symptoms; Existential aspects with subcategories Quality of Life and Safety; Social Aspects with subcategories Social behavior and Relationships. Discussions: Review and discussion of the selected method. Discussion of the results with the selected theoretical framework: Antonovsky's theory of Sense of Coherence (SOC) and the salutogenic approach. The results were discussed based on the concepts of comprehensibility, manageability and meaningfulness.

Denna studie har genomförts i syfte att öka kunskapen om psykosocial utvevckling hos barn med autismdiagnos i relation till aktiviteter med hästar. Studien är kvalitativ, baserad på fem intervjuer av föräldrar och det ingår fältobservationer. Intervjuerna har bearbetats enligt induktiv tematisk analys och redovisas under tre teman relaterade till barnens samspel med sin omvärld. Resultatet visar att aktiviteten med hästar inverkar positivt  på barnens vilja och förmåga att samspela och kommunicera med omvärlden. Färdigheterna visar sig i samspel med barn såväl som med vuxna, både inom familjen och i andra sammanhang. Studiens resultat visar överensstämmelse med tidigare forskning, samt att aktivitetens mångfassetterade innehåll och effekter synliggörs. Resultat som överraskar är erfarenheter av barnens annorlunda relation och kommunikation med hästar, samt iakttagelser av ridningens omedelbara effekter på barnen. Forskning föreslås ur ett familjeperspektiv där barnets röst lyfts fram, samt fortsatt forskning på ridningens fysiologiska effekter i relation till socialt interagerande. / This study has been conducted in order to increase knowledge about psychosocial development in children with autism diagnosis in relationship to activities with horses. The study is qualitative, based on five interviews with parents and includes field observations. The interviews have been processed according to inductive thematic analysis and are reported under three themes related to the childrens interaction with their environment. The result shows that the activity with horses has positive impact on the children's desire and ability to interact and communicate with the outside world. The skills manifests in interaction with children as well as with adults, both within the family and in other settings. The result of the study indicates conformity with previous research, and the event's multi-facetted content and effects are made visible. Surprising results are experiences of the children's different relationship and communication with horses, and observations of the immediate impact on the children when riding. Research from a family perspective highligtening the voice of the child is proposed, as well as further research on physiological effects of horseback riding in reltionship to social interacting.

Syftet med detta examensarbete var att undersöka hur behandlare inom olika professioner använt sig av hästunderstödd terapi, som en del av en terapeutisk behandling. Detta för att se om behandlarna kunde märka en förändring hos deltagaren. Examensarbetet baserades på kvalitativ metod där fyra telefonintervjuer genomförts med personer som arbetar med hästar i terapeutisk behandling. Resultaten visade att behandlarna upplevde att hästarna kunde hjälpa till med samspelet mellan behandlare och deltagare. Det framkom att behandlarna upplevde att det skedde genom ett icke-verbalt deltagande från hästen i samspel med behandlaren och den som deltog. Deltagarna fick en möjlighet att skapa mening med hjälp av vardagliga rutiner och strukturer. Del kunde känna tillit till andra, samt började våga skapa relationer med andra människor vilket gav en känsla av förhållande till samhället. Samtliga behandlare menade att det var svårt att avgöra vad som hade skapat en förändring. Gemensamt var behandlarnas upplevelse av en positiv förändring hos flertalet av deltagarna. / This bachelor thesis analyses the use of horse-assisted therapy amongst mental health practitioners within multiple sectors. The aim was to establish whether a change could be detected in participants. Adopting a qualitative approach the research was mainly conducted through four semi-structured interviews with equine-assisted therapy practitioners. The results show that the practitioners believe the horses improve the interactions between the practitioners and participants. The practitioners believe this improvement is due to the non-verbal participation of the horse in interface with the practitioner and participant and that the horses increase the participants’ trust in others as well as their confidence when establishing relationships with others. The participants gained an opportunity to create meaning within their lives through everyday routines, structures and feel a sense of context. Some of the practitioners struggled to identify what causes the change but recognised a positive change in the majority of participants.

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.

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.

Bakgrund: Hundterapi är ett relativt outforskat område, i dagsläget finns det en begränsad mängd med evidensbaserad forskning rörande vårdhundens effekter. Vårdhunden har många olika användningsområden inom sjukvården. Sjukdomar som demens och psykisk ohälsa är vida utbrett i världen och det syns en ökning av personer som drabbas av demens vilket kan kopplas till en ökad medellivslängd. Syfte: Syftet med denna litteraturstudie var att beskriva vårdhundens effekter på välbefinnandet hos personer med kognitiv nedsättning samt att som metodologisk aspekt beskriva på vilket sätt hunden använts som oberoende variabel i studiernas interventioner. Metod: En deskriptiv litteraturstudie där tio kvantitativa experimentella studier har granskats och sammanställts. Huvudresultat: Sammanställningen av studierna gav tre olika utfall, förbättrad effekt, försämrad effekt samt oförändrat utfall. Flera av studierna visade på att vårdhunden hade minskat deltagarnas depressiva symtom och deras nedstämdhet. Samtidigt syntes en ökad emotionell stabilitet samt en minskad ångest och aggressivitet hos deltagarna. De ingående studierna visade även en försämrad effekt av välbefinnandet och en ökning av dementa symptom vilket yttrade sig genom att deltagarna blev mindre adekvata och mer verbalt aggressiva, huruvida denna effekt berodde på vårdhunden framkom inte. Utifrån den metodologiska frågeställningen framkom det ur studierna att deltagarna fått klappa, leka, utfodra, promenera samt fått välja själva hur de spendera tiden med hunden. Slutsatser: Ur litteraturstudien framkom det förbättrade effekter på välbefinnandet hos deltagarna med kognitiva nedsättningar efter hundterapin, vilket framhåller hundens hälsofrämjande egenskaper. Vidare saknade stora delar av de ingående studierna statistisk signifikans och blev därför inte tillförlitliga. Det behövs därför mer evidensbaserad forskning för att kunna fastställa vårdhundens effekter inom området. / Background: Dog therapy is an unexplored area within the field of nursing, to date there´s a lack of evidence based research regarding the therapeutic effects of the dog in health-care. The therapy dog has a variety of areas in the healthcare which it can be used. Dementia and mental illness is a widely spread over the world and there is an increase in people diagnosed with the disorder, it´s thought to be related to increased average life expectancy. Aim: The aim of this literature-review was to describe the effects of the therapy dog on the wellbeing on patients with cognitive dysfunctions and as methodological aspect describe in which way the dog has been used as an independent variable in the interventions of the studies. Method: A descriptive literature-review where ten quantitative experimental studies has been reviewed and complied. Main result: The result of the included studies were summarized under three different outcomes, improved effect, degraded effect and unchanged effect. Several of the studies showed a decrease in the participant’s depressive symptoms, it was thought to be due to the effects of the dog. The participants showed an increased emotional stability and a reduced grade of anxiety as well as decreased aggressive behavior. The outcome of the included studies also showed a decreased tendency in the participant’s self-experience quality of life and an increased frequency of dementia symptoms, which were revealed as les adequateness and more verbally aggressive. Based on the methodological question the studies showed that the activities the participants did during the intervention were; pet the dog, play with the dog, feed it, take walks with the dog and they could choose individually what they wanted to do. Conclusion: The literature- review revealed that the therapy dog had a improved impact on the participants wellbeing after the intervention, compared to before the intervention. This emphasizes the dog´s health-promoting characteristics. Furthermore, the outcome of the literature- review shows that the result from the included studies lack statistical significance, therefore these results were not counted as reliable. The present review underlines the need for further evidence- based research regarding the health-promoting effects of the therapy dog.

Bakgrund: Animal Assisted Therapy (AAT) har i tidigare studier visat sig vara en effektiv metod inom äldrevården och pediatriken för att öka känslan av sammanhang och livskvalité. En person med autism behöver ha en anpassad miljö runtomkring sig för att bibehålla bland annat kognitiva funktioner som i sin tur kan främja hälsa och skapa livskvalité. Ett djur skulle kunna vara ett sätt att anpassa miljön omkring barnet med autism, då det visat sig att djurs närhet har en positiv effekt inom andra vårdområden. Djurterapins huvudområde är att minska sociala, emotionella och kognitiva problem i patientens handlingsplan. När ett barn har någon form av diagnos, blir hela familjen involverad i vården av barnet. Barnet med autism har också särskilt svårt att berätta om sina egna känslor och upplevelser, därför bygger den föreliggande studien på familjernas erfarenheter av djurens betydelse. Syfte: Att beskriva familjers erfarenheter av vilken betydelse djur har för barn med autism. Syftet var också att beskriva den metodologiska aspekten undersökningsgrupp i de inkluderade artiklarna. Metod: En deskriptiv litteraturstudie gjordes. Genom att använda sig av inklusionskriterier, exklusionskriterier och limits, valdes elva artiklar ut - nio kvantitativa och två tvärvetenskapliga - och granskades utifrån frågeställningarna som satts upp. Huvudresultat: Resultatet visade att djurterapi har stor betydelse för barnets sociala förmåga. Även positiva resultat sågs angående kommunikation, problemlösningsförmåga, repetativa beteenden, fysisk styrka och motorik. Undersökningsgrupperna var ojämna, då de hade en ojämn könsfördelning. Slutsats: Resultatet visade att djurterapi haft en positiv betydelse för barn med autism och deras sociala liv. Vidare forskning behövs göras för att göra djurterapi till en evidensbeprövad behandlingsform i framtiden. / Background: Previous research has shown that Animal Assisted Therapy (AAT) is an efficient method to increase the Sense of Coherence and Quality of Life in pediatric- and geriatric care. A person with autism needs to have an adapted environment to maintain cognitive functions which can promote health and promote Quality of Life. In this case, animals could be a means to create environmental adaptation for a child with autism, since animals have proven to have a positive effect on patients in other areas of care. The main purpose of the AAT is to reduce social, emotional and cognitive problems in the care-plan of the child. When a child has some kind of diagnosis, the whole family gets involved in the caring process. The child with autism also have difficulties to share feelings and life experiences. Therefore the present study is based on the experience of families regarding the importance of animals. Aim: To describe families experiences of the importance of animals for children with autism. The aim was also to describe the methodological aspect study group in the included articles. Method: A descriptive literature study was conducted. By using inclusion- and exclusion criterias and limits, eleven articles were chosen – nine with quantitative approach and two with interdiciplinary approach – and were reviewed on the basis of the chosen questions. Main result: The result has shown that AAT is of great importance for the childs social abilities. Also, positive results were shown in communication, problem solving skills, repetative behaviour, physical strength and motor skills. The study groups were uneven, as they had a gender bias. Conclusion: The results showed that AAT have had a positive effect for children with autism and their social life. More research is needed to make AAT an evidential form of treatment in the future.

Bakgrund: Demens är den fjärde största folksjukdomen i Sverige. Ofta behandla demens med läkemedel för Behavioural and Psychological Symtoms in Dementia (BPSD) som ger olika biverkningar. Det finns ett stadigt samband mellan umgänge med djur och livskvalitet där termer som återhämtning, trivsel och stressreduktion räknas in. Alternativa metoder som djur i omvårdnaden av personer med demens bör därför övervägas för att förbättra dementas livskvalitet. Syfte: Att beskriva forskning om djur i omvårdnad av personer med demens och hur det kan förbättra deras livskvalitet. Metod: En litteraturöversikt där resultatet var baserat på tio vetenskapliga artiklar hämtade från databaserna Cinahl, Pubmed, Psychinfo och Web of Science publicerade mellan 2011-2016. Nio av artiklarna var kvantitativa, en var kvalitativ. Resultat: Deltagarnas emotionella och kognitiva status påverkades av umgänge med djur. Glädje var en känsla som uppstod och som sedan resulterade i att deltagarna log. Depression och nedstämdhet påverkades i en positiv riktning i flera studier där djur implementerats i omvårdnaden, motivation till att delta i aktiviteter och genomföra dagliga sysslor likaså. Slutsats: Djur i omvårdnaden hade en positiv inverkan hos personer med demens och att livskvaliteten främjades genom att djur, främst hundar, förbättrade olika faktorer hos personer med demens. / Background: Dementia is the fourth largest national disease in Sweden. Dementia is often treated with medications for Behavioural and Psychological Symtoms in Dementia (BPSD) giving different side effects. There is a firm link between socializing with the animals and quality of life where terms such as recovery, wellbeing and stress reduction are included. Alternative methods such as animals in the care of people with dementia should be considered to improve the demented quality of life. Aim: To describe research on animals in the care of people with dementia and how it can improve their quality of life. Methods: A literature review in which the outcome were based on ten scientific articles from the databases Cinahl, Pubmed, Psychinfo and Web of Science published between 2011-2016. Nine of the articles had a quantitative approach, one had a qualitative approach. Results: The participants' emotional and cognitive status were influenced by association with animals. Joy was a feeling that arose which resulted in that the participants smiled. Depression and depressed moods were affected in a positive direction in several studies in which animals were implemented in the care, motivation to participate in activities and carry out daily chores as well. Conclusion: Animals in the care had a positive effect in people with dementia and the quality of life encouraged by animals, mainly dogs, improved various factors in people with dementia. / <p></p><p></p><p></p>

Background Exhaustion disorder (ED) is a common mental and behavioural disorder which often leads to severe negative consequences for the individual and the society. Natural environments have positive effects on mental, physiological and attentional recovery in stressed persons, which encouraged us to test if forest visits could improve recovery from ED. The main objective of the thesis was to study if visits to different kinds of forest environments have positive health effects on patients suffering from ED, and if forest visits can be utilized for rehabilitation. Methods Participants in the MiniRest study (n=20) and the Pilot study (n=6) (Papers I and II) were recruited from the Stress Rehabilitation Clinic (SRC) at the University Hospital in Umeå.  Participants in the randomised controlled study, ForRest (n=99) and the Interview study (n=19) (Papers III and IV) were recruited from both the SRC and the Swedish Social Insurance Agency in Umeå. The MiniRest study involved only female ED patients and focused on immediate mental, physiological and attention capacity effects in one urban and three forest environments. The Pilot study investigated the practical arrangements for the forthcoming ForRest study. Participants in the ForRest study were randomised into either a three-month forest rehabilitation group; A (forest visits twice a week/4 hours per day) or to a control condition; B. Both groups received Cognitive Behavioural Rehabilitation (CBR) at 24 occasions/once a week after the three-month study period. Preferences for forest environments, mental state and attention capacity were studied for group A only. Psychological health measurements and sick leave data were compared between the groups after (i) the forest rehabilitation and (ii) the CBR. The Interview study was conducted according to grounded theory methodology and consisted of 19 participants from group A to explore personal experiences from the forest rehabilitation. Data collection was implemented through questionnaires, medical records, physiological measurements, and interviews. Results Exposure to forest environments was associated with higher preference, more favourable mental state and physiological responses, and increased attention capacity compared to an urban environment (Paper I). Open and accessible forest environments were preferred (Papers I, II and III). Recovery from ED was found in both groups in the ForRest study, but there were no differences between the groups over time. In group A, positive effects on mental state and attention capacity were found during the forest visits. An interaction effect was found with more positive effects on mental state during spring compared to autumn (Paper III). Solitude, feelings of freedom and no demands were important for finding peace of mind during the forest visits. Moreover, easier access to peace of mind, reflective thinking and positive feelings were reported as the forest rehabilitation progressed (Papers II and IV). Conclusions Forest visits have restorative effects for ED patients through enhanced mental well-being, easier access to peace of mind, beneficial physiological reactions and increased attention capacity which support the use of forest environments in rehabilitation. However, forest rehabilitation tested in a randomised controlled trial did not improve recovery from ED. Potentially rehabilitation with CBR and forest visits integrated could be more effective and should be further investigated in nature-assisted rehabilitation for ED patients.