Breaking News! Animal-Assisted Intervention in the ICU

A new journal article has just been published by (Hosey et al. 2018) “Animal-assisted intervention in the ICU: a tool for humanization” (as referenced below). As described in their abstract:

Abstract

“The combination of an aging population and advances in critical care medicine is resulting in a growing number of survivors of critical illness.[1] Survivors' descriptions of their stay in an intensive care unit (ICU) are frequently filled with traumatic events, and include experiences of confusion, anxiety, sleeplessness, pain, and loneliness.[2,3] Sedative and anxiolytic medications administered to manage patient symptoms are associated with delirium and worse physical and mental health outcomes.[4] Therefore, there is growing interest in the use of non-pharmacologic interventions and in creating a more humanized environment in the ICU for patients and their families.[5] Such efforts have included a focus on understanding the critically ill patient as an individual and providing comprehensive medical, psychological, and rehabilitation care.[6–8] This publication aims to: 1) suggest a conceptual model for the use of non-pharmacologic interventions to reduce suffering and promote recovery in a more humanized ICU environment; 2) describe animal-assisted intervention (AAI) as an exemplar of a non-pharmacologic intervention and provide a conceptual model for the utility of this intervention; and 3) discuss the basic principles for introducing a non-pharmacologic intervention program in the ICU.” (Hosey et al. 2018, p. 1)

Highlights of this study include:

“Some healthcare facilities have integrated AAI, in populations ranging from pediatrics to geriatrics, in order to reduce suffering and promote recovery behaviour”.

“Anecdotal evidence suggests that a dog sitting in a patient's lap eases suffering and builds motivation in ways that medical interventions may not”.

Directly quoted below, Hosey et al. (2018, p. 5) have identified six critical success factors to build an AAI Program in an ICU:

1.  designating a champion who is consistently present in the ICU with established credibility to create systematic change;
2.  having clear program goals with milestones and measurable outcomes, such as a.    improving patient mood, b.    improving engagement in medical care and rehabilitation therapies, and c.    reducing perceived pain; 
3. including stakeholders who can help identify and surmount barriers to implementation, such as risk management and hospital epidemiology and infection control staff; 
4. identifying animal teams and partnering them with an organization that has credibility in training teams for the hospital environment, such as Pet Partners, Inc. (https://petpartners.org/) and Assistance Dogs International (https://assistancedogsinternational.org); 
5. creating a policy that a.    establishes goals of the program, b.    outlines roles/responsibilities for all involved in the program, c.     outlines logistics of animal visits, d.    specifies what do in the event of an accident, and e.    establishes a plan for program evaluation; and 
6.  launching the program with patients who have a high likelihood of success, such as patients without delirium, communicable disease, or the need for contact precautions due to colonization with a drug-resistant microorganism, to build confidence and create momentum for the program.

Finally they conclude that in terms of non-pharmacological interventions, Animal Assisted Interventions has the potential to reduce patient suffering and enables people to be able to take and “active role in their recovery”.

Reference

Hosey, MM, Jaskulski, J, Wegener, ST, Chlan, LL & Needham, DM 2018, “Animal-assisted intervention in the ICU: a tool for humanization”, Critical Care, vol. 22, no. 22, pp. 1-5.

Focusing on Positivity, Hope and Acceptance NOT the “Illness”

Its difficult topic to discuss, but one that needs a serious discussion, both in the area of mental health, acute care and chronic illnesses. I stumbled across an article yesterday that gave me pause to reflect upon the “Recovery Framework” that is bandied around by mental health professionals, and indeed by myself at times. One striking quote is as follows:

“The word “recovery” suggests that people need to return to a “normal” state, rather than embrace their differences. What does a person with bipolar disorder or autism need to “recover” from? When people realize they are not their diagnoses, they can start to find things that actually work to help them live successful and productive lives. That’s hope, not recovery.” (Liza Long, 2015: https://www.huffingtonpost.com/liza-long/5-reasons-i-wish-we-would_b_6502318.html)

She then discusses the differences between chronic illnesses and mental illness – both in terms of stigma and then subsequent “recovery”:

“… if people recover, why aren’t you recovering? It must be a choice you are making, or something you’re doing wrong. Some people tell you the medications you take are preventing you from recovery. Others tell you that your choice to stop medication is preventing you from recovery. Who is right? Hope is a universal concept that embraces a wide range of possibilities. Recovery seems dependent on a prescribed set of treatments that may not work for everyone… We would never apply the blanket expectation of recovery to any other chronic illness or disability. With cancer and autoimmune disorders, we use the term “remission” to describe a life-threatening systemic illness that with luck and treatment has been stopped in its tracks. With other chronic illnesses like diabetes, we talk about managing the illness. But with mental illness, we expect people to “choose” recovery, even when they are experiencing psychosis, or when their disease steals their ability to make rational choices.” (Long, 2015)

Ms. Long talks then about the concept of hope… What I have noticed is that when people focus on their diagnosis and their limitations, this would seem to hold true – it psychologically takes away the concept of hope. Moving further, how can one maintain a positive outlook on life should one lose hope?

Ms. Mims (2016, https://themighty.com/2016/12/focusing-on-positives-of-life-with-chronic-illness/ ) discusses her journey of being diagnosed with Celiac disease and discusses the initial feeling experienced such as “anger, grief, sadness, frustration and fear. There may be tears, and there may be mourning… The thoughts flash quickly through your mind: “But I can’t…”, “But I won’t ever be able to…”, “But now I’ll never have a ‘normal’ life.” Interestingly however, her outlook is that she perceives that these negative thought patterns have the potential make her captive of her own mind, in this way she highlights the fact that she has noted that some let the disease define them and it is there identity. She chooses the opposite of that. In that way, while she struggles at time, she fights for joy in her life so she doesn’t become a captive of her own mind and her identity remains separate to her di-ease.

So what are we left with? First, how to regulate your behaviours and emotions and then how to move forward onto a path of positivity and hope.

So in this way you need to be able to think that these thought patterns that your behaviours and thoughts are actually causing you harm, and test whether you can resist in these thought patterns or behaviours. “Self-destructive or dysregulated behaviours provide relief or even pleasure in the short-term – but ultimately get in the way of living a life that feels satisfying and fulfilling.” (Wupperman, 2016 Psychology Today). One helpful avenue is to actually process your emotions at the time Wupperman suggests so they do not continue to build into a virtual pressure cooker waiting to explode. If not, it may become a repetitive cycle.

A useful way to think about moving forward has been discussed by Ms. Mulder, a Psychologist who is living with a chronic illness (2017: https://thehealthsessions.com/lessons-learned-about-recovery-from-illness/ ). Albeit, this is at odds with previous assertions about the divergent terminology about “recovery”. Nevertheless, I believe it is up to the individual to choose their own terminology to “fit” with their own journey in order to move forward along their own pathway in life in order to promote hope and positivity. Mulder’s seven steps are exceptional, simple and I believe can be applied to most situations. It moves one from a situation of feeling powerless to feeling empowered. That is a critical switch in thinking that must be taken in many situations whether one is chronically ill, acutely ill or diagnosed with a mental illness. Yet again however terminology is important and thus I will simply say a disabling condition with ascribing or labelling further.

She suggests that one should decide what recovering from this means for yourself: “The conventional definition of ‘recovery’ is too limiting for these people: it implies a fixed final destination at the end of the road – one that many of us may never reach. So what if we stop thinking of recovery as an all-or-nothing deal, but rather as a continuum with many more stages, variations and dimensions than simply “being better”? ‘Recovery’ can mean anything you want it to be: (small) physical or mental improvements, a better quality of life or being able to do something you couldn’t do before. Meaningful examples of this new version of recovery could be being able to walk to the shops again, becoming more independent, picking up your favorite hobby again or getting back to work parttime.” (Mulder, 2017).

Next, one must remember that it is a long and at time a winding arduous journey: “Healing is not a linear process. … There are many ups and downs along the way. Depending on your illness – whether it’s curable or chronic, relatively stable or progressive – this process of setbacks and personal victories can repeat itself multiple times. That’s because ‘being healthy’ isn’t as black-and-white as it’s usually portrayed. Most of us find ourselves in the huge grey area between optimally fit and terminally ill. Even a healthy person’s immune system can be working overtime to (successfully) fight off a nasty virus, and even a chronically ill person can have a relatively good week. Your health fluctuates every day for as long as you will live, constantly trying to find that illusive equilibrium... So don’t give up too soon if you don’t notice any improvements straight away. Recovery is a marathon, not a sprint.” (Mulder, 2017).

While I am unsure of the next one (more of a terminology than anything) she discusses the fact that you can fight for your recovery, whilst at the time accepting you illness. Arguably, fighting means a battle and a battle means expending energy that one may not have. Accepting your illness as well may make one resigned to the fact and then you could lose hope. However she most poignantly says here: “Contrary to what you might think, it is possible to accept your current limitations and keep fighting for your recovery at the same time. Because facing today’s reality doesn’t mean you give up hope for tomorrow. It just means you make the best of the given situation in this moment, instead of forcefully trying to change something that cannot be changed right now. It’s saying: “Apparently, this is all my body and mind are capable of doing right now, and I will live life the best way I know how despite of my illness.” At the same time, you can still take smalls steps every day towards a better health, just without the constant struggle and disappointment of not being able to live up (your) expectations. Focus on what you can control or improve, however little that might be today, and find ways to accept the things you cannot change.” (Mulder, 2017).

Finally Mulder suggests that one needs to arrive at the conclusion that sometimes there is no end goal: “But sometimes, no matter how hard you try, your body and mind just can’t (fully) heal themselves. If there’s no victory, is it even worth the struggle? Only you can decide that. But to me, it’s not just the destination that matters, it’s the journey – basically, your life – as well. What will you have done along the way? How much joy did you experience? Were you able to achieve some of your dreams by striving? Did you have less pain and symptoms – and therefore a better quality of life – thanks to your recovery efforts? If you’re anything like me, knowing you’ve done all you could have to get better, feel better, live life the way you wanted to can help you learn to accept remaining limitations and disappointments.” (Mulder, 2017).

If we look at this in its entirety (terminology aside) there demonstrates a lot of hope, a lot of positivity and very little focus on the dis-ease itself. Rather the mind, body, spirit continuum and the ability to self-regulate destructive behaviours and the cycles that can occur that will eventually end up making one bitter, twisted and sick of their life as evidence would suggest that leads to chronic depression and a multitude of other co-morbidities ((Singer 2001: https://www.ncbi.nlm.nih.gov/books/NBK43790/ ). Changing habits takes a long time to occur (Evans, 2012: https://www.huffingtonpost.co.uk/jules-evans/mental-health-recovery-top-ten-tips-for-recoveri_b_2165212.html ). Termed “Neuroplacicity”, work on developing your brain to develop those hopes, dreams and goals into a serious of goals and then into habits and then keep a journal to the document your progress (Evans, 2012). You may be surprised at the results on what you have achieved!

In sum the take home message is to change your habits, change your thought patterns and definitively choose to think that the dis-ease does not define you as a person. Rather you are a useful, contributing member of society that can go out and achieve what you want to – you may just have to do it in a variety of creative ways that other people may not. A final note is that becoming self-absorbed in your dis-ease bodes no one any good. If you become the observer self, you will begin to understand that everybody has problems, issues and daily struggles and each person considers them just as important as yours; this means you do need to think of others as well during this journey (Evans, 2012). Optimism and social support is vital and also has been proven to prevent a relapse in chronic depression, so I urge you to give this serious consideration (Singer 2001). Without this, there may indeed spark a pathway of self-destructive behaviours that will ultimately affect your health (Wupperman, 2016). By focusing on positivity and hope and considering that this is your journey, allows one to also develop empathy for others, consideration for others and who knows, you may just move that bit closer to the goals you have set yourself without even knowing it! 

Animal Assisted Therapy & its Affects on the Dog

Quoted from Pet Industry News:

 
Animal-assisted interventions (AAIs) are becoming increasingly popular in clinical settings. AAIs are defined as the ‘purposeful incorporation of specially trained animals in services to improve human health’, and dogs are commonly used for these interventions.
These therapy dogs interact with a variety of patients in a clinical setting, and it is possible that the dogs find these interactions stressful. There is currently a lack of agreement regarding if and how AAIs affect animal welfare, and further research is needed to ensure the welfare needs of therapy dogs are being met. This study measured the physiological and behavioural effects of regular AAI sessions on therapy dogs.
The AAIs monitored in this study occurred between therapy dogs and children between the ages of 3-17 years who had recently been diagnosed with cancer in the USA. The children were enrolled in the study for a four-month period, during which they received weekly visits from the same therapy dog and handler. A total of 26 therapy dogs were used to visit 60 children, and each visit lasted for approximately 20 minutes. The dog handlers completed a questionnaire relating to how their dog typically responds to common events and stimuli in the environment, and collected saliva samples at home and immediately after an AAI to determine changes in stress physiology (cortisol). The behaviour of the dogs was video recorded during each AAI and the total frequency of stress-related behaviours and affiliative behaviours were recorded for each session.
The results of this study indicate that therapy dogs show minimal signs of distress during AAI sessions. The therapy dogs did not have a significantly increased physiological stress response following the session, nor did they exhibit significantly more stress-related behaviours than affiliative-related behaviours. There were significant relationships found between salivary cortisol and behaviour, with a higher cortisol concentration associated with more stress behaviours, and lower cortisol concentration associated with more affiliative behaviours. This study provides valuable and rigorous evidence that AAI participation in paediatric hospitals does not appear to place therapy dogs at significant risk of stress.
McCullough A, Jenkins MA, Ruehrdanz A (2018)
Physiological and behavioural effects of animal-assisted interventions on therapy dogs in pediatric oncology settings.
Applied Animal Behaviour Science 200:86-95.
Source: RSPCA Animal Welfare Science

Dealing with Anxiety

What is Anxiety

Anxiety is an emotion that is characterised with feelings like worrying thoughts, feeling tension and physical symptoms such as increased heart rate and blood pressure. There are two kinds of anxiety – normal anxiety (such as being anxious before sitting an exam) or an anxiety disorder (requiring medical intervention – and this means the anxiety experienced is out of proportion to the trigger or the severity of the anxiety is disabling to the point of being able to function in your day to day life).

Anxiety is your body’s reaction designed to keep you safe – but when it is hard to control, then it becomes problematic! Yet sometimes, no matter how much we tell ourselves not to be anxious, we cant’s stop those emotions or physical symptoms.

Changing your mindset

Changing your mindset doesn’t happen overnight, However, small repeated steps, will assist in transforming – remember don’t hurry the process! Also, don’t try and do all of these suggested strategies at once, it will only make you more anxious! Just be you and rejoice in one accomplishment at a time!

BE PRESENT:

Don’t worry about the past or future. Don’t follow your anxious thoughts. Anxiety is all about “maybes” and “what if’s” then takes you to a potentially threatening and uncertain future. Try experimenting with being fully present in the future and focus fully on what’s happening around you – the noises, the sound of your breath, the outside noises – just even for 2 minutes – set yourself a time limit. Congratulate yourself after! What you’ve just done is developed an ability to pull yourselve back from your anxious thoughts to the present. Try to practice this everyday regularly.

BE PATIENT:

Always know that feelings and thoughts come, stay and then go. There’s a saying “this too shall pass”. So be patient, ride the feeling/s and thought/s. Develop the wisdom to know that you can stay with these feelings long enough to know that eventually that they will leave and that you do not need them today. You could try developing an internal dialogue and saying to yourself “thank you for these thoughts and feelings, you’ll leave when you’re ready”. Then breathe deeply.

DON’T ENGAGE:

Observe your thoughts and feelings without engaging with them. Anxiety is exhausting. If you engage with the thoughts and feelings it’s downright exhausting! So just observe them, don’t try to change them, let them be, don’t try to understand them or talk yourself out of them – let them float around you without becoming part of you.

TRUST YOURSELF:

Finally trust yourself! Know that you are strong and resourceful! You have gotten this far in life and so no matter what happens in life, you can deal with what ever comes your way! Remember, underlying anxiety is anxiety worry, rejection and stress of failure  and that you may not be able to cope with what comes your way… Move towards trusting in yourself – act as if until it becomes that. You can do it!

You Get 25,000 Mornings as an Adult: Here are 8 Ways to Not Waste Them by James Clear

An excerpt from an article From James Clear to read in its entirety, please visit: https://jamesclear.com/25000-mornings

"1. Manage your energy, not your time. If you take a moment to think about it, you'll probably realize that you are better at doing certain tasks at certain times. For example, my creative energy is highest in the morning, so that's when I do my writing each day.
By comparison, I block out my afternoons for interviews, phone calls, and emails. I don't need my creative energy to be high for those tasks, so that's the best time for me to get them done. And I tend to have my best workouts in the late afternoon or early evening, so that's when I head to the gym. What type of energy do you have in the morning? What task is that energy best suited for?"

"2. Prepare the night before. I don't do this nearly as often as I should, but if you only do one thing each day then spend a few minutes each night organizing your to–do list for tomorrow. When I do it right, I’ll outline the article I’m going to write the next day and develop a short list of the most important items for me to accomplish. It takes 10 minutes that night and saves 3 hours the next day."

"3. Don’t open email until noon. Sounds simple. Nobody does it. It took me awhile to get over the urge to open my inbox, but eventually I realized that everything can wait a few hours. Nobody is going to email you about a true emergency (a death in the family, etc.), so leave your email alone for the first few hours of each day. Use the morning to do what's important rather than responding to what is “urgent.” "

"4. Turn your phone off and leave it in another room. Or on your colleagues desk. Or at the very least, put it somewhere that is out of sight. This eliminates the urge to check text messages, Facebook, Twitter, and so on. This simple strategy eliminates the likelihood of slipping into half–work where you waste time dividing your attention among meaningless tasks."

"5. Work in a cool place. Have you ever noticed how you feel groggy and sluggish in a hot room? Turning the temperature down or moving to a cooler place is an easy way to focus your mind and body. (Hat tip to Michael Hyatt for this one.)"

"6. Sit up or stand up. Your mind needs oxygen to work properly. Your lungs need to be able to expand and contract to fill your body with oxygen. That sounds simple enough, but here's the problem: most people sit hunched over while staring at a screen and typing.
When you sit hunched over, your chest is in a collapsed position and your diaphragm is pressing against the bottom of your lungs, which hinders your ability to breathe easily and deeply. Sit up straight or stand up and you'll find that you can breathe easier and more fully. As a result, your brain will get more oxygen and you'll be able to concentrate better. (Small tip: When sitting, I usually place a pillow in the small of my back. This prevents my lower back from rounding, which keeps me more upright.)"

"7. Eat as a reward for working hard. I practice intermittent fasting, which means that I eat my first meal around noon each day. I've been doing this for almost two years. There are plenty of health benefits, which I explained in great detail here, here, and here.
But health is just one piece of the puzzle. I also fast because it allows me to get more out of my day. Take a moment to think about how much time people spend each day thinking, planning, and consuming food. By adopting intermittent fasting, I don’t waste an hour each morning figuring out what to eat for breakfast, cooking it, and cleaning up. Instead, I use my morning to work on things that are important to me. Then, I eat good food and big meals as a reward for working hard."

"8. Develop a “pre–game routine” to start your day. My morning routine starts by pouring a cold glass of water. Some people kick off their day with ten minutes of meditation. Similarly, you should have a sequence that starts your morning ritual. This tiny routine signals to your brain that it's time to get into work mode or exercise mode or whatever mode you need to be in to accomplish your task. Additionally, a pre–game routine helps you overcome a lack of motivation and get things done even when you don’t feel like it."

"For more details about why this works, read this: How to Get Motivated."

25 Ways to be a happier healthier you!

Starting uni a happier and more healthy self:-) An interesting concept isn't it? How can one be a happier and healthier self? Yet when you are starting uni, in the middle, or about to graduate, it pays to make some small changes to ensure longevity.


When we think about nursing in particular, these small changes can be transferred as you educate your clients as they too embark upon their life's journey. This YouTube clip gives a slightly humorous look at 25 ways we can all make some small changes to be a happier healthier version of ourselves.