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

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

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

BACKGROUND

Chronic diseases, such as opioid use disorder (OUD) require a multifaceted scientific approach to address their evolving complexity. The Council for the Advancement of Nursing Science's (Council) four nursing science priority areas (precision health; global health, determinants of health, and big data/data analytics) were established to provide a framework to address current complex health problems.

PURPOSE

To examine OUD research through the nursing science priority areas and evaluate the appropriateness of the priority areas as a framework for research on complex health conditions.

METHOD

OUD was used as an exemplar to explore the relevance of the nursing science priorities for future research.

FINDINGS

Research in the four priority areas is advancing knowledge in OUD identification, prevention, and treatment. Intersection of OUD research population focus and methodological approach was identified among the priority areas.

DISCUSSION

The Council priorities provide a relevant framework for nurse scientists to address complex health problems like OUD.

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

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

Companion animals and human health: benefits, challenges, and the road ahead for human-animal interaction

There is ample evidence that human-animal interaction (HAI) is associated with health. Studies encompass three general categories: those that compare companion animal owners with individuals who do not own companion animals, those examining brief, 'one-off' contacts with animals, and those that review animal-assisted interventions. The health benefits demonstrated typically include reductions in depression and loneliness, while enhancing social interaction or social skills, and decreasing anxiety and arousal. Other health benefits associated with companion animals include the promotion of exercise or physical activity. The types of human-animal contact that have been evaluated include visual contact, physical contact, and looking at images of animals. The species used in interventions include dogs, cats, horses, rabbits, goats, hamsters and crickets. Despite these benefits, HAIs are also associated with problems, including allergies, asthma, zoonoses, animal bites and scratches, and human falls. Other problems include grief and negative emotions when a companion animal is injured or dies. Companion animal ownership is also expensive. Inconsistent policies concerning keeping animals in housing and enabling service animals to access public places make it difficult to live with companion animals or keep service animals in some circumstances. Additional research is needed to provide an evidence base to evaluate the efficacy of particular types of HAI using a given type of animal. This will document specific outcomes for an individual with certain characteristics and assist in promoting the future use of HAI to enhance human and animal health and well-being.

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

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

National nursing science priorities: Creating a shared vision

BACKGROUND

Nursing science is essential to advance population health through contributions at all phases of scientific inquiry. Multiple scientific initiatives important to nursing science overlap in aims and population focus.

PURPOSE

This article focused on providing the American Academy of Nursing and nurse scientists in the Unites States with a blueprint of nursing science priorities to inform a shared vision for future collaborations, areas of scientific inquiry, and resource allocation.

METHODS

The Science Committee convened four times and using Delphi methods identified priorities with empirical evidence and expert opinion for prioritization, state of the science, expert interest, and potential target stakeholders.

DISCUSSION

Nursing science priorities for 2017 were categorized into four themes including: (a) precision science, (b) big data and data analytics, (c) determinants of health, and (d) global health.

CONCLUSION

Nurse scientists can generate new knowledge in priority areas that advances the health of the world's populations.

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

BACKGROUND

Veterans with post-traumatic stress disorder (PTSD) are a vulnerable population at high risk for depression, isolation, and suicide. A substantial body of anecdotal evidence exists supporting the use of canines as an effective adjunct treatment for this population. However, a comprehensive review of its use based on scientific literature has thus far not been conducted.

METHODS

A narrative literature review was conducted to examine the current state of the science on canine assistance for veterans diagnosed with PTSD in order to synthesize current empirical knowledge on the subject. Articles were retrieved among the small body of recent literature using computerized database searches. Inclusion criteria included peer-reviewed journal publications published through October 1st, 2015. Only originally published articles that examined the outcomes of canine assistance on veterans with PTSD were examined. Additionally, each included article was specific to veterans, dogs, and, PTSD in combination rather than article that discuss the concepts separately. Exclusion criteria included symposia and conference material, dissertations, media articles, and no mention of canines as a treatment modality. 563 articles were retrieved; 6 met the criteria. When evaluating data, information and themes were extracted into an Excel table; this table was employed in the synthesis of information into manuscript form.

RESULTS

The following themes were explored within the selected publications: What is Canine Assistance; Why Use Canine Assistance for PTSD in Veterans; Concerns; and Future Directions. The literature endorsed canine assistance for PTSD in veterans as a promising modality. Authors also raised concerns about lack of protocols, cost and availability barriers, and animal welfare calling for additional, rigorous research to advance its use as a treatment for veterans with PTSD.

CONCLUSIONS

PTSD continues to pose significant psychological, health, and welfare challenges to veterans and the multi-disciplinary providers who treat them. Analysis of this literature should expand knowledge and outline future directions for healthcare professions and improve health and wellness for veterans with PTSD through the use of canine assistance.

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

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

No-Nit Policies in Schools: Time for Change

No-nit policies that exist in many schools throughout the United States were established years ago based on fear and misinformation, rather than scientific evidence. Children who are found to have live lice are no more infectious on the day of diagnosis than they had been prior to the discovery. Transmission of head lice requires close personal contact, which is not common in the school setting. To date, no scientific literature exists to support the exclusion of children from school due to head lice infestation. Therefore, there is a need to develop updated school policies using research-based evidence to determine the best method of treating infestations while allowing children to remain in school.

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

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

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

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

Factors related to type of companion pet owned by older women

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

Human–Canine Interaction: Exploring Stress Indicator Response Patterns of Salivary Cortisol and Immunoglobulin A

A repeated measures design was used to analyze the effect of a canine interaction on salivary cortisol and immunoglobulin A (IgA) in 33 adults; 16 were pet owners and 17 were non-pet owners. Cortisol and IgA levels before and after a canine interaction (experimental) or viewing a canine movie (control) were measured by enzyme-linked immunosorbent assay and spectrophotometer. Data show a significant interaction effect for salivary cortisol in non-pet owners (p = 0.003). Changes in IgA levels were not significant. The findings suggested that interaction with canines may help reduce the biological effects of stress that influences human health. Further studies with larger sample sizes are necessary to support these results.

School nurses in New Jersey: a quantitative inquiry on roles and responsibilities

PURPOSE

This study examined types of chronic diseases present and nursing procedures administered in school, health promotion and disease prevention efforts, collaborative efforts, perception of school nursing activities, documentation media of school nursing activities, and student academic outcomes.

DESIGN AND METHODS

A nonexperimental research design was employed. The sample (N= 63) was practicing school nurses in New Jersey public schools.

RESULTS

The increased numbers of students with chronic illnesses in mainstream classrooms have increased the roles and responsibilities of school nurses.

PRACTICE IMPLICATIONS

School nurses can use the findings as a framework to articulate their roles and responsibilities.

Facts, fiction, and figures of the Sarcoptes scabiei infection

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

Bedbugs: an equal opportunist and cosmopolitan creature

Currently there is a rise in bedbugs seen in schools. The wingless, blood-sucking insects can arrive at school via student book bags, student clothing, or other personal items. If a student presents in the health office with a bite mark, the school nurse will need to differentiate between a bedbug bite and other insect bites, such as fleas, spiders, and scabies in order to provide the most accurate and appropriate intervention measures. This article will further provide school nurses with information about the etiology of the bedbug, mode of transmission, and eradication options for the school and community setting.

Military Children: When Parents Are Deployed Overseas

Members of the Armed Services and Reserve Unit Members, both male and female, are being deployed to distant lands for long periods of time, disrupting family life and causing stressful times for the adults and children in the family. Traditionally, the mother of the military family was left to be the caregiver after the deployment of the husband/father. Today, extended family members as well as mothers or fathers are asked to serve as caregivers for dependent children of deployed servicemen and servicewomen. This article provides information about the challenges families face and the psychosocial developmental needs of children and families during the five stages of military deployment: predeployment, deployment, sustainment, redeployment, and postdeployment. School nurses can offer children and families support and link them with available resources and networks that will assist them with their needs.

Loneliness in the School Setting

Loneliness is a phenomenon that has been recorded in literature throughout the ages. It is now being recognized as problem not only in adults but in children and adolescents as well. Loneliness is an emotional state that can be a barrier to a student’s social development and affect their physical and mental health. Various contributing factors and recognizable situations that contribute to loneliness have been identified. Loneliness is also risk factor for other related health problems. It is important for school nurses to be alert to symptoms of loneliness and know how to assist students to cope with loneliness in the school setting.

Tooth avulsion in the school setting

Tooth avulsions occur when a tooth is displaced from its socket. Tooth avulsions are common dental injuries that may occur before, during, or after school. Therefore, it is essential that school nurses be well prepared to intervene when such a dental emergency arises. It is also imperative that school nurses and school personnel are fully equipped to manage a tooth avulsion. Time is of the essence when attempting to save an avulsed tooth. The goal is to successfully reinsert the avulsed tooth and to preserve the periodontal ligament. The school nurse is responsible for implementing the appropriate actions needed to save the avulsed tooth.