Assignment: Safety of Animals and Patients Reflection Paper
Assignment: Safety of Animals and Patients Reflection Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Safety of Animals and Patients Reflection Paper 1.Critically read two CLC EBP Projects (other than your own) (ATTACHED). Name one barrier for each that could impact the implementation of the guideline in practice, and explain how you would work through this issue. Grand Canyon NUR504 Mod 7 Safety of Animals and Patients Reflection 2.Discuss what is meant by mixed-methods designs . What are the limitations of mixed-methods designs. Assignment: Safety of Animals and Patients Reflection Paper MUST INCLUDE REFERENCE AND IN TEXT CITATIONS. 350-450 words each Assignment: Safety of Animals and Patients Reflection Paper attachment_1 attachment_2 attachment_3 attachment_4 Animal-Assisted Therapy and Health Promotion Christine Orlando, Suzen Angle, Darren Reed Grand Canyon University: NUR-504 Health Care Research Analysis and Utilization September 26, 2018 Animal-Assisted Therapy and Health Promotion According to Polit and Beck (2017), evidence-based practice (EBP) is using the best evidence in meeting a patients specific clinical needs. As clinical questions emerge, a review of research can determine the best clinical approach or research can be conducted to provide evidence-based care. This paper will identify a clinical need, define a problem statement, review the relevant literature, provide an appraisal of the evidence, develop a clinical guideline and implementation plan for a research problem. The EBP process model has been performed following the guidelines found in the textbook Nursing Research: Generating and Assessing Evidence for Nursing Practice (Polit & Beck, 2017) and the IOWA Model of Evidence Based Practice (Titler et.al., 2001). Grand Canyon NUR504 Mod 7 Safety of Animals and Patients Reflection Problem Statement In the geriatric population, what role does animal-assisted therapy (AAT) have in promotion of health? With life expectancy increasing in the United States due to modern medical care, quality of life issues become more of a concern in the aging population. In the framework for healthy aging, The World Health Organization published the importance of enabling people to live independent and active as long as possible (While, 2017). Social isolation, loneliness, depression, and cognitive decline can contribute to mental health issues and decreased sense of well-being in the institutionalized geriatric patient. Some studies in the UK have shown those who live in care facilities have up to 40% depression rates and most do not receive any therapy (While, 2017). It has been shown that the introduction of pets can provide a sense of purpose, companionship, and serve as a social catalyst while improving the quality of life (Cipriani, 2013). According to Cipriani et al. (2013), improvement in human cognitive, social, emotional, and/or physical functioning can be achieved with AAT or pet-facilitated therapy. In addition, physiologic effects of lower blood pressures have been demonstrated (Cherniack, 2014). Despite evidence in support of dog-assisted therapies related to quality of life outcomes, published studies are lacking. Both, Cherniack (2013) and Cipriana et al. (2014) reference the lack of research. AAT has achieved positive results in improving social behavior, reduced anxiety and aggression, increased physical activity, and quality of life among dementia patients (Swall, Ebbeskog, Hagelin, & Fagerberg, 2017). The therapeutic use of animals, as clinical interventions, has the goal of improving over-all health of individuals, especially those who are experiencing age and/or health related life changes or may be nearing end of life. Implementing the use of AAT can be shown to promote health in the geriatric population. Grand Canyon NUR504 Mod 7 Safety of Animals and Patients Reflection This protocol will research the clinical problem of depression in the geriatric population in a long-term care (LTC) facility. With the implementation of AAT, and exposure to the animal companions, residents will have less signs and symptoms of depression over time. Improvement of depression will be achieved following the use of AAT. Assignment: Safety of Animals and Patients Reflection Paper Literature Search and Appraisal of Evidence Following the EBP process model, a review of the relevant literature and research was performed following the identification of a research problem. Using an evidence of hierarchy, literature and research were reviewed, and levels of evidence were applied. An appraisal of the evidence was also performed, and irrelevant references were discarded. The evidence of hierarchy and the appraisal of evidence guidelines were found in the textbook Nursing Research: Generating and Assessing Evidence for Nursing Practice (Polit & Beck, 2017). The findings of this appraisal and a review of the relevant literature is located in Appendix A. Assignment: Safety of Animals and Patients Reflection Paper Synthesis of Evidence and Hypothesis Assignment: Safety of Animals and Patients Reflection Paper Common findings within the literature found evidence for improvements in patients when AAT was introduced into their care. There was an overwhelming mention that additional research in this area needs to be performed. Nonetheless, AAT was found to promote better health in geriatric populations, increased concentration and social interaction, decreased loneliness and depression as well as other behavioral symptoms. Improved experiences of personal meaning were obtained while reducing neuropsychiatric symptoms. Therefore, the hypothesis is if AAT is applied to geriatric populations then a decrease in depression will occur. Instruments The depression, anxiety, stress scale, DASS-42, is a parametric self-report instrument that measures negative states of emotion. See Appendix B. This scale was chosen because it is readily available in the public domain and involves no cost. Additionally, it may be administered and scored by non-psychologists. The original test, developed by Australians, Lovibond and Lovibond in 1995, allows rephrasing the questions in proper tense. The scale measures three dimensions of emotional states and can define clinically significant findings. As utilized for this research study, the discrimination between the three diagnostic categories is less important than an overall score, which will demonstrate diminished sense of purpose and well-being. The inclusion criteria for this intervention, the following parameters are considered: Depression > 9, anxiety > 7, stress > 14. Any one score over the given guidelines qualifies for inclusion. The Delta society sponsors Pet Partners (http://www.petpartners.org/), which is an evidence-based program utilizing ATT to enhance well-being and health. In addition to providing volunteer animal handlers, a training program is offered for training handlers, which may be useful with future implementation in the LTC. Using the expertise of this organization will jump start this initiative and give added assurances for the welfare of the animals and the protection of the residents, as well as adding knowledge and skills for a successful outcome. Grand Canyon NUR504 Mod 7 Safety of Animals and Patients Reflection Piloting the change Based on concerns of nursing staff at the LTC facility, the literature review, and appraisal of evidence, a team of key stakeholders held a meeting to discuss implementation of pet therapy for selected residents. The key stakeholders included the research nurse, the nursing director, and the day time nursing manager. The overall plan called for a pre-questionnaire using the DASS-42, intervention with eight weekly dog visits using pet partners as handlers, and a follow up questionnaire using the DASS-42. The outcome measurement is expected to show improvement in the scoring per the parameters discussed previously. Any improvement score in any of the three categories will be considered a positive outcome. Utilizing evidence-based guidelines for AAT and the expected positive outcomes, the intervention will be implemented throughout the facility eventually. Grand Canyon NUR504 Mod 7 Safety of Animals and Patients Reflection Barriers to Change Some of the concerns raised at the key stakeholders meeting included safety issues. Animals can be unpredictable, and the elderly are frail. The introduction of animals also causes concerns for risks for zoonotic infections. It was agreed that the benefits outweigh the risks. With consideration to using pet partners as handlers, the safety issue, while still a concern, was diffused. With the potential for a full implementation of the intervention, some residents may have a dislike of dogs. However, there are other options that other research studies have included, which could be a consideration going forward. Assignment: Safety of Animals and Patients Reflection Paper Clinical Guideline The clinical guidelines to consider for the implementation of the plan, include full disclosure of the nature of the study and the personal choice to volunteer. It is important that a private space is available to administer the questionnaire, as questions may need to be re-phrased for clarity. The researcher will be the only person involved in the questionnaire administration, for continuity reasons. Assignment: Safety of Animals and Patients Reflection Paper Implementation Plan The sample group will be selected from those residents identified as not having visitors on a regular basis and/or those who do not have family members visit, since that is the population the nurses identified as exhibiting depression. From that group, volunteers to participate will be solicited. Once the questionnaires have been collected, analyzed, and scored, those that meet the inclusion criteria will sign consents. The participants will have arrangements for eight weekly visits, on the LTC premises, by a dog and the handler. Using guidelines for dog selection by pet partners, the same dog will visit the same resident. The sessions will last 30 minutes each. At the end of eight weeks, the researcher will repeat the DASS-42 in the same manner. Assignment: Safety of Animals and Patients Reflection Paper Conclusion EBP provides the clinical evidence for nurses to provide clinically effective care. With the use of the EBP model, clinical questions are developed, relevant research and literature is reviewed, appraisal of evidence is conducted, investigation is performed, and clinical practice is defined. This EBP protocol of utilizing AAT for residents of a LTC facility can be shown to have improvement in the symptoms of depression. This EBP protocol allows for the promotion of quality care and improvement in the residents quality of life. Assignment: Safety of Animals and Patients Reflection Paper References Birks, M., Bodak, M., Barlas, J., Harwood, J., & Pether, M. (2016). Robotic seals as therapeutic tools in an aged care Facility: A qualitative study. Journal of Aging Research , 2016 , 1-7. doi:10.1155/2016/8569602 Cherniack, E. P., & Cherniack, A. R. (2014). The benefits of pets and animal-assisted therapy to the health of older individuals. Current Gerontology and Geriatrics Research . https://doi.org/10.1155/2014/623203 Cho, S. (2017). Effects of horseback riding exercise on the relative alpha power spectrum in the elderly. Archives of Gerontology and Geriatrics, 70(2017), 141-147. doi:10.1016/j.archger.2017.01.011 Cipriani, J., Cooper, M., DiGiovanni, N. M., Litchkofski, A., Nichols, A. L., & Ramsey, A. (2013). Dog-assisted therapy for residents of long-term care facilities: An evidence-based review with implications for occupational therapy. Physical and Occupational Therapy in Geriatrics , 31(3) , 214-240. doi:10.3109/02703181.2013.816404 Huff-Mercer, K. A. (2015). Animal-assisted therapy and application to older adults in long term care. Journal of Arts and Humanities , 4 (5), 16-27. doi: 10.18533/journal.v4i5.717 Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales. (2nd. Ed.) Sydney: Psychology Foundation. Nordgren, L., & Engstrom, G. (2014). Effects of dog-assisted intervention on behavior and Psychological symptoms of dementia. Nursing Older People, 23(3), 31-38. Retrieved from https://lopes.idm.oclc.org/login/http://search.ebscohost.com/login.aspx?direct=true&db=hch&AN=95281806&site=eds-live&scope=site Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer Pope, W. S., Hunt, C., & Ellison, K. (2016). Animal assisted therapy for elderly residents of a skilled nursing facility. Journal of Nursing Education and Practice , 6 (9), 56-62. doi:10.5430/jnep.v6n9p56 Swall, A., Ebbeskog, B., Hagelin, C. L., & Fagerberg, I. (2017). Stepping out of the shadows of alzheimers disease: A phenomenological hermeneutic study of older people with alzheimers disease caring for a therapy dog. International Journal of Qualitative Studies on Health and Well-Being , 12 . doi: 10.1080/17482631.2017.1347013 Titler, M. G., Kleiber, C., Steelman, V.J., Rakel, B. A., Budreau, G., Everett, L. Q., Goode, C. J. (2001). The Iowa model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13 (4), 497-509. Retrieved from http://www.ebcp.com.br/simple/upfiles/pdfs/2001TitlerCrCareNursingIOWAModel.PDF Tournier, I., Vives, M. F., & Postal, V. (2017). Animal-assisted intervention in dementia. Swiss Journal of Psychology , 76(2) , 51-58. doi:10.1024/1421-0185/a000191 While, A. (2017). Pet dogs as promoters of wellbeing. British Journal of Community Nursing , 22(7) , 332-336. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123971644&site=eds-live&scope=site Grand Canyon NUR504 Mod 7 Safety of Animals and Patients Reflection Appendix A Animal Assisted Therapy Literature Review Citation Abstract Study Methods Setting/Subject Findings/Results Variables Implication for Practice Independent Variable Dependent Variable Birks, M., Bodak, M., Barlas, J., Harwood, J., & Pether, M. (2016). Robotic seals as therapeutic tools in an aged care facility: A qualitative study. Journal of Aging Research, 2016, 1-7. doi: 10.1155/2016/8569602 Robots have been used as alternatives to live pets in animal assisted therapies (AAT) to promote health and wellbeing. The purpose of this study was to identify, explore, and describe the impact of using Paro robotic seals in an aged care facility. The robot seals were introduced to residents by employed therapists as a diversional therapy during group and individual activity. The effectiveness of the robot seal was evaluated by data collected through interviews with the therapists, who maintained a log of interactions with the robot and the residents. Analysis of the data revealed three major themes including: a therapeutic tool that may not be for everyone, each interaction has power, and keeping the momentum. The research supported the use of the robot seals as a tool for therapy and revealed improvement in the residents emotions, behaviors, and interactions. Grand Canyon NUR504 Mod 7 Safety of Animals and Patients Reflection The study utilized a qualitative, descriptive, and exploratory design. Assignment: Safety of Animals and Patients Reflection Paper After the robot seals had been introduced to the residents and in use for approximately four months, data was collected by semi-structured interviews with the participants and it was transcribed. Researchers utilized inductive thematic analysis of the interview transcripts and therapists logs to develop the major themes of the study. This study was in the setting of a 127-bed aged care facility in a specific city in Australian. The facility was operated by a Nongovernment Organization that employed 125-130 staff. The sample was three recreational therapists employed at the facility and selected residents in individual and group activity. The findings of this study revealed three major themes. First, the use of robotic seals is not for everyone. Reactions from dismissal through excitement were found. Differences in individual responses were found as those with no cognitive impairment were more dismissive of the robot than those residents with dementia or advanced-stage dementia. Residents under palliative care responded positively to the robot. Second, the study found that every interaction was powerful in the therapeutic benefit to the residents. Three subthemes developed to include emotional, behavioral, and social benefits to the robotic seals. The emotional benefits include a bond developed between the robot and residents that allowed for the resident to come out of their shell, talk, express affection, and provide comfort at the end of life. The behavioral benefits include decreased disruptive and loud behavior. The social benefit includes the indirect benefit of an improved relationship between the therapist and the resident. The third major theme is keeping the momentum. This theme indicates the need for continued and consistent use of the robot to provide maximum benefits to the residents. Paro RoboticvAssignment: Safety of Animals and Patients Reflection Paper Seal ImpAssignment: Safety of Animals and Patients Reflection Paperact of the Paro robotic seal on promotion of wellbAssignment: Safety of Animals and Patients Reflection Papereing This research provided support for utilization of ATT in health promotion in the geriatric population. This study and use or the robotic seal as an alternative in ATT provides value to the use of ATT as a therapeutic tool for the geriatric population in that it offers improved social connections, interactions, expression of emotion, decreased loneliness, assisting with activities of daily living, and sleeplessness. Cherniack, E.P., & Cherniack, A.R. (2014). The benefits of pets and animal-assisted therapy to the health of older individuals. Current Gerontology and Geriatrics Research. doi: 10.1155/2014/623203 Initial studies have shown the positive effects on physical and psychological health using animal assisted therapy (ATT), yet the research has been inadequate mainly due to methodological problems. This examination of the evidence considers the ways in which AAT has impacted the elderly. The summaries include studies in which AAT was the independent variable in assessing dementia, blood pressure, physical activity, cardiovascular disease, and other psychological states. Additionally, the harmful aspects of animal assisted therapy is discussed. The case is made for the positive aspects of ATT intervention while also suggesting the need for more rigorous studies and elimination of barriers that inhibit access in institutions, training programs, and blinded investigators. Basic literature review in PubMed and review of references in original articles. Meta-analysis of five studies. Review of literature and categorized as either potential benefit or potential harm. Within these categories, subdivided into studies on dementia, physiologic, physical activity, cardiovascular disease. Elderly population in general. Settings varied with each study. The health benefits of ATT, while not conclusive, can be demonstrated as having a positive effect on mental and physical well-being. The effects on mental health were the most frequently cited studies, demonstrating some improvement among patients with dementia and behavioral problems. Additionally, it was noted that mood improvements occurred. Of the types of studies, included were case studies with observation, prospective self-controlled with observation, and controlled, unblended, prospective, observational. Animals Mental, social, and psychological health. Health care practitioners should be aware of the benefits of animal assisted therapies and can be an advocate for the implementation in practice. Additionally, the field is open to more research in this area. In an Evidence Based Practice, practitioners can have confidence that ATT promotes well-being in the geriatric population. Cho, S. (2017). Effects of horseback riding exercise on the relative alpha power spectrum in the elderly. Archives of Gerontology and Geriatrics , 70(2017) , 141-147. doi: 10.1016/j.archger.2017.01.011 This study uniquely tied electroencephalogram (EEG) evaluation data with a horseback riding activity. The researchers utilized this approach to see the impact such interventions would have on the psychological phenomena, as well as depression. Additionally, the study used these methods to determine the pathological progression of normal aging as well as cognitive decline. In addition to the use of a live horse a mechanical alternative that simulated the movements of a horse was used. The research described an increase in alpha waves that are an indicator of mental health. This means that such interventions can have a potential positive effect on psychological health. Quantitative study with the utilization of EEG data Split groups of live horseback riding and mechanical horseback riding were performed 25 minutes twice a week for three months (12 weeks). EEG data was analyzed with focus on the alpha power index. Normal adults without chronic diseases. Hypertension, diabetes, hepatitis, and renal insufficiency were exclusionary factors. Additionally, participants could not be taking any medications that could be affected by alcohol consumption. The researchers found that there was an increase in alpha power waves from the EEG data after horseback riding exercises. This identifies it as having potential in increase psychological stability. Some considerations were provided as well, detailing the importance of evaluating health, time restrictions, economic level, and preferences of the participants. With all of that combined one would see the improvement of quality of life. Horseback riding or mechanical horseback riding Alpha power waves and psychological health This article is useful as it details the benefits of utilizing animals in therapy or even interactions and the effects they have on the mental health of individuals. Such data can help forestall the impact of cognitive impairing diseases. This can also help develop standardized routines that could help provide EBP interventions. Cipriani, J., Cooper, M., DiGiovanni, N.M., Litchkofski, A., Nichols, A.L., & Ramsey, A. (2013). Dog-assisted therapy for residents of long-term care facilities: An evidence-based review with implications for occupational therapy. Physical and Occupational Therapy in Geriatrics, 31(3), 214-220. doi:10.3109/02703181.2013.816404 To determine if the quality of life in residents living in long-term care facilities is positively influenced by dog assisted therapy. For occupational therapists, animal-assisted therapy presents an intervention that can enhance quality of life. Specifically, the researchers looked at emotional regulation, communication, social, cognitive, sensory-perceptual, and motor skills as well as activities of daily living. In the field of occupational therapy, there have been very few published studies on animal assisted therapy and the case for more rigorously designed studies on larger populations is expressed. For occupational therapists, this review of the literature can support rationale for the implementation of animal assisted therapies and serve as evidence-based practices. Evidence based systematic literature review of 61 studies, narrowed to 19 after exclusion criteria applied. Reviewed published and unpublished studies. Use of McMasters guidelines for critical review (MQCRF). Assigned levels of evidence (I-VI) and summary sheet for each article. Residents of long-term care facilities. Ages from 50-105 years old. Most of the studies from the review demonstrated statistical significance to support positive outcomes with dog assisted therapy. The indicators utilized proved that quality of life for this population can be enhanced. Of the evidence found, there were three randomized controlled trials, eleven cohort studies, four pre and post studies, and one single case design. Twelve of the nineteen studies reported improved outcomes. Dog Memory, attention, and social interaction In working with the geriatric population, especially those in long-term care environments, health care providers can consider new ways to improve the quality of life by using innovative interventions. This supports the use of ATT in an Evidence Based Project as an intervention. Gocheva, V., Georgiadis, M., & Hediger, K. (2018). Effects of animal-assisted therapy on concentration and attention span in patients with acquired brain injury: A randomized controlled trial. Neuropsychology , 32(1) , 54-64. doi: 10.1037/neu0000398 This study was performed with individuals that had acquired brain injury. They were held to a routine therapy schedule with an equal-sized control group that did not participate in animal assisted therapy. Subsequently, those patients rated themselves with a questionnaire to provide a self-determined alertness. Additionally, the therapists involved with the interventions provided a concentration assessment. With all of these interventions and evaluations it was shown that participants did not have any change to their attention spans. However, it was found that the participants as well as the therapists evaluated that concentration was increased and that the participant was more alert when an animal was present. Qualitative study design based on the evaluations provided as well as the fact that observations were utilized. Utilization of the Multidimensional Affect Rating Scale as well as the Visual Analogue Scale. Each participant had 24 therapy sessions over a 6-week period. 2 of the sessions were with an animal. Video analysis was performed with behavioral coding software. The setting for the study was with in-patient adults in a rehab facility between the ages of 21-76. All the patients had a diagnosis of acquired brain injury from either traumatic or non-traumatic events. Additionally, the participants had to be medically stable, they needed to be able to walk, no phobias or allergies related to the animals. Finally, the participants were required to not have any aggressive behaviors towards animals. It was found that the participants presented with more distraction during animal assisted therapy, however, alertness and concentration as assessed by the participants was increased. Attention span did not change with the inclusion of animal therapy or without it. In addition, the therapist evaluations showed in increase in alertness and concentration. The researchers mention that even with increases in distraction, the attention span did not change. It is recommended that further research be performed especially on different aspects of attention. Animal-assisted therapy Distraction, attention, concentration This study is valuable to the EBP as a whole due to the fact that it doesnt show an impressive correlation between animal-assisted therapy and improved psychological attributes. Such data is exceptionally valuable in determining what is effective and what is not, thus helping provide the best evidence-based practice. Huff-Mercer, K.A. (2015). Animal-assisted therapy and application to older adults in long term care. Journal of Arts and Humanities, 4(5), 16-27. doi: 10.18533/journal.v4i5.717 Older adults living in a long-term care (LTC) facility frequently experience loneliness. It has been found that animal contact improves feelings of loneliness and despair. The purpose of this study is to evaluate the use of animal assisted therapy (ATT) as an intervention to decrease loneliness of residents living in a LTC. The Sphynx cat is hairless and decreased the chances of allergic reactions by the residents. The ATT intervention introduced to the residents was visits from a Sphynx cat therapy animal. Data was collected from the participants in the form of a pre-intervention and post-intervention checklist and the use of open-ended questions. The responses provided the effectiveness of decreasing loneliness with the ATT intervention. The research findings from this study revealed a notable decrease in loneliness among participants. This study utilized the ACE Star Model of Knowledge Transformation design. ATT visits with the Sphynx cat were conducted twice per week for 13 weeks, a total of 26 visits. During the ATT visit with the cat, participants were asked an open-ended question, how do you feel now? during both the pre-intervention and post-intervention phase. During the pre and post intervention question, the subjects responses of engagement in conversation, eye contact with others, and interest in the cat were evaluated. Themes were revealed during the course of the study during the pre and post intervention phases. The setting for this study is a LTC facility in Texas. The sample included seven residents, voluntarily recruited, over the age of 60 years old in the LTC. The findings of this study concluded that ATT in older adults residing in LTC had the benefit of decreased loneliness. There were no unfavorable responses noted from the participants. Common themes were noted in the replies and responses during the pre and post intervention question. Pre-intervention replies included but not limited to, alone, lonely, isolated, hopeless, and depressed; and participants did not make eye contact or engage in conversation. Post-intervention replies included but not limited to less lonely, cheered up, hopeful, joyful, upbeat, and more alive. Sphynx cat Decreased loneliness in older adults This research study provided support for the use of ATT in health promotion in the geriatric population. The use of the Sphynx cat in ATT in this study, shows improved feelings of loneliness as well as other behaviors to contribute to the wellbeing of the geriatric population. Nordgren, L., & Engstrom, G. (2014). Effects if dog-assisted intervention on behavioural and psychological symptoms of dementia. Nursing Older People , 26(3) , 31-38. Retrieved from https://lopes.idm.oclc.org/login?http://search.ebscohost.com/login.aspx?direct=true&db=hch&AN=95281806&site=eds-live&scope=site This study analyzed the usage of the Cohen-Mansfield Agitation Inventory (CMAI) and Multi-Dimensional Dementia Assessment Scale (MDDAS) in coordination with interventions performed with the assistance of a dog. This study was performed to answer the question of whether dog-assisted interventions could be an alternative to medications or even a compliment to them. They found this to be the case, that dogs can help improve the behavioral and psychological symptoms of the participants in conjunction with medications or even without them. Additionally, it was found that the value of such interventions as well as its settings need continued evaluation. However, they mentioned that a small sample size may have contributed to the data. Quantitative study utilizing multiple tools in the evaluation of the patients as well as the data. The CMAI tool as well as the MDDAS tool were utilized in the data collection phase. Initially, background data was gathered via chart review. Cognitive impairment was assessed with the Mini Mental State Exam, then additional behavioral and psychological assessments were performed. This was done before and at least 1 to 7 days after completion of each session with the dog. Additional assessments were performed at later dates as well. The data was then entered into the Statistical Package for Social Sciences and comparisons were made with the Mann-Whitney U test. All participants were residents in one of eight nursing homes. Age ranging from 63-94. Alzheimers disease was the most common diagnosis with a moderate to severe dementia score. The researchers state that no conclusions can be drawn in general about this study. Nonetheless, they do state that the use of dog-assisted intervention can help reduce behavioral symptoms and that it can be used in conjunction with medication or even as an alternative. Dog-assisted interventions Behavioral and cognitive symptoms This study is valuable to the EBP project due to the impressive amount of data provided. It would be easy to reproduce the variables and it gives realistic outlooks to the interventions performed. Pope, W.S.