Effect of Animal-Assisted Therapy (AAT) on Social Interaction and Quality of Life in Patients with Schizophrenia during the COVID-19 Pandemic: An Experimental Study.

PURPOSE: Most patients with schizophrenia exhibit low willingness to return to society because of negative social experiences. The COVID-19 pandemic led to severe social isolation for schizophrenia patients. However, animal-assisted therapy (AAT) can improve individuals' empathy, social functions, and quality of life. The study aimed to evaluate the effectiveness of AAT in improving social interactions and quality of life in patients with chronic schizophrenia during the COVID-19 pandemic. METHODS: An experimental study was conducted, with six institutions for psychiatric rehabilitation in Taiwan as the case institutions. Patients in these institutions were randomly allocated to the experimental group, which received 60 minutes of AAT once a week for 12 weeks, or the control group, which engaged in routine discussion groups and watched short films about animals. Comparisons between the two groups were made before and after the intervention on social function, social adaptive function, and quality of life. Data were collected before the intervention (T1), immediately after the intervention (T2), and 3 months after the intervention (T3). RESULTS: Comparison between groups showed that social functioning was significantly higher in the experimental group than in the control group at T2. However, there was no sign of improvement in social adaptive functions of the experimental group. The experimental group exhibited significantly higher quality of life than the control group at T2 and T3. CONCLUSIONS: There was an impact of COVID-19 on the studied effects. AAT improved social functioning and quality of life in patients with chronic schizophrenia. The effect on quality of life lasted only up to 3 months after the intervention. AAT should be promoted for use as a community-based rehabilitation tool in patients with chronic schizophrenia. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2200061715. https://www.chictr.org.cn.

Anti-stigma psychosocial intervention effects on reducing mental illness self-stigma and increasing self-esteem among patients with schizophrenia in Taiwan: A quasi-experiment.

Previous studies have noted that as self-stigma in patients with schizophrenia increases, their quality of life and self-esteem decrease. Considering the cultural differences and scarcity of self-stigma intervention research in Asia, the purpose of this study was to evaluate the intervention effects of the Against Stigma Program on reducing self-stigma and increasing self-esteem among patients with schizophrenia. In this study, 70 patients with schizophrenia were recruited from 3 community psychiatric rehabilitation institutions in Taiwan and assigned to the experimental and control groups. Controls received their usual treatment, and those in the experimental group participated in the Against Stigma Program (60-minute weekly sessions for 6 weeks). The participants were assessed at baseline, post-intervention, and 1-month follow-up, using the Internalized Stigma of Mental Illness Scale (ISMIS) and Rosenberg Self-Esteem Scale (RES). Generalized estimating equations (GEE) were used to analyze the changes in scores over time and differences between the experimental and control groups. Self-stigma significantly decreased and self-esteem significantly increased after participation in the Against Stigma Program. The GEE analysis revealed significant group and time interactions such that self-stigma reduction effect (B = -0.291) was stronger in the experimental group at post-intervention, and self-esteem promotion effects at post-intervention (B = 0.823) and 1-month follow-up (B = 0.543) were both greater in the experimental group. In conclusion, these findings suggest that the Against Stigma Program can help reduce self-stigma and increase self-esteem of patients with schizophrenia. This study can be used as an empirical reference to inform future clinical care of patients with schizophrenia in Taiwan.

Effectiveness of a Sexuality Workshop for Nurse Aides in Long-Term Care Facilities.

BACKGROUND: In long-term care facilities, there are frequent conflicts related to elderly residents' sexual expression. Nurse aides usually handle such conflicts with negative or negligent attitudes; therefore, elderly sexuality is considered "problem behavior" and is stigmatized. OBJECTIVES: This study aimed to improve elderly residents' quality of sexual life by enhancing nurse aides' knowledge and attitudes toward elderly sexuality through sexuality workshops. METHODS: A quasi-experimental study was conducted with 64 nurse aides and 58 residents, who were divided into two groups, i.e., an experimental group and a control group, according to the floor where the residents resided. The nurse aides in the experimental group participated in sexuality workshops and were compared with those in the control group with respect to their knowledge of and attitudes toward sexuality; the residents' quality of sexual life was also compared between groups. RESULTS: Compared with the control group, in the experimental group, the nurse aides' knowledge of and attitudes toward elderly sexuality as well as the residents' quality of sexual life significantly and continually improved after the sexuality workshops. CONCLUSION: The four-week sexuality workshop is effective and may be used as an example in developing occupational education programs regarding elderly sexuality in long-term care facilities.

[Effects of Aromatherapy on Depression and Loneliness in Elderly With Frailty Living in Day-Care Centers].

BACKGROUND: In addition to playing significant role in the decline of physiological functions and the onset of depression, frailty is involved in a vicious circle with depression that has serious physical and mental impacts on sufferers. Furthermore, elderly people with frailty are less mobile, at increased risk of dissociative interpersonal relationships, and prone to develop a sense of loneliness, which also pose health threats. PURPOSES: This study was designed to explore the improvement effects of an aromatherapy intervention on depression and loneliness in the elderly with frailty living in daycare centers. METHODS: This study adopted a quasi-experimental, pre-and-post-test research design. This study enrolled 82 frail elderly people from six daycare centers in Taipei City as the research subjects. The subjects in the experimental group received aromatherapy twice a week for 30 minutes each session for four weeks. The researcher guided the experimental group in a small group setting to perform self-massage on the face and hands with lavender essential oil. The control group was guided in the same self-massage routine using pure base oil. RESULTS: Depression in the subjects was found to be positively correlated with degree of frailty. After the intervention, depression and loneliness was found to have decreased significantly in the experimental group (p < .05). CONCLUSIONS: The findings support the beneficial effects of aromatherapy interventions on depression and loneliness in the elderly with frailty living in daycare centers without adverse reactions. Aromatherapy may be used to improve depression and loneliness in elderly people with frailty.

A Study on the Correlations between Musculoskeletal Disorders and Work-Related Psychosocial Factors among Nursing Aides in Long-Term Care Facilities.

BACKGROUND: Among the nursing aides employed at long-term care facilities (LTCFs), those with musculoskeletal disorders (MSDs) are most likely to experience disability or develop an intention to leave. The purpose of this study was to investigate the association of work-related psychological factors among nursing aides in LTCFs with MSDs in Taiwan. METHODS: Purposive sampling was used in this cross-sectional study to enrol 308 nursing aides from residential LTCFs in Taiwan as research subjects. A demographic and job background survey, a job content questionnaire (JCQ), and the Nordic musculoskeletal questionnaire (NMQ) were used to collect data. RESULTS: Lower job control associated with higher psychological job demands, and lower social support was associated with more severe MSDs for the nursing aides (p < 0.001). Among the MSDs reported by nursing aides in LTCFs, lower back pain was the most serious. In addition, nationality, age, exercise habits, chronic diseases, worksite, lack of rest time, lack of assistive devices, low coworker support, and high psychological job demands were significant factors affecting MSDs. In total, 42.1% of the variance in MSDs among nursing aides in LTCFs was explained. CONCLUSIONS: Work-related psychological factors among nursing aides in LTCFs have an important association with MSDs. For nursing aides, coworker support should be improved, and their psychological demands at work should be reduced.

The effect of caregiver's and nurse's perception of a patient's discharge readiness on postdischarge medical resource consumption.

AIMS: The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with postdischarge medical consumption. DESIGN: The study employed a descriptive research, prospective longitudinal study design. METHOD: The study was performed in a ward of a medical centre in Taipei, Taiwan, from June 2017-May 2018. Obtained data were analysed using an independent t test, one-way ANOVA and logistic regression approach. RESULTS/FINDINGS: The number of comorbidities and the number of days of hospital stay were positively associated with post discharge emergency room visits. Caregiver readiness for hospital discharge had significant negative correlation with patient's 30-day readmission. Both caregiver and nurse readiness for the hospital discharge scale score were not factors associated with the patients' 30-day emergency room visit. CONCLUSION: Based on the research findings, to assess the discharge readiness as perceived by caregivers at patients' discharge is recommended. IMPACT: Caregiver and nurse scores on readiness for hospital discharge showed a significant positive correlation. The higher the score of a caregiver's readiness for a patient's hospital discharge, the lower the 30-day readmission rate. Family-centred care enables patients to safely pass though the transition phase from hospital to community and reduces the postrelease consumption of medical resources. The discharge readiness perceived by caregivers should be included in any decision-making.

Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation.

BACKGROUND: One of the most common symptoms observed in patients with dementia is agitation, and several non-pharmacological treatments have been used to control this symptom. However, because of limitations in research design, the benefit of non-pharmacological treatments has only been demonstrated in certain cases. The purpose of this study was to compare aroma-acupressure and aromatherapy with respect to their effects on agitation in patients with dementia. METHODS: In this experimental study, the participants were randomly assigned to three groups: 56 patients were included in the aroma-acupressure group, 73 patients in the aromatherapy group, and 57 patients in the control group who received daily routine as usual without intervention. The Cohen-Mansfield Agitation Inventory (CMAI) scale and the heart rate variability (HRV) index were used to assess differences in agitation. The CMAI was used in the pre-test, post-test and post-three-week test, and the HRV was used in the pre-test, the post-test and the post-three-week test as well as every week during the four-week interventions. RESULTS: The CMAI scores were significantly lower in the aroma-acupressure and aromatherapy groups compared with the control group in the post-test and post-three-week assessments. Sympathetic nervous activity was significantly lower in the fourth week in the aroma-acupressure group and in the second week in the aromatherapy group, whereas parasympathetic nervous activity increased from the second week to the fourth week in the aroma-acupressure group and in the fourth week in the aromatherapy group. CONCLUSIONS: Aroma-acupressure had a greater effect than aromatherapy on agitation in patients with dementia. However, agitation was improved in both of the groups, which allowed the patients with dementia to become more relaxed. Future studies should continue to assess the benefits of aroma-acupressure and aromatherapy for the treatment of agitation in dementia patients. TRIAL REGISTRATION: ChiCTR-TRC-14004810; Date of registration: 2014/6/12.

Using acupressure and Montessori-based activities to decrease agitation for residents with dementia: a cross-over trial.

OBJECTIVES: To explore the effectiveness of acupressure and Montessori-based activities in decreasing the agitated behaviors of residents with dementia. DESIGN: A double-blinded, randomized (two treatments and one control; three time periods) cross-over design was used. SETTING: Six special care units for residents with dementia in long-term care facilities in Taiwan were the sites for the study. PARTICIPANTS: One hundred thirty-three institutionalized residents with dementia. INTERVENTION: Subjects were randomized into three treatment sequences: acupressure-presence-Montessori methods, Montessori methods-acupressure-presence and presence-Montessori methods-acupressure. All treatments were done once a day, 6 days per week, for a 4-week period. MEASUREMENT: The Cohen-Mansfield Agitation Inventory, Ease-of-Care, and the Apparent Affect Rating Scale. RESULTS: After receiving the intervention, the acupressure and Montessori-based-activities groups saw a significant decrease in agitated behaviors, aggressive behaviors, and physically nonaggressive behaviors than the presence group. Additionally, the ease-of-care ratings for the acupressure and Montessori-based-activities groups were significantly better than for the presence group. In terms of apparent affect, positive affect in the Montessori-based-activities group was significantly better than in the presence group. CONCLUSION: This study confirms that a blending of traditional Chinese medicine and a Western activities program would be useful in elderly care and that in-service training for formal caregivers in the use of these interventions would be beneficial for patients

[Acupressure in the care of the elderly].

Acupressure is a longstanding treatment in traditional Chinese medicine, and involves the stimulation of certain acupoints by pressing with the fingers or moving limbs or joints slowly to promote health or offer comfort. Acupressure treatment, which conforms to the same principles as acupuncture, is characterized by the pressing of acupuncture points and sense of chi. Chi is regarded as the universal life energy and the vital potential that is inborn in each person and which maintains that person until death. Sleep disturbance, pain and agitation are common health problems in gerontological nursing. Both pharmacological and non-pharmacological forms of treatment have been applied to deal with the problems. Studies have revealed, however, that the benefits that the elderly derive from drug use might not outweigh the adverse effects of such treatment. Non-pharmacological forms of treatment, like acupressure, though, not only caused no side effects, but also relieved the symptoms. Also, nurses, nurse's aides, or elderly people who have received training in acupressure can administer this non-pharmacological treatment independently. Therefore, this paper addresses common health problems in the elderly, such as sleep disturbance, pain, and agitation, the principles and maneuvers of acupressure, and application of acupressure in the elderly.

The efficacy of acupressure for decreasing agitated behaviour in dementia: a pilot study.

AIMS AND OBJECTIVES: To investigate the efficacy of acupressure in decreasing agitated behaviours associated with dementia. BACKGROUND: Agitated behaviour is found in nearly half of all patients who have dementia. The presence of these behaviours increases the likelihood of injury, weakness, dehydration and lack of sleep and contributes to caregiver frustration and fatigue. DESIGN: This pilot study was designed with subjects receiving both acupressure and the control treatment. Each subject served as his or her own control. Subjects received four weeks of acupressure protocols; to avoid a carry-over effect there was a treatment-free period of one week. Subjects then were visited by one of the investigators for a six-week period. METHODS: Participants were recruited from a nursing home caring specifically for patients with dementia. Twenty of the 31 subjects (64.5 %) completed the study, while 11 were discharged or hospitalized. All the subjects were assigned to an experimental protocol and had a six-week acupressure treatment program. Baseline data were collected in the first week. Individual treatment sessions began at the second week of the study and lasted 15 minutes, twice a day, five days a week for four weeks. After a treatment-free period of one week, all the subjects served as controls undergoing a four-week control protocol consisting of companionship and conversation. RESULTS: Comparison between the control and experimental phases indicated significant differences between the two groups on all outcome measures (Cohen-Mansfield Agitation Inventory, daily agitation records about physical attack, verbal and non-verbal attack and non-physical attack) with better results found during the acupressure phase. CONCLUSIONS: Acupressure is recommended as an efficacious and non-intrusive method for decreasing the agitation behaviours in patients with dementia. RELEVANCE TO CLINICAL PRACTICE: Conducting the acupressure treatment takes 15 minutes. It could provide caregivers with a viable alternative to deal with patients with dementia.