Dog‐assisted interventions and outcomes for older adults in residential long‐term care facilities: a systematic review and meta‐analysis

Objective To comprehensively review studies on dog‐assisted interventions (DAIs) among older people in residential long‐term care facilities (RLTCFs) and to provide an overview of their interventions, outcomes and methodological quality. Method We searched 18 electronic databases to identify English articles (published January 2000–December 2019) reporting on well‐defined DAIs targeting older adults (≥65 years) in RLTCF. Data were extracted by two independent reviewers. Descriptive statistics were produced for quantitative studies, with key themes identified among qualitative studies. Where possible, estimates were pooled from randomised controlled trials using random effects meta‐analyses. Results Forty‐three relevant studies (39 quantitative; 4 qualitative) were identified. The majority of quantitative studies were assessed as low‐quality according to the MMAT criteria (n = 26, 67%). Almost half of the quantitative studies (n = 18, 46%) found no significant changes over time or between groups across outcomes measured. The most salient intervention effects included improved social functioning (n = 10), reduced depressive symptoms (n = 6) and loneliness (n = 5). A random‐effects meta‐analysis revealed a medium effect in favour of DAT on reducing depressive or loneliness symptoms (pooled SMD: 0.66, 95%CI 0.21–1.11; I2 = 50.5; five trials), relative to treatment as usual. However, compared to treatment as usual, no overall effect of DAI on activities of daily living was detected (p = .737). Key themes from qualitative studies included (a) animals as effective transitional objects, (b) the therapeutic value of pets and (c) the significance of the care environment and stakeholders in facilitating DAI. Implications for practice The findings of this review indicate that while DAI has value for older people in RLTCF, challenges remain in accurately measuring its impact to provide a stronger evidence‐base. Standardisation of DAI service design, delivery and evaluation is required for future research and practice in providing holistic care for older adults

Critical care nurses experiences of providing care for adults in a highly technological environment: A qualitative evidence synthesis

Abstract Aims To synthesise the available body of qualitative evidence relating to nurses' perceptions and experiences of care provision in adult critical care environments. Methods The study adhered to ENTREQ (Confidence in Evidence of Reviews of Qualitative Research) guidelines. See Supplemental File 1. A systematic search of the literature in nine databases was undertaken: CINAHL, Web of Science, Medline, Embase, PsycINFO, Campbell Collaboration, Proquest A & I, DART, Lenus. Blind screening to select relevant studies was undertaken and each selected study was assessed for quality using the Critical Appraisal Skills Programme framework (CASP). Guided by Thomas and Harden's three‐stage approach to thematic analysis, line‐by‐line coding of participants' verbatim accounts and the researchers' interpretations in the selected studies' findings was undertaken and then organised into higher order analytical themes. Confidence in the findings were reviewed using GRADE‐CERQual. Results Twelve studies reported in thirteen papers, including 122 nurses were selected in the final sample for synthesis. Three analytical themes were identified: 1) sometimes machines get all the attention 2) with experience the patient becomes the focus, and 3) technology can't save everybody. Conclusions Providing care for adult patients in a highly technological environment is challenging particularly for novice nurses, who face the potential of technology drawing all their attention. Experienced critical care nurses learn to keep technology in abeyance and deliver person‐centred care within the bounds of a technological environment. Relevance to clinical practice The review supports Locsin's theory of technological competence and highlights that providing care in critical care requires nurses to actively balance attention for the person while managing machines. Experienced nurses achieve this balance and can offer support to novice nurses. Critical care nurse orientation programmes should be underpinned by a holistic approach which addresses the dualism of technology and care.peer-reviewed2020-08-2