NLN Nursing EDge Unscripted

Scholarship - The Impact of Therapy Dogs on Prelicensure Baccalaureate Nursing Student Anxiety

May 04, 2023 Cristen Walker Season 3 Episode 14
NLN Nursing EDge Unscripted
Scholarship - The Impact of Therapy Dogs on Prelicensure Baccalaureate Nursing Student Anxiety
Show Notes Transcript

This episode of the NLN Nursing EDge Unscripted Scholarship track features Cristen Walker. Learn more about Dr. Walker's work, The Impact of Therapy Dogs on Prelicensure Baccalaureate Nursing Student Anxiety.

Walker, C. The Impact of Therapy Dogs on Prelicensure Baccalaureate Nursing Student Test Anxiety. Nursing Education Perspectives, 10.1097/01.NEP.0000000000001042


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[Music][Music][SP] Welcome to this episode of NLN podcast Nursing EDge Unscripted the Scholarship track. I'm your host, Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspectives. Nursing EDge Unscripted in our track entitled Scholarship celebrates the published work of select nurse educators from the NLN's official journal Nursing Education Perspectives and the NLN Nursing EDge blog. The conversations embrace the author's unique perspectives on teaching and learning innovations and implications for nursing program development and enhancement. This episode is about the use of therapy dogs to reduce nursing students test anxiety. We will discuss the author's article, The Impact of Therapy Dogs in Pre-licensure Baccalaureate Nursing Student Test Anxiety. This discussion will focus on the unique findings of the author who published a manuscript in this current March-April 2023 issue, volume 44, issue 2 in Nursing Education Perspectives. Our speaker today is Dr. Kristen M. Walker who is an assistant professor and family nurse practitioner.. She's in the Department of Nursing at the University of Scranton and I want to welcome you Dr. Walker.[KW] Thank you, thank you for having me today.[SP] Oh you're very welcome it's a very interesting article and I'm excited for the audience to to hear about it a little I'd just ask you first to just briefly describe your purpose of the study and talk about, I found interesting the difference between state anxiety and trait anxiety and maybe just kind of in your description of the study[KM] Yeah.[SP] Define those terms for us.[KM] Sure. I'll tell you a little bit about the purpose of the study and then I can lead into that. So my study is quite unique. The purpose of my study is really what the title says And the purpose of the study was to examine the impact of a structured therapy dog interaction on test anxiety of baccalaureate nursing students The intervention was conducted about one hour prior to a scheduled exam to measure test anxiety. I used three different measurements which included heart rate and salivary cortisol levels, which was done by the students basically self-swabed the inside of their mouth and then those samples were sent to a lab so both of those things served as physiological measures of anxiety. And then there was also a brief 20 item survey called the state-trait anxiety inventory to measure psychological anxiety. I had 91 participants, all of whom were junior level students enrolled in their first adult health nursing course. Sometimes we call that their first med-surg course and the study was conducted at three different sites within the northeast Pennsylvania region. So that kind of tells you a little bit about the purpose and the measurements and a little bit about the sample size. You asked me earlier a little bit about state and trait anxiety. So let me me begin by just briefly defining test anxiety, which dates back in the literature probably about, gosh, now at least 50 to 60 years give or take. So test anxiety is is simply defined as an unpleasant emotional state experienced in a testing situation and it's characterized by two things: worry and emotionality. And test anxiety is also associated with two types of anxiety: state and trait. So people ask, what does that mean? State anxiety is really a temporary state of anxiety and it results in worrisome thoughts and apprehension right before and during the time of taking a test and then as that state anxiety increases, physiological symptoms start like the heart starts to race, sweating, a feeling of warmth, nausea, upset stomach, and restlessness. You know for a lot of students these symptoms are really debilitating and they're very aware of them so that distracts from their test-taking ability. They start to lack concentration, lack focus and forget basically what they've studied. Now trait anxiety relates as well, but it's a long-term anxiety so it's repetition of what I just explained in future testing experiences. So one is immediate - in the immediate moment, the other is long term and I hope that kind of makes sense but nonetheless both negatively can influence the outcome of a test.[SP] So the intervention, is it more specific to state anxiety, that short-term anxiety?[KW] Yes, and for that reason I use the state-trait anxiety inventory as opposed to something called the test anxiety inventory, same author from the 1980s, but the the state trait inventory helped me to measure anxiety in that immediate moment and not long term because that's what I was looking for. When you come in to take your test, about an hour before the students arrived, what is your anxiety right now and then we measure that anxiety after they interacted with the dogs to see if it decreased in that 30-minute interaction period. So did these students - these participants self-select into the study?[KW] Yes because you know, I recruited I verbally recruited I went to three different sites and I went into junior classrooms and I verbally recruited along with a written informed consent and then they were able to participate if they were interested.[SP] The reason I ask is because I'm thinking some people are very fearful of dogs well actually increase their state anxiety yeah coming into a room with with dogs[KW] And that's a good question I very clearly explained that verbally and in writing that exclusion criteria included three things, one of which was a fear of dogs. Tis is not an intervention for someone that doesn't find calming comfort from dogs. Number two was an allergy to dogs and then number three was anybody with an adrenal disorder, which is unlikely because we used cortisol as a measurement. [SP] Right, right well that's good okay. And that kind of begins my next question which was describing the intervention therapy with the dogs. So I've more about how the dogs actually interacted with the participants, was it a like just a kind of informal interaction or was there something more planned?[KW] Let me just go back and I'll tell you. So the students arrived at a site which was near or and sometimes in the same building as where they were going to take their test. They came about an hour early and they did their measurements took about five minutes: heart rate, cortisol and they filled out their survey. Then they went to another area, sometimes multiple rooms right down the hall basically and there were a minimum of seven dogs up to 12, each dog with a handler. And you know, I don't know how to explain it but it was a wonderful experience. So if you're a dog lover you can appreciate this. If it was one big room they were just spread out sitting on the floor and students just went in and they could do whatever they wanted and they were they would basically you know I took pictures during it which I wasn't supposed to do but I did just for my own personal well-being. The students would just sit on the floor pet the dog. The handlers had treats for them. They had little balls like it was calm and quiet and then the students could just get up and walk around the room or into various rooms depending on on the location and just hang out with the dog for up to 30 minutes so as many dogs as they wanted it was very calm there was no barking .The dogs were extremely well-behaved unlike my own. It's interesting because something that I learned during this is you know the handler said to me these dogs had been doing this for so long, so many of them have been doing this for years that they know they're at work and you know they they might be crazy at home but when they're in this environment they know that they're working. And it was just phenomenal.[KW] Yeah.[SP] And then you did the post samples.

hour early, maybe 45 minutes:

five minutes to do the pre-test measurements and I had research assistance and everything went off very, very organized and smooth they had up to 30 minutes to interact with the dog. I recommend it to the students spend at least 20 minutes up to 30. They came back to that same room and did the exact same test again and then they went. I actually well I fed them if it was breakfast for most of these students so I you know after the study was over they had some snacks and some breakfast and then they went to take their test.[SP] Great so any difficulty[KW] Yeah, you know I'm laughing because, yes and no. And it actually went very well. So two of the sites are already dog friendly campuses and they have some therapy dog programs on campus. Once a month, twice a month they have groups that come in for anybody on campus. For example they'll have a therapy dog group or a session I should say in the library every other Monday so that was not a problem. I had no problem getting a location. Campus security was great everything went well. At the third university it was a little more challenging because that university is not necessarily dog friendly. It's not that they're not dog friendly, but they don't bring therapy dogs on campus so it took a little bit more each study obviously. I had to have IRB approval in addition each school required me to also have approval through another committee called the institutional animal care and use committee. Now this committee is designed specifically to protect the animals.[SP] Okay, that makes sense.[KW] So even mice in biology to you know that was not hard because this was play time really but I had to go through that whole protocol meet with them and get approval and then the third university that was a little bit more unsure...they were okay with all of that and they also asked me to get approval with the institutional biosafety committee as I was handling saliva. So it was a little more work, but it worked out really well.[SP] Well this is good to know for anybody who wants to replicate this or do this in their own schools. It's actually a lot but I think because this was research you know I think it made it a little bit harder you know they're just having a general therapy dog program.[SP] Well that leads us to the next question very well about, so what can schools of nursing, those who are interested in doing something like this on their campus what are some of the steps and you kind of describe the steps already as well using the therapy dogs but you know any anticipated complications, bites or scratches? speak to that in in my proposals okay however that has never happened you know I talked to all of the handers and handlers individually that has never been a complication so is that a possibility I guess it is and in that scenario it it could be a potential risk. The handler assumes all responsibility for the dog. Now I have to tell you these are certified dogs so they have to and I actually looked into this for one of my own dogs and it is a grueling process to certify your dog as a therapy dog.[KW] You have to show documentation of health vaccinations, obedience training and the dog has to perform 50 visits.[SP] Wow. are dogs that have done this a minimum of 50 some organizations require a hundred visits before they'll certify them so that complication is pretty much off the table you just have to keep in mind too to tell students this is not aggressive play, this is just sit calm, pet the dog and always ask the handler for instructions as to how you should approach the dog. Back to your question though, to do this on another campus. The first thing is to learn about I learned so much online just by going to therapy dog websites and I read and while did I learn I then call them on the phone and ask some questions. These organizations will then direct you as as the organizer to local handlers and dogs in the area and you just have to contact them by email or phone and invite them to campus. They are more than willing to come. They come fully prepared, they assume all responsibility I think the next step you know beyond learning about this and what it entails, is to work with the university to find the right space. A big space, you might need multiple rooms. You need it to be accessible with an outside door. You need a place for the dog to go to the bathroom should they have to go. Parking for the handler, things like that. So a lot of people if you wouldn't want the students having to walk across campus after they just did this to calm themselves right and that that was a big thing for my study the one location was a little bit further than I would have liked, however, it did not seem to pose a problem. The other two were in the same building so they just had to go upstairs or downstairs you know for their test. So it's a matter of learning about it, organizing a space and permission with the school, contacting the volunteer handlers. This is all volunteered, no pay. You know you can give them gifts, which I gave gifts to the dogs and things like that but that's about it and then working with campus security to acquire parking and then basically putting it out there to the students. I actually they would love to do this again at my school, not from a research standpoint but I would just like to do the intervention.[SP] Right, I was[KM] Even if it's not for test anxiety just student anxiety in general. It's a big trend. If you look at literature, there's not a lot of literature as far as research goes but there's a lot of anecdotal information about college campuses and the positive impact of therapy dogs mostly for anxiety and stress you know.[SP] Well briefly[KW] The results were fantastic. I was pleasantly surprised. All three measures significantly decreased from pre to post-test again before the dog therapy, after the dog therapy, heart rate decreased, cortisol levels decreased, indicating decreased anxiety and stress and then also the survey results showed the same thing. Now, my study did not look at impact on test grades itself. It was just the emotional state before they walked in the door right so it was statistically significant and pretty much related to other research that is out there.[SP] I would love to replicate end as far as test scores correlate those with the three different measures that you had and also have a control group, you know, that didn't have the dog the intervention but it still takes the exam and everything.[SP] Right and and that's a really good point because I was asked that question a number of times, why don't you have a control group? Yes I could have done that and being honest I looked at it this way: the students were about to go take a big test junior year like I teach juniors. Junior year first semester that med-surg course is overwhelming and junior year tends to be a very high level stressed year because of clinical and class. It bothered me to have half of the students get to play with the dogs and the other half not and I was worried that would impact them emotionally.[SP] And they would know that the other group played with the dogs obviously this study is pretty they're gonna announce that's supposed to be helpful and this isn't helpful. And that's the difference between effectiveness research and efficacy research, right like the real world and then trying to do a controlled environment where it may work really well in the controlled environment but then when you get in this real world it wouldn't, it wouldn't have been simple.[KW] I mean you are right, having a control group would have been, that's the probably the next step just to increase the rigor of the study and to really analyze the results a little bit better so yeah on my list.[SP] Yeah, having a control group, this is just giving suggestions to others if they want to follow up. Having a control group at another site yes really isn't even told about the dog intervention, it's just we're gonna do your anxiety levels before taking an exam. We're gonna bring you in do this this pre-measures, have you sit in a room for an hour with your peers and then do another one an hour and just kind of do it that way because that's something I'm thinking too that would be really interesting to look at that too.[KW] Yeah, absolutely. welcome. I thought your study was just really unique and something different and really I think would piqued the interest of a lot of our readers and our listeners. It's something that you know there's some work to be done to have these dogs come to campus ,but if you already have a dog friendly campus it wouldn't be that difficult to do I appreciate your time and expertise in sharing this work with us. To our listeners, if you have not had the opportunity to read about this work you'll find Dr. Walker's manuscript in the current issue of Nursing Education Perspectives which may be the past issue once the podcast comes out. The impact of therapy dogs in pre-licensure baccalaureate nursing students and test anxiety published in the March-April issue of Nursing Education Perspectives. And again everybody out there listening, thank you so much, thank you for coming to our session and thank you so much to Dr. Walker we really appreciate it.[KW] Thanks for having me.