Whether nurses like it ornot, patients respondto cuddly animals.

GLORIA FRANCISANITA BALY

There is a considerable literatureabout the therapeutic effect on in­stitutionalized persons-particu­larly disturbed children and theelderly-when domestic animalsare introduced into the setting. In

140 Geriatric Nursing May/June 1986

fact, the field has grown so muchthat Arkow has put together a 106-­page, annotated bibliography onpet therapy(l).

Live animals, however, havedrawbacks in institutional settings.They require special facilities, andhandlers, and cannot be thrown inthe washing machine or put on thecloset shelf. Hence the questionarose: Can plush animals be usedwith any therapeutic success?

This study tested the hypothesisthat giving self-selected, personal

plush animals to nursing home resi­dents would increase health self­concept, life satisfaction, psycho­logical well-being, social compe­tence and interest, personal neat­ness, and psychosocial and mentalfunction; and would decrease peri­ods of depression.

Definition of Terms• Self-selected, personal plush ani­mals: harmless, stuffed, washable,plush finish, 6- to 14-inch tradition­al animals selected by the residents

from among bears, birds, bobcats,bunnies, dogs, horses, kittens,lambs, mice, monkeys, owls, pigs,skunks, squirrels, and tigers.• Health Self-Concept: concept ofself as a relatively ill or healthyperson, as measured by the HealthSelf-Concept Index. The index hasface and construct validity (2).• Life Satisfaction: contentmentwith the way one is cllrl:ently living,as measured by a single item onsatisfaction with life. Test-retestreliability T = .59 to ..70.. Criterion­related validity r = .. 18 to .59 (3).• Psychological Well-Being: ac­knowledged happiness, as meas­ured by Affect Balance Scale(ABS). Coefficients are .83 for po­sitive affect, .81 for negative affect,and .76 for ABS over a three-dayintervaL They are "considerablyhigher .....over much longer timeperiods(4)." Criterion-related val­idity, using "selected happiness in­dication," ranges from coefficientsof .49 to .59 for positive affect scaleand .61 to .71 for negative affectscale. The ABS has construct valid­ity(4).• Social Competence: the meansfor making decisions, rememberingwhat to do, bathing and dressingoneself in the absence of physicaldisability. and keeping oneself andone's bed unsoiled, as measured byObserved Patient Behavior (sub)Scale (OPB) which has only con­tent validity(5).• Social Interest: degree of atten­tion to certain expected social ame­nities, as measured by an OPB sub­scale(5).• Personal Neatness: degree of at­tention to bodily cleanliness, in­cluding hair, clothes and eatinghabits, as measured by an OPBsubscale (5).• Psychosocial Function: ability toact in areas of life not immediatelyconnected to the biochemical main­tenance of life, including knowl­edge and ability to interact withother people in the interests of pres­ervation of self and enjoymentthereof, as measured by the Psy­chosocial Function Scale. The PFShas a reliability coefficient (inter­nal consistency) range of 4 = .84to .96. Validity coefficients (criteri-

on-related) range from T == .62 (p.001),-to .44 (p .01) (6).*• Mental Function: one's perform­ance in communicating, games,reading, beginning conversation,helping others and having friends,as related to states of confusion andorientation, as measured by theGeriatric Rating Scale (mentalfunction subscale). The entire­scale, including a physical subscale,has reliability (stability) of r =

Owning and naminga plush animalenhances self-concept,prompts interaction.

.87. Validity (criterion-relatea) is T

= .95 (7).**• Depression: an alteration inmood that includes a negative self­concept associated with reproachand blame, regressive and self-pu­nitive wishes, and vegetative andactivity-level changes, as measuredby the Beck Depression Inventory_Reliability of the inventory (inter­nal consistency) is r = .93, and va­lidity (criterion-related) rangesfrom T = .55 to r = .96(8) ..***Literature Review

A literature search revealednothing about the use of plush ani­mals with institutionalized elderly,and very few studies with otherpopulations(9-10). The idea for thestudy reported here arose when a

·Used with permission of GerontologicalSociety of America.··Used with permission of American Ger­iatrics Society and Professor Plutchik, Ye­shiva .University.···Used with permission of Aaron T. Beck,Center for Cognitive Therapy, Philadel­phia.

Gloria Francis, RN, PhD, is a professor inthe Department of Community and Psy­chiatric Nursing at Virginia Common­wealth University/Medical College of Vir-

Richmond. Anita Baly, JD t MDil., isa doctoral student at the Union TheologicalSeminary, Richmond.

nursing home declined a domesticanimal study but accepted the ideaof plush animals.

Riehl and Roy's system modelprovided the conceptual frame­work(ll). A person is a being inconstant interaction with a chang­ing environment. To cope with thechanges. the person uses innate andacquired biological, psychological,

.and social mechanisms. Health andillness are inevitable in life and, inorder to respond positively, the in­dividual must adapt.

The extent of adaptation dependson the stimuli to which an individu­al is exposed and his or her adapta­tion level. The level includes a zonethat indicates the range of stimula­tion that will lead to positive re­sponse.

One also has modes of adapta­tion. Owning and naming a plushanimal is a means of treating prob­lems in the modes of self-conceptand interaction. That is to say, el­derly institutionalized personswhose reality testing is intact willexhibit a more positive affect, feelbetter about themselves, and so,better about those around them,and, given a curious vehicle forconversation, will interact more.

The plush animal is a new andpositive environmental stimulus toself-concept and interaction. Feel­ing better about themselves andothers will enhance individuals so..ciopsychologically, and thus willimprove their quality of life.

Design

The design was a pretest-post­test, experimental and controlgroup. A nonprobability sample ofall residents from two geographi­cally separated units in a 169-bedintermediate skilled care (munici­pal) nursing home in the Southeastyielded 22 and 18 participants, re­spectively. The groups did not comein contact with each other. The ex­perimental group was composed of10 women and 12 men. The controlgroup consisted of 7 men and 11women. All participants werewheelchair bound. They ranged inaf;e from 52 to 86.

All 40 persons were pretested byinterview on the seven paper and

Geriatric Nursing May/June 1986 141

example of the introduction of verysimple, inexpensive, and easilymanaged therapies for the infirmelderly. Apparently, having a newstimulus that is pleasurable to lookat, touch, own, care for, and talkabout makes a difference-a bigdifference-even when that some­thing is a plush animal..

Clearly, some of the instrumentsand other aspects of the study mayraise questions, in.eluding the mat­ter of long-term results. Ours wasan eight-week study, but we plan toreplicate it with varying popula­tions of institutionalized elderly,and to examine long-term results.

ReferencesI. Arkow1 P. Pet therapy: a Study of the Use of

Companion Animals in Selected Therapies.Colorado Springs, Humane Society of PikesPeak Region 1 1982. .

2. Jacox, Ada, and Stewart, May. Psychosocialcontingencies of pain experience. Iowa CitY1University of Iowa, 1973.

3. Converse, P., and Robinson, J. Life satisfac­tion. IN Measures of Social PsychologicalAttitudes. ed. by J. P. Robinson and P. R.Shaver. Ann Arbor, MI1 Institute for SocialResearch, University of Michigan, 1973, p.13.

4. Bradburn, N. M. The Strucure ofPsycholog­ical Well-Being. Chicago, National OpinionResearch Center, 1969, pp. 35·89.

5. Barajas, J. D. K. Sensory Deprivation in Ger­iatric Patients in Nursing Homes. Tucson,University of Arizona, 1971. (Unpublishedmaster's thesis)

Sa. Honigfeld. G., and Klett, C. J. The nurses'observation scale for inpatient evaluation: anew scale for measuring improvements inchronic schizophrenia. J. CUn. Psych01.21:65~71, Jan. 1965.

6. Putnam, P. A., Nurse awareness and psycho­social function in the aged. Gerontologist.13:163-166, Summer 1973.

7. PIutchik1 Robert, and Conte1 Hope. Changein social and physical functioning of geriatricpatients over a one·year period. Gerontolog­ist. 12:2:181 .. 184, Summer, 1972.

8. Beck, ~ A. T., and Beamersderfer, A. Assess­ment of depression: the depression inventory.Psychol.M easurements in Psychopharmaco­logy. 7:151-169, 1974.

9. Ferrara, Cindy, and Hill, S. D. The respon­siveness of autistic children to the predictabil­ity of social and nonsocial toys. J.Autisnl De­vel.Dis.• 10:51-57. Mar. 1980.

10. Mulick, J. A.• and others. Reduction of aUnervous habit" in a profoundly retardedyouth by increasing toy play. J.Be­hay. Ther.Exper. Psychiatry. 9:381-385. Dec.1978.

II. Riehl, J. R.t and Roy, S. C. Conceptual Mod­els lor Nursing Practice. 2nd ed. New York,Appleton-Century-Crofts. 1980, pp. 179­188.

12. Rodin, Judith, and Langer, E. J. Long·termeffects of a control-relevant intervention withthe institutionalized aged. J.Pers.Soc.Psy­chaf. 35:897·902, Dec. 1977.

13. . . Aging labels: the decline ofcontrol and the fall of self-esteem. J.Soc./s­sues 36:(2): 12-29, 1980.

six of the nine variables measured:well

Variables not affected at the ..05level were: health self-concept

p<.064», social compe-1.57, 1.34), physical

p<.183.The is reminded that the

three unaffected variables weremeasured with some of the instru­ments that are weaker in reliabilityand validity.

There were no significant differ­ences in any of the variables for thecontrol group. Probabilities of TypeI errors for the nine variables inthis group ranged from .10 to ..98.

The experimental variable, theintroduction of personal plush ani­mals, made a significant, positivedifference in multiple psychosocialaspects of the lives of the nursinghome residents. Differences in per­haps a few variables, notably socialinterest, were expected, but notsuch highly significant differencesin so many variables..

Perhaps surprise was unwar­ranted, however.. In a study byRodin and Langer, the introductionof plants for which the elderly nurs­ing home residents cared resultedin the experimental group becom­ing "more active" and "happier."They also "showed significant im­provement in alertness ~ and in­creased social involvement in manydifferent kinds of activi­ties.... (12)" The control group re­ceived plants for which the staffcared; the control group showed nochange. This and other work byRodin and Langer led them to be­lieve that an "increased sense of ef­fectance," that is, "opportunitiesfor control over ongoing dailyevents" produced "higher healthand activity patterns, mood and so­ciability.... (13)"

Ownership of plush animals andinteraction with and about themperhaps have little to do with con­trol; nevertheless, here is another

Social interest andmental function weresignificantly higher.

respond more and differently toresidents in the experimentalgroup, using the plush animals as atopic of conversation.

Residents were frequently seenwith their animals on their laps intheir wheelchairs. Animals werekept, at the farthest, on the resi­dent's bed or dressing table.. Mostresidents named the plush animalsfor people or pets they had knownin the past.. A few gave the animalsclassic proper names, such as Min­nie for the plush mouse.

The control group received noth­ing.

Eight weeks after the party, 37subjects were posttested. Three ofthe 40 had died or been transferred..This left a total of 37 participants,1I men and 9 women in the experi­mental group, and 6 men and I Iwomen in the control. The two in­vestigators posttested each other'spretest groups.

Results

Data analyses revealed statisti­cally significant differences in theexperimental group at p < .05 on

nine ... _J......... _ .._....

Aftermental group waslarge room whereplush animals wereble. The animals wereat a time and residentsthe one they wanted. Each had a

_... "'"... _......_'w. There was a little com­petition, but they resolved the dif­ferences among themselves. Theywere encouraged to name the ani­mals and talk with each otherabout them.

Although staff were told nothing,unsystematically collected observa­tions revealed that they appeared to

142 Geriatric Nursing May/June 1986