ARLINGTON, Texas — A pod of six seals is helping Texas Health researchers studying dementia patients and compassion fatigue in nurses.

The robots, which are FDA-approved medical devices, respond to touch and voices, moving their head and flippers, and making sounds that imitate the voice of a real baby harp seal. They are most commonly used to help calm dementia patients in nursing homes and reduce the need for medication.

"Research indicates that pain, depression, anxiety and stress can be treated with the robotic seals, which bring the benefits of pet therapy without the risks," said Sandra Petersen, D.N.P., APRN, FNP/GNP-BC, PMHNP, an associate professor of nursing at the University of Texas at Tyler who was the keynote speaker at the 2017 Texas Health Research Symposium. Petersen has researched the use of robotic seals in dementia care, uses them with her own patients and is one of only three certified trainers in the United States.

Five Texas Health nurses launched three studies after hearing Petersen. They are testing the cuddly robots' effects on dementia patients in an acute-care setting and determining whether the seals can help prevent or alleviate compassion fatigue in nurses.

Robotic Seal -- Texas Health Resources

"It is so exciting to see the dissemination of patient-centered outcomes research as the result of the Texas Health Nursing Research Symposium in our local research efforts," said Mary Robinson, Ph.D., R.N., NEA-BC, vice president of Professional Practice, Research and Magnet. "After the symposium, our staff quickly identified this as an intervention that might have application in the hospital setting. The Texas Health studies are intended to show how this exciting new technology can assist nurses and achieve better outcomes."  

Dementia

Texas Health Harris Methodist Hospital Southwest and Texas Health Harris Methodist Hospital Fort Worth are conducting a joint study with dementia patients. Each hospital has two seals — Tex and Rosie at Texas Health Southwest and Jack and Jill at Texas Health Fort Worth — purchased by its auxiliary. The study is being run by Ellen Munsterman, M.S.N., APRN, AGCNS-BC, gerontology program coordinator at Texas Health Fort Worth; Patricia Newcomb, Ph.D., R.N., nurse scientist at Texas Health Fort Worth; and Kathy Baldwin, Ph.D., R.N., FAAN, ACNS-BC, AGPCNP-BS, nurse scientist at Texas Health Southwest.

Jack and Jill have interacted with 10 patients, while control patients are exposed to parallel sessions of human therapeutic presence.

"We've had an overwhelmingly positive response from patients and their families," Munsterman said. "The patients often aren't verbal, but they seem very comforted by the seals. They'll stroke them, snuggle with them, and mimic the seals' squeaks and squeals."

L. Annette Cox, M.S.N., R.N., SCRN, clinical educator, is launching a separate study of patients with a diagnosis of dementia or delirium at Texas Health Presbyterian Hospital Dallas in collaboration with UT Tyler.

"There are a lot of studies with seals being used in long-term care but not many in acute-care settings, so that's one of our goals," Cox said. "We're interested to see if we get the same kind of responses with our patients."

The Texas Health Dallas seals, purchased by the Texas Health Resources Foundation through its geriatric fund, are named Wally and Dottie — after Cox's mother, Dorothy, who had Alzheimer's disease. They use artificial intelligence, so the seals evolve over time.

"The more you spend time with them and interact with them, the more interactive they become and the more their personalities develop," Munsterman said. "They start responding to their name and to the sound of your voice."

Compassion fatigue

In the third study, Sheree Henson, M.S.N., RN-BC, NEA-BC, program manager, Department of Clinical Excellence, Texas Health Resources, is using the seals with Texas Health Southwest nurses to see if the robots' calming effect can help prevent or alleviate compassion fatigue.

"The more you spend time with them and interact with them, the more interactive they become and the more their personalities develop," Munsterman said. "They start responding to their name and to the sound of your voice."

Henson decided to study the seals' effect on nurses after hearing about another project of Petersen's.

"She had done a small study with nursing students who were having difficulty with test anxiety and test scores," Henson said. "She measured their anxiety, then had them spend 30 minutes with the seal as a group. Then she measured again and gave them their test. They all had significantly higher test scores and lower anxiety."

Henson wanted to expand on that. "This is the first time the seals are being used with nurses," she said. "Since the nurses were already going to be working with the seals for their patients, it made sense."

Henson's study includes 47 nurses divided into two groups. After completing two surveys that measure compassion satisfaction, compassion fatigue and burnout, participants in the control group spend 15 minutes with a plain stuffed harp seal for each of three 12-hour shifts, while the other nurses spend that time with a robotic seal. After the intervention phase, they retake the surveys. Henson also plans to hold focus groups to get more qualitative data.

Attention getters

Study participant Daniel Call, B.S.N., R.N., said he enjoys his time with Rosie.

"At first it sounded a little hokey, but it's been really good," Call said. "The first five minutes, I'm sitting there thinking of all the things I need to be doing, but once I'm past that hurdle, it's actually really relaxing."

Call said he was surprised by Rosie's level of interaction.

"If you squeeze her or move too fast, she kind of gets scared," he said. "And there are little things, like she hates having her whiskers touched. One time I plopped down in a chair in the breakroom, and just sitting down that fast made her yelp."

Even people who aren't involved in the study enjoy Rosie.

"We have people passing by the office (where Rosie is stored), asking, 'What's that?" said Gina Adair, B.S.N., R.N., and nurse manager in the Progressive Care Unit. "One employee recently lost her mother, so a few times I've gotten Rosie out to give to her. She said Rosie's been very helpful and soothing."

After the current studies are completed, Baldwin hopes to use Tex and Rosie in other areas of the hospital.

"Baby clothes fit them, so Physical Therapy might use them, too," Adair said. "We also want to use them with kids in the Emergency Room, and they might be useful in day surgery or the intensive care unit."

All four researchers have grown attached to their furry assistants.

"It's really hard not to think of her as something alive," Baldwin said. "It took them less than 24 hours to learn their names. It's hard not to fall in love with her."