Making Pet Therapy a Comfortable Experience for the Pets

The hospital can be a traumatic and frightening experience for anyone, let alone a pediatric patient. Not only are hospitalized children experiencing pain and anxiety in an unfamiliar environment, they may also experience separation from family and friends. These stressors may hinder a child’s ability to cope with hospitalization leading to regression and non-compliance. Animal-Assisted Activities (AAA), more commonly known as pet therapy, is a form of complementary alternative therapy that has been examined in this population. Although not a new concept, the use of therapy dogs to help those affected by disease and illness has become increasingly popular. Many children’s hospitals have now implemented pet therapy programs, however, there is a gap of evidence indicating the understood effects of these programs on pediatric patients. This research is conducted to determine the physiological and psychological benefits of pet therapy on hospitalized pediatric patients.

It has long been known that pets provide people with a source of comfort. The founder of modern nursing, Florence Nightingale, may have even spearheaded the animal therapy movement when she wrote in her book, “a small pet animal is often an excellent companion for the sick...” (Nightingale, 1946, p. 103). Nightingale’s recognition of the impact animal therapy has on individuals has developed throughout the years. Pet Partners, formerly known as Delta Society, was the first comprehensive, standardized training in Animal-Assisted Activities and therapy for volunteers and healthcare professionals. According to Pet Partners, Animal-Assisted Activities (AAA), focuses on providing “opportunities for motivational, education, and/or recreational benefits to enhance quality of life” (Pet Partners). Animal-Assisted Activities are delivered by a specially trained professional or volunteer, in partnership with an animal that meets specific criteria for suitability. In terms of the population of focus, these AAA are typically short visits to a patient from a canine where the individual can pet, snuggle, interact with the canine and owner and observe tricks.

Existing literature suggests that Animal-Assisted Activities may be a beneficial alternative therapy used as an adjunct to enhance the care. While each population and every individual produce varied results, studies have shown to have some generalized benefits amongst all the populations of people studied including a reduction in pain level (and analgesic requirements), easing anxiety, and improving mood. Silva and Osório’s study results demonstrated AAA’s effectiveness in the pediatric oncology setting. Twenty-four children aged 6 to 12 receiving outpatient care for a solid tumor or acute lymphoid leukemia underwent an AAA program consisting of three thirty minute sessions for four weeks. Before and after the program, the children and their caregivers completed self-assessments evaluating outcomes such as quality of life, mood, and anxiety. The children experienced significant reductions in pain, irritation, and stress while it was observed that the caregivers had an improvement in anxiety, mental confusion and tension (Silva & Osório, 2018). Furthermore, a randomized controlled study, Calcaterra et al. (2015) found that when treatment was supplemented with AAA in the immediate post-surgical period, patient’s pain perception was lowered, they recovered from anesthesia faster, and their cerebral oxygenation increased.

Although recent data regarding the efficacy of AAA that involves dogs in addressing the needs of children who are hospitalized is extremely limited; broad research with adults who experienced AAA while hospitalized should serve as an indication of benefits for pediatric patients. A study of patients hospitalized on an inpatient mental health unit by Nepps, Stewart, and Bruckno (2014) identified significant decreases in depression, anxiety, pain, and pulse after an AAA program, compared to patients in a more traditional stress management group. Moreover, in a retrospective study, Havey et al. (2014) found that adults undergoing total joint replacement surgery used less pain medication post-surgery when they had their operation performed in a hospital with an AAA program and received at least one post-operative AAA visit. John Hopkins rehabilitation and intensive care unit experts have also concluded that non-pharmacological intervention programs, such as AAA, may reduce suffering and help patients take an active role in their recovery. Megan Hosey, a co-author of “Animal-assisted intervention in the ICU: a tool for humanization,” described how she saw a patient standing for a longer period of time while patting a dog (Hosey, Jaskulski, Wegener, Chlan, & Needham, 2018). From these observances, it is evident that Animal-Assisted Activities support individuals in various ways.

As someone who accompanied and led the pet therapy visits at Saint Peter’s University Hospital in the pediatric unit, I was able to witness first-hand the overwhelming benefits this program had on our patients and families. From increasing overall mood and demeanor to encouraging ambulation and distracting the patients from pain, it is remarkable to see the positive effects a canine can have on these vulnerable patients. I can remember vividly, bringing one of the pet therapy dogs into the room of a fourteen-year-old who was newly diagnosed with Lymphoma. Her mother pulled me aside with tears in her eyes and whispered, “this is the first time I have seen her smile since she was diagnosed, I was so afraid I would not see this smile for a while.” A ten-minute visit from a pet therapy dog can make a world of a difference to someone. It has also been proven that AAA’s benefits do not stop at the patient level. They may extend to healthcare providers and staff too, increasing morale, decreasing stress, and boosting performance. Ginex, et al. (2018) evaluated staff responses to the animal-facilitated therapy program and responses consisted of, “they make a stressful day better,” and “the [Caring Canines] program gives me something to look forward to.” Saint Peter’s University Hospital staff always look forward to the days pet therapy is scheduled and even have a box of treats located in their break room for the dogs. Many of the pediatric nurses mentioned that they felt the pet therapy visits helped to establish a better nurse-patient relationship and facilitate communication as their patients were eager to discuss their visit. After all, happy and satisfied patients make a happy nurse.

As with any change, when it comes to implementing Animal-Assisted Activities into a setting there will be hurdles to overcome, primarily staff perceptions toward AAA in a facility and fear of infection. Requiring an additional nurse to witness medication wasting in the policy or having to learn how to navigate a new EMR system employed; these are all mandatory changes staff have to abide by. However, acknowledging and accepting a living, breathing animal that comes to the pediatric unit is not in the job description. From the start, prior to implementing Animal-Assisted Activities to a setting, the staff members should be not only be educated on the patient benefits and policies but, encouraged to participate in the visit. Bibbo (2013) conducted a study at an outpatient cancer center in northern California to examine the perceptions of staff members toward an AAA program and found that the staff were generally accepting. The results indicated that staff members who had a greater interaction with the AAA team and observed a visit agreed that the program was beneficial to the patients, while those who had limited or no interactions felt the program was not beneficial to the patients. Another barrier is the fear of infection spread from animals to patients. While there may be benefits to patient care, the evidence on the role canines plays in the transmission of pathogens in healthcare facilities is largely unknown. Snipelisky & Burton (2014) completed a comprehensive literature review on canines in inpatient hospital settings and found that overall, the risks of these types of interactions, including infection, were very minimal and that they should not prohibit their implementation. Until further data is available, specific guidelines and policies need to be developed on standard infection prevention and suitability of patients prior to the initiation of a program. From comparing facility policies and looking at research, it is evident that there is no standard protocol for operating an AAA program in a hospital setting, however, many hospitals have similar guidelines. According to Saint Peter’s University Hospital Pet Therapy Policy, “visits will not be allowed to patients in the following categories: patients on isolation, neutropenic precautions, the doctor can decide on a case by case basis; or those with any open sores such as decubitus ulcers or skin grafts.” Many polices also state that staff members, patients, and visitors are required to perform hand hygiene before and after interacting with Animal-Assisted Activities. Lastly, all handlers and therapy dogs must also have all their immunizations up-to-date. Aside from the existing policies mentioned, there are additional measures that staff members can follow to enhance patient safety and further prevent the spread of infection. Especially when working with pediatric patients, the existing practice should include asking the caregiver if a visit from a pet therapy dog would be of interest prior to the child seeing the animal. This method can help avoid unnecessary exposure to something a child may fear or may even be allergic to. Furthermore, if a patient wishes to have the dog put their paws on the bed or fully get into the bed, a clean sheet should be placed on the bed and removed once the visit has ended. Establishing a clear vision of the change and facilitating open communication throughout the change process are imperative for the success and sustainability of a program.

Learning about other children’s hospitals with AAA programs and the policies they have surrounding the program can be of assistance to guide a hospital into implementing one. A publication by Murthy et al. (2015) is also a valuable reference when creating a proposal for an Animal-Assisted Activities program. This guide from The Society for Healthcare Epidemiology of America includes written policies and procedures and best practices to adopt in order to establish a safe and effective Animal-Assisted Activities program (Murthy et al., 2015). Evidence should be compiled, and feedback from those who have participated in Animal-Assisted Activities should be obtained to present a strong argument to the Hospital Administrators, Nurse Managers and Infection Control, as to why this program should be implemented onto the pediatric unit.

Animal-Assisted Activities is a low-cost initiative that yields measurable rewards. This non-pharmacological intervention has been proven to have both physiological and psychological benefits, aiding in a more positive healthcare experience for both the patient and family. In an environment where pediatric patients have little to no control, therapy dogs help provide a sense of normalcy, calmness, and distraction from treatment and/or painful procedures. Animal-Assisted Activities offer a chance for kids to do what they do best, be kids. In order to fully integrate AAAs into all inpatient pediatric settings, additional research needs to be conducted to confirm accuracy and understand factors that contribute to both effectiveness and ineffectiveness of a program.