The benefits of an animal-assisted intervention service to patients and staff at a children's hospital

Implementation feasibility of animal-assisted therapy in a pediatric intensive care unit: effectiveness on reduction of pain, fear, and anxiety

Animal-assisted therapies are an innovative strategy within health care humanization initiatives, and they could play a role in the reduction of pain or anxiety. The main objective of this work was to evaluate the feasibility of implementing animal-assisted therapy in a pediatric intensive care unit and its effectiveness for the reduction of pain, fear, and anxiety. A prospective, quasi-experimental study of animal-assisted therapy was designed in the pediatric intensive care unit of the Hospital Universitario 12 de Octubre of Madrid, from January 2019 to December 2019. The study sample included patients who had been admitted to the unit and were over 3 years old. Satisfaction surveys were collected from the patients, family, and health personnel involved. Physiological variables and the level of pain (visual analog scale or Wong-Baker scale), fear (Child Medical Fear Scale), and anxiety (modified Yale Preoperatory Anxiety Scale) were evaluated before and after each session. Any existence of adverse events was recorded. A total of 74 therapy sessions were performed on 61 patients. All sessions were completed without any adverse effects. A total of 164 surveys were collected, providing an overall project rating of 9.69 out of a possible 10. The survey comments were found to be positive in most cases. No differences were found in the physiological variables measured before and after each session. There was a statistically significant decrease in pain, fear, and anxiety levels (p < 0.01).   Conclusion: The implementation of an animal-assisted therapy project in a pediatric intensive care unit is feasible and safe and has a high degree of acceptance among both participants and healthcare staff. Animal-assisted therapy is effective for the reduction of pain, fear, and anxiety, and therefore, it could be considered an adjunct to non-pharmacological therapy. What is Known: • Animal assisted therapies (AAT) are an innovative strategy that could be beneficial to help pediatrics patients cope with admission difficulties and could even play a role in reducing pain, anxiety and/or delirium. • To date there are not studies to analyze the effectiveness of AAT in the field of Pediatric Intesive Care. What is New: • Our study confirms the feasibility and effectiveness of the implementation of an AAT in the field of Pediatric Intensive Care with a high degree of acceptance by participants, caregivers and healthcare personnel. • AAT demonstrated a reduction in pain, fear and anxiety in pediatrics patients admitted to Pediatric Intensive Care Unit.

A Review of Creative Play Interventions to Improve Children's Hospital Experience and Wellbeing

CONTEXT

Being in the hospital can be stressful for children and caregivers. Evidence-based play interventions to reduce this stress, such as play therapy or Child Life services, have been introduced in hospitals globally, with growing awareness of potential benefits.

OBJECTIVES

To evaluate the impact of nonmedical/illness-specific creative or play-based programs in hospital settings on children's (<18 years) and their caregivers' hospital experiences, wellbeing, and other health outcomes.

DATA SOURCES

PubMed, CINAHL, Google Scholar.

METHODS

We conducted a systematic review of original articles published since 2011, screening 2701 de-duplicated articles.

RESULTS

We identified 25 eligible articles, representing 1629 children (57% male), 422 caregivers, and 128 health professionals. Included studies most commonly evaluated professional children's entertainers (n = 8 studies), music therapy (n = 4), unstructured play (n = 3), and humanoid/animal robots (n = 3). Most studies evaluated the impact on the child's level of anxiety (n = 14/25), mostly supporting a reduction (n = 13/14 studies). Several studies provided evidence for a reduction in children's pain (n = 4/6), and negative emotional/behavioral outcomes (eg, sadness, anger, irritability; n = 5/6 studies). There was mixed evidence for the impact of the included interventions on physiologic outcomes (eg, systolic pressure, heart frequency; n = 3/5 studies) and fatigue (n = 1/2 studies). Evidence on caregiver outcomes and the impact on health care services was limited.

CONCLUSIONS

The findings of our review generally supported the value of play-based interventions on children's' wellbeing while in the hospital, particularly reducing anxiety and pain. Further evaluation of their impact on caregivers' outcomes and the health care system is needed.

Developing and Planning a Protocol for Implementing Health Promoting Animal Assisted Interventions (AAI) in a Tertiary Health Setting

The Ottawa Charter identifies that multiple levels of government, non-government, community, and other organizations should work together to facilitate health promotion, including in acute settings such as hospitals. We outline a method and protocol to achieve this, namely an Action Research (AR) framework for an Animal Assisted Intervention (AAI) in a tertiary health setting. Dogs Offering Support after Stroke (DOgSS) is an AR study at a major tertiary referral hospital. AAI has been reported to improve mood and quality of life for patients in hospitals. Our project objectives included applying for funding, developing a hospital dog visiting Action Research project, and, subsequent to ethics and governance approvals and finance, undertaking and reporting on the Action Research findings. The Action Research project aimed to investigate whether AAI (dog-visiting) makes a difference to the expressed mood of stroke patients and their informal supports (visiting carers/family/friends), and also the impact these visits have on hospital staff and volunteers, as well as the dog handler and dog involved. We provide our protocol for project management and operations, setting out how the project is conducted from conception to assess human and animal wellbeing and assist subsequent decision-making about introducing dog-visiting to the Stroke Unit. The protocol can be used or adapted by other organizations to try to avoid pitfalls and support health promotion in one of the five important action areas of the Ottawa Charter, namely that of reorienting health services.

The Importance of the Treatment Rationale for Pain in Animal-Assisted Interventions: A Randomized Controlled Trial in Healthy Participants

Animal-assisted interventions (AAIs) is a promising treatment approach for pain, but possible mechanisms still need to be elucidated. This study set out to investigate the analgesic effects of an animal provided with a treatment rationale in a randomized controlled trial employing a standardized experimental heat-pain paradigm. We randomly assigned 128 healthy participants to: dog treatment (DT), placebo treatment (PT), dog and placebo treatment (DPT), and no treatment (NT). Primary outcomes were heat-pain tolerance and the corresponding self-reported ratings of pain unpleasantness and intensity. Results revealed no differences in heat-pain tolerance between the conditions. However, participants in the DT condition experienced heat-pain as significantly less unpleasant at the limit of their tolerance compared to participants in the NT condition (estimate = -0.96, CI = -1.58 to 0.34, P = .010). Participants in the DT condition also showed lower ratings of pain intensity at the limit of their tolerance compared to participants in the NT condition (estimate = -0.44, CI = -0.89 to 0.02, P = .060). This study indicates that a dog has analgesic effects on pain perception when integrated into the treatment rationale. We assume that providing a treatment rationale regarding the animal is important in AAIs for pain. PERSPECTIVE: This study shows that the presence of an animal is not sufficient for animal-assisted interventions (AAIs) to have an analgesic effect on pain unless they are provided with a treatment rationale. This could imply that not only the animal but also contextual factors are important in AAIs. TRIAL REGISTRATION: Clinical Trials NCT04361968.

Race, Zoonoses and Animal Assisted Interventions in Pediatric Cancer

Emerging evidence accumulates regarding the benefits of animal-assisted interventions (AAIs) in facilitating pediatric cancer treatment and alleviating symptomatology through positive changes in the patients’ emotional, mental, and even physical status. A major concern expressed by healthcare providers and parents in implementing AAIs in hospital settings is the transmission of disease from animals to patients. Immunocompromised children, such as pediatric cancer patients are at increased risk for pet-associated diseases. Furthermore, existing disparities among the racial and ethnic minority groups of pediatric cancer patients can potentially exacerbate their risk for zoonoses. This literature review highlights the most common human infections from therapy animals, connections to the race and ethnic background of pediatric oncology patients, as well as means of prevention. The discussion is limited to dogs, which are typically the most commonly used species in hospital-based animal-assisted therapy. The aim is to highlight specific preventive measures, precautions and recommendations that must be considered in hospitals’ protocols and best practices, particularly given the plethora of benefits provided by AAI for pediatric cancer patients, staff and families.

Improving the Emotional Distress and the Experience of Hospitalization in Children and Adolescent Patients Through Animal Assisted Interventions: A Systematic Review

Introduction

Animal Assisted Interventions (AAIs) are increasingly common in pediatric care settings as a means to promote the physical, mental, and emotional well-being of hospitalized children and adolescents.

Objectives

The aim of this work was to review published studies implementing AAIs in hospital settings and to assess the effects of AAIs on the biobehavioral response to stress and pain, social behavior, quality of life and level of satisfaction with hospitalization in children and adolescents. Stress and burden, quality of life, mood and level of satisfaction with hospitalization in parents/caregivers as well as stress and burden, perception of the work environment and job satisfaction in hospital staff were also reviewed.

Methods

All published studies reporting quantitative assessments were systematically searched using PubMed, Scopus, ProQuest and Web of Science databases in accordance with PRISMA guidelines. The aim was to identify studies examining the effects of AAIs on behavioral, psychological and physiological responses to stress in children and adolescents (0-18 years) formally admitted to a hospital for a stay, as well as in those undergoing a visit for treatments or medical examinations.

Results

Of the 350 studies screened, 21 were eligible for inclusion. Most of them focused on stress, pain, and anxiety reduction in pediatric patients, and used both physiological parameters and behavioral and psychological observations/scales. All studies employed dogs. Results show the potential of AAIs to reduce anxiety and behavioral distress in pediatric patients while acting on physiological measures associated with arousal.

Conclusion

Although further, more rigorous studies are still needed, the findings of this review may have implications for clinical practices suggesting appropriate planning of AAIs by pediatric healthcare professionals.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=178993], identifier [CRD42020178993].

Perspectives on facility dogs from pediatric hospital personnel: A qualitative content analysis of patient, family, and staff outcomes

An increasing number of children's hospitals feature full-time resident facility dogs, which are specially trained to work alongside pediatric healthcare professionals to improve the patient experience. This qualitative study aimed to describe the role that facility dogs play in the lives of patients, families, and hospital staff. A total of N = 73 pediatric healthcare professionals that worked with 46 facility dogs across 17 children's hospitals in the US completed a set of open-ended questions in an online survey. Responses were analyzed via a conventional thematic analysis and organized into themes and sub-themes. Facility dogs were described to benefit pediatric healthcare professionals' daily lives through improving stress and wellbeing, staff relationships, and job-related morale. Negative impacts included increased burdens and responsibilities in the workplace. Facility dogs were also described to benefit patients and families by helping build rapport, providing a comforting presence and positive resource, and normalizing the hospital environment. In conclusion, facility dog programs were found to be a promising complementary intervention to benefit both staff as well as and patients and families. Future research is warranted to examine short-term and long-term implications of facility dog programs for staff, patient, and family wellbeing.

Animal assisted interventions in the children's hospital: protocol for a scoping review

The introduction of Animal Assisted Interventions (AAIs) in healthcare is relatively common; however, their actual effectiveness and long-term impact are not so well known, especially in relation to the children’s hospital setting.  It is important to plot where and why animal interventions take place but also to focus on how the human animal bond impacts on children in a children’s hospital setting.  Family members, including companion animals, are important supports which help children to relax and give them a sense of familiarity to navigate the busy and stressful hospital environment.  The scoping review of the literature proposed will explore the scientific evidence base for AAIs in children’s hospitals and will map results prior to undertaking a full scale research project.   Arksey and O’Malley’s framework guided by the Joanna Briggs Institute will frame this review protocol.  Appendices are used to ensure transparency of methods. The protocol is presented in narrative style to demonstrate flow, fluency, and appeal to wider readership.

When patients' priorities conflict with those of their medical team; a challenging case of a bleeding patient and his dying pet

We present an unusual case of an acutely unwell patient with an upper gastrointestinal bleed whose resuscitation efforts were delayed by the discovery of his, similarly, acutely unwell pet on the medical high dependency unit. We highlight the challenges this provided the clinical team and focus on the issues relating to patient safety, consent and multidisciplinary action which may be more relevant to daily clinical practice.

Dog Welfare, Well-Being and Behavior: Considerations for Selection, Evaluation and Suitability for Animal-Assisted Therapy

Simple Summary

Benefits for humans participating in animal-assisted therapy (AAT) have been long documented; however, welfare considerations for the animal counterparts are still quite non-specific, often relating to more general concerns associated with animal-assisted interventions (AAIs). Providers of AAT have a moral and ethical obligation to extend the “Do No Harm” tenet to the animals with whom they work. Companion animals do not ask or voluntarily sign up to be a part of a therapeutic team and their natural traits of love and sociability can easily be misinterpreted and exploited. This article reviews the current state of animal-assisted interventions; it highlights the lack of sufficient evaluation processes for dogs working with AAT professionals, as well as the risks associated with not protecting the dogs’ welfare. Finally, the authors make recommendations for determining the suitability of specific dogs in the clinical setting and ensuring that the population, environment, and context of the work is amenable to the dogs’ welfare and well-being.

Abstract

Health care and human service providers may include dogs in formal intervention settings to positively impact human physical, cognitive and psychosocial domains. Dogs working within this context are asked to cope with a multitude of variables including settings, populations, activities, and schedules. In this article, the authors highlight how both the preparation and operation of dogs within animal-assisted therapy (AAT) differs from less structured animal-assisted activities (AAA) and more exclusive assistance animal work; the authors highlight the gaps in our knowledge in this regard, and propose an ethically sound framework for pragmatic solutions. This framework also emphasizes the need for good dog welfare to safeguard all participants. If dogs are not properly matched to a job or handler, they may be subjected to unnecessary stress, anxiety, and miscommunication that can lead to disinterest in the work, overt problematic behavioral or health outcomes, or general unsuitability. Such issues can have catastrophic outcomes for the AAT. The authors propose standards for best practices for selection, humane-based preparation and training, and ongoing evaluation to ensure the health, welfare and well-being of dogs working in AAT, which will have concomitant benefits for clients and the professionalism of the field.

Animal assisted activities in the children's hospital: protocol for a scoping review

The introduction of animal interventions in healthcare are relatively common; however, their actual effectiveness and longer term findings are not so well known or published, especially in relation to the children’s hospital setting.  It is important to plot where and why animal interventions take place but also to focus on how the human animal bond impacts on children, their parents and staff in a children’s hospital setting.  Family members, including companion animals, are important supports which help children to relax and give them a sense of familiarity to navigate the busy and stressful hospital environment.  The scoping review of the literature proposed will explore the scientific evidence for animal assisted activities (AAA) in children’s hospitals and will map results prior to undertaking a full scale research project.   Arksey and O’Malley’s framework guided by the Joanna Briggs Institute will frame this review protocol.  Appendices are used to ensure transparency of methods. The protocol is presented in narrative style to demonstrate flow and fluency and appeal to wider readership.

The Best Medicine: Personal Pets and Therapy Animals in the Hospital Setting

Companion animals can have a positive impact on people's health and well-being. Personal pet visitation and animal-assisted interventions (AAIs) can benefit patients' pain, blood pressure, stress, depression, and anxiety, as well as increasing mobility and socialization with staff and families. Implementing personal pet visitation and/or AAI programs requires the involvement of stakeholders from multiple disciplines. AAI is generally well received by staff. Animal presence in the intensive care unit carries few risks for humans and animals but is not risk free. Programs should be designed to minimize these risks. Effective planning can create programs that support patient-centered and family-centered care.