The Role and Impact of Animals with Pediatric Patients

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The Role and Impact of Animals with Pediatric Patients
Continuing Nursing Education
Objectives and instructions for completing the evaluation and statements of disclosure can be found on page 70.
The Role and Impact of Animals with
Pediatric Patients
Anna Tielsch Goddard and Mary Jo Gilmer
T
he human-animal bond continues to be a topic of exploration in research, philosophy, and psychology. Animalfacilitated therapy (AFT) is considered
to be a subset of complementary and
alternative medicine (CAM) because it
complements treatment and affects
the way a patient experiences symptoms (Urbanski & Lazenby, 2012).
The American Veterinary Medical
Association (AVMA) (2012) estimates
that 69.9 million U.S. households
own a pet dog, and 74.4 million own
a pet cat. Veterinary researchers have
found that benefits to pet ownership
include an increase in social interactions and attention, improvement in
mood, and extended life expectancy
(Beetz, Uvnas-Moberg, Julius, &
Kotrschal, 2012; O’Haire, 2010).
Clear distinctions exist between
therapy and service animals. Service
animals are trained, often with specific purpose, to aide with specific disabilities, such as visual or mobility
impairments, and are owned by the
person for whom they provide service. Service animals are also legally
defined and recognized by federal law
(Rossetti & King, 2010). For example,
under the Americans with Disabilities
Act (ADA), businesses are required to
allow people with disabilities to bring
their service animal onto premises
where customers are allowed, such as
Anna Tielsch Goddard, MSN, BS, RN,
CPNP-PC, is a Pediatric Nurse Practitioner,
Children’s Medical Center Dallas at Legacy,
Dallas, Texas. She is a PhD doctoral student
at Vanderbilt University School of Nursing.
Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN,
is a Professor of Nursing, Vanderbilt
University School of Nursing, and the Director
of the Pediatric Palliative Care Research
Team and a Professor of Pediatrics, Monroe
Carell, Jr., Children’s Hospital at Vanderbilt,
Nashville, TN.
Animal-facilitated therapy (AFT), more specifically known as animal-assisted therapy (AAT) or “pet therapy,” has had an increased presence in the literature with a
surge of recent research methodologies exploring this complementary alternative
medicine (CAM) intervention. However, limited studies have been conducted in the
pediatric population, with many articles anecdotal in nature. A literature review
included primary data sources PubMed, PsychINFO, Medline, and CINAHL, and
yielded positive and beneficial outcomes to be gained through AAT in the pediatric
population. Primary outcome variables of decreased anxiety and pain are the most
commonly reported results. Further research studies are indicated to include the
effects of AFT with children with different diseases and diagnoses. Exploration of
other psychosocial and physical variables, such as self-esteem, would be useful.
Interdisciplinary strategies are needed to develop interventions to help reduce
patient symptoms and treatment-associated stress, as well as to facilitate healing
and wellness beyond traditional medical treatment plans. Complementary therapies are of continued interest to the health care community, especially for pediatric
nurses. Effective use of animals to facilitate conversation, lead discussion, or break
communication barriers has been demonstrated through both research and anecdotal reports.
restaurants, hotels, retail stores, taxicabs, and sports facilities (U.S. Department of Justice, 2008).
Companion animals, a subset of
service animals, have received increased attention for their value in
detecting underlying disease in their
owners, including cancer, seizures,
and hypoglycemia (Wells, 2012). As
opposed to the federal recognition of
service dogs, therapy animals are not
defined or regulated by the federal
government. Therapy animals are usually not owned by the clients or responsible for their well-being, and are
brought to the pet therapy session by
the owner, who is called the “handler”
in these sessions. Therapy animals are
also not subjected to the extensive
and somewhat rigorous training spanning between 1 to even 2 years that
service animals endure (Rossetti &
King, 2010). However, both handlers
and therapy animals are required to
complete prerequisite courses offered
through Pet Partners licensed programs. Therapy animals must also pass
a series of tests by a certified pet therapy agency to be a licensed therapy
animal (Pet Partners, 2012a).
PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2
History of Animal-Assisted
Therapy
Dr. Boris Levinson is often credited as a pioneer in use of animal-assisted therapy (AAT) (Rossetti & King,
2010). A practicing child psychologist
in the 1960s, he theorized that his
patients were less anxious and had less
resistance to therapy when his dog,
Jingles, was involved in the sessions
(Levinson, 1965). Levinson noticed that
one of his child patients, who had previously refused to speak during sessions, would interact and speak to
Jingles prior to his sessions. Levinson
conjectured that Jingles allowed him
to build a sense of rapport with his
patients and felt Jingles was an “extension” in therapeutic milieus (Fine,
2006; Levinson, 1969). Jingles was a
transitional object to facilitate the relationship between Levinson and his
pediatric patient (Levinson, 1969).
Levinson then began to bring Jingles
to sessions with other pediatric patients and later coined the term “pet
therapy” in 1964.
Succeeding Dr. Levinson’s work
was Dr. Samuel Corson who used dogs
65
The Role and Impact of Animals with Pediatric Patients
to implement his biophysical research
with in-patient psychiatric patients.
Dr. Corson continued this work
through his career and was labeled
the “father of pet-assisted therapy”
after his death in 1998 (Thomas,
1998). Dr. Corson was a professor of
psychiatry and biophysics at Ohio
State University who originally
focused his research on the effects of
stress on dogs. Corson recalled a case
of an adolescent with selective
mutism who was unresponsive to
treatment who opened up and began
speaking when a dog was brought to
his room (Corson, Corson, Gwynne,
& Arnold, 1977). Corson then began
focusing his work on pet-assisted
therapy and the effects pets had in
psychotherapy with patients. He
started to publish manuscripts reporting the positive social interactions
and influences on the patients and
the staff when dogs were brought to
the psychiatric inpatient and milieus
with the psychiatry profession
(Corson et al., 1975, 1977). This research has been credited as a catalyst
for interest into the use of animals,
particularly dogs, in therapy with
people (Thomas, 1998).
Other therapists have labeled animals as having a “social lubricant”
effect with patients; humans with animals are sometimes seen as more
approachable and provide a topic for
conversation (Fine, 2006; Nimer &
Lundahl, 2007; Rossetti & King,
2010). For example, patients who are
more withdrawn may engage in increased communication with new
acquaintances in the presence of a
dog (Rossetti & King, 2010).
Florence Nightingale also used
what she called “animal-companion
therapy” for her patients who were
sick and disabled (Snyder &
Lindquist, 2010). Nightingale described the benefits of an animal-companion as a source of therapy to her
patients. She used pets with wounded
soldiers in the early 19th century and
found that pets were companions in
the healing process (Chu, Liu, Sun, &
Lin, 2009). Sigmund Freud has been
credited with recognizing the role of
animals in therapy and stated that his
dog had a “special sense.” Freud
believed the calming presence of his
canine was especially useful with children and would bring his Chow
Chow, “Jo-Fi,” to therapy sessions
(Fine, 2006).
Pet Partners, formerly known as
the Delta Society, is the international
66
non-profit professional organization
for volunteers interested in AAT. The
organization provides professional
resources, training programs, and research for volunteers interested in
animal based therapeutic services (Pet
Partners, 2012a). Pet Partners has
trained over 10,000 handler/animal
teams in both their companion animal and therapy animal programs.
The organization is funded through
individual, foundation, and corporation financial support (Pet Partners,
2012a).
Method of Review
This literature review provides a
synthesis of the current state of the
science of animal therapy in pediatric
patients. A comprehensive database
search was conducted in October and
November 2012 to accessible library
databases, including PubMed, PsychINFO, Medline, and CINAHL. The
main search terms used were animalassisted therapy, animal-assisted activities, animal therapy, pet therapy, and
canine therapy. The literature search
was specifically focused on the use of
animals as therapeutic agents within
pediatrics identified with search terminology of pediatrics, youth, child,
children, and adolescents. In PubMed, medical subject headings
(MeSH) terms were used with Boolean
operators. Secondary searching of
journal manuscripts not found in the
primary search was also reviewed for
additional references. Expert recommendations were sought through
email inquiry to Pet Partners and the
AVMA. Limitations to the literature
search were the various uses of and
definitions for the terms “animalassisted therapy” or “pet therapy.”
Only studies available in English were
explored. Results were not restricted
to date. Identified databased manuscripts were critically analyzed for
quality research design and methodology.
Terminology related to the types
and titles of pet therapy differs among
the literature reviewed. Therapeutic
animal interactions have been interchangeably referred to as “animalfacilitated therapy,” “pet therapy,”
“animal-assisted activities,” “animalassisted therapy,” and “animal-assisted interactions.” Upon reviewing scientific studies and results using these
interventions, distinguishing among
terminologies may be necessary to
properly evaluate the researchers’
claims of study results. For instance,
Sobo, Eng, and Kassity-Krich (2006)
reported positive benefits after
“canine visitation therapy” as an AAT
intervention. However, on review of
specific intervention methodology,
the therapeutic visit consisted of
spending time with the child, sleeping with the child, allowing the child
to pet her, and performing tricks for
the child (Sobo et al., 2006). This specific intervention actually describes
AATs that, although are therapeutic to
the patient, are not classified under
Pet Partner’s classification of animalassisted “therapy.” Although the variety of animal interactions may differ
in actual definition, benefits have
been found among all substitute
terms for these animal-facilitated
interactions in both adult and pediatric patients.
Animal-Facilitated Therapy
Animal-facilitated therapy (AFT),
also referred to as “pet therapy,” is
the overarching term that refers to
both animal-assisted activities (AAA)
and animal-assisted therapy (AAT)
(Urbanski & Lazenby, 2012). AAA and
AAT are sometimes used interchangeably in the literature, but significant
differences exist. Table 1 provides a
comparison summary of AAA and
AAT. AAA refers to activities that involve pets visiting the patient or
client, often use the same activity,
and do not use specific treatment
goals. Detailed notes on the AAA visit
are often unnecessary, and the visit
content is spontaneous (Pet Partners,
2012b). In contrast, AAT can be a significant part of treatment for people
with a physical, social, emotional, or
cognitive diagnosis through the use
of an animal (Rossetti & King, 2010).
AAT requires stated goals for each session, and the treatment is often individualized to the patient. Progress
notes in the patient’s chart should be
recorded after each session, and visits
are usually scheduled with a predetermined length of time based on
the patient’s needs (Pet Partners,
2012a). Pet Partners provides examples of AAT on its website. For instance, a therapist may have a child
manipulate buckles, clasps on leashes,
or collars in order to improve the
patient’s fine motor skills. Additionally, a therapist may have a child
open a container of treats and feed
small pieces of food to the cat in order
to work on the child’s ability to
PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2
Table 1.
Differences between Types of Animal-Facilitated Therapies (AFT): Animal-Assisted Activity (AAA)
and Animal-Assisted Therapy (AAT)
Animal-Assisted Activity (AAA)
Animal-Assisted Therapy (AAT)
Definition
• Activities that involve pets visiting people
• Often “meet and greet” in nature
• Integrated part of treatment plan
• Often for people who have physical, social,
emotional, or cognitive needs
Goals
No specific treatment goal
Specific treatment goal for each session
Activity
Same activity with many patients
Individual treatment activity for each patient
Charting
Unnecessary
Required
Visits
Spontaneous
Scheduled
Length of time
Spontaneous
Differs as desired
Pre-determined to best fit the patient’s needs
Example
• Dog performs tricks in patient’s room
• Child holds/pets visiting cat in a long-term care
facility
• Goal = sequencing of events: have the child
open a container of treats, break treats into
pieces, feed to cat
• Goal = increase ambulation skills with a physical
therapist; child walks the dog short distance
around facility
Source: Adapted from Pet Partners, 2012.
sequence events. The more general
animal-assisted activities may include
volunteers taking their dog or cat to a
nursing home to visit or bringing an
animal to a children’s facility to
“play” with the patients. AAT visits
are performed by volunteer services
and are a cost-saving intervention to
the hospital (Marcus, 2012).
Table 2.
Animal-Assisted Therapy Goals
Type of Goal
Physical goals
Improving fine motor skills
Improving wheelchair skills
Balancing while standing
Mental goals
Increasing verbal interactions between group members
Increasing attention skills
Developing recreation skills
Increasing self-esteem
Reducing anxiety or loneliness
Educational goals
Increasing vocabulary
Improving knowledge of concepts (e.g., color, size)
Motivational goals
Improving child’s willingness to be involved in group activities
Improving interactions with others
Exercise
AAT Goals
A variety of goals may be incorporated into AAT and focus on physical, mental, educational, or motivational objectives. Physical goals may
include improving fine motor skills,
wheelchair skills, or balancing while
standing. Mental health goals may
range from increasing verbal interactions among group members, increasing attention skills, developing recreation skills, increasing self-esteem, to
reducing anxiety and loneliness in a
child. Educational goals are often
based on increasing vocabulary or
improving knowledge of concepts
(e.g., color, size). Finally, examples of
motivational goals refer to improving
a child’s willingness to be involved in
group activities, improving interactions with others, or simply exercise
(Pet Partners, 2012b). See Table 2 for
examples of potential AAT interventional goals.
Examples
AAT Dogs
The most common AAT animal is
the dog. AAT dogs have rigorous
requirements that are often set forth
by the Pet Partners. The dogs must
undergo initial temperament tests,
obedience class training for basic
commands, and then additional AAT
training for appropriate behavior in a
facility (Pet Partners, 2012a; Rossetti
& King, 2010). The dogs must be able
to ride on elevators; be calm around
wheelchairs, walkers, or other ambulation-assistance devices; and not be
PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2
sensitive to loud noises (e.g., alarms,
IVs, children screaming or speaking
loudly). The dog must not startle
around the sudden and sometimes
erratic movements of children in the
rooms or hallways. The dog must be
of good physical health, current on all
vaccinations, and have yearly veterinary health checks (Marcus, 2012; Pet
Partners, 2012a). Certifying agencies,
such as Pet Partners, provide insurance for dogs if they have passed and
abided by the certification program
(Marcus, 2012). See Figure 1 for exam67
The Role and Impact of Animals with Pediatric Patients
Figure 1.
Source: Photograph © Paws Across Texas, Inc. (PAT). Used with permission. The
author allows reprint permission and copyright release.
Note: Paws Across Texas, Inc. (PAT) is a nonprofit community service organization
established in 1986 providing animal-assisted therapy with certified PAT therapy dogs
in multiple diverse populations throughout the Dallas and Fort Worth metropolis in
Texas.
ple of therapy dogs that are certified
through Pet Partners and practice in
the Dallas-Fort Worth metroplex at
the local area Children’s hospitals.
Studies show that the presence of
AAT dogs does not increase zoonotic
infections. One study on the effects of
AAT in an elderly population in a
long-term care facility (N = 1,690)
reported no zoonotic infections when
the AAT dogs visited over a five-year
period (Banks & Banks, 2002). Another pilot study performed at a children’s hospital to look at the potential
occurrence of infection with AAT
showed no difference in the rates of
hospital infections over one year of
weekly dog visits. There were also no
known occurrences of microorganism
or contagious illness transmission by
the dogs (Caprilli & Messeri, 2006).
Benefits of Canine Therapy
Much of the research on AFT has
been done in the adult population
with studies in pediatrics consisting
mainly of anecdotal evidence, consistent with the research trend of using
adult participants as research subjects.
In these adult studies, therapy reduced pain, anxiety, depression, and
fatigue in both inpatient and outpatient populations (Marcus, 2012).
Studies done in nursing care facilities
68
have shown a decrease in loneliness
and anhedonia (Banks & Banks, 2002;
Chu et al., 2009; Nathans-Barel,
Feldman, Berger, Modai, & Silver,
2005). In one study of adult patients
receiving chemotherapy, 86% of
patients opted to have their chemotherapy performed in a room with a
therapy dog when given the option
(Davis, 1988). Further, a statistically
significant decrease in depression
scores in the patients receiving dog
therapy (p = 0.01), and patients experienced increased arterial oxygen saturation (p = 0.004) (Davis, 1988).
Therapy dogs have even been
shown to reduce anxiety scores in
patients waiting for appointments
(Ruchman, Ruchman, Jaeger, Durand,
& Kelly, 2011). Investigators found a
33% reduction in anxiety scores after
spending 15 minutes with a therapy
dog prior to a scheduled MRI (p <
0.001) (Ruchman et al., 2011). Other
adult literature reports that AAT
enhances socialization, activities of
daily living, and general well-being in
adults with mental health diagnoses,
such as dementia and schizophrenia
(Barak, Savorai, Mavashev, & Beni,
2001; Rossetti & King, 2010).
A larger study conducted in an
outpatient tertiary care pain management clinic was designed to explore
potential benefits in using therapy
dogs in a chronic pain facility (Marcus
et al., 2012). Rigorous methodology,
such as the use of a single therapy dog
and handler for all 295 therapy dog
visits, was used to control for confounding variables. Pain severity was
significantly reduced in 23% of patients. Among patients with a preAAT pain score greater than 5 (with
numeric pain ratings of 5 or higher
correlating with substantial painrelated interference and disability),
clinically meaningful pain relief
occurred in 26.2% of patients with
the visiting therapy dog. Among
patients with primary mood disorders
(to include depression and anxiety),
significant improvements in anxiety
were found after the AAT intervention (p = 0.001) (Marcus et al., 2012).
Investigators also included qualitative
themes verbalized by the therapy dog
participants, with overarching themes
reported as time with the dog reduces
discomfort; time with the dog is relaxing; the dog provides a positive distraction from symptoms; patient
comments on overall positive impression of the dog. Patient comments
included “this dog is like a sanctuary
to me” and “this dog helps me to forget my misery and pain” (Marcus et
al., 2012, p. 53).
Canine Therapy
With Children
In experimental studies within the
pediatric population, physiological,
psychological, and emotional benefits
have been supported. For example, a
pilot study on canine visitations with
children in pain showed overarching
themes that were often based on reducing anxiety (Sobo et al., 2006). These
themes included providing distraction
from the pain and/or situation, bringing pleasure and happiness, entertainment, reminding the child of home,
enjoyment of snuggling and contact
with the dog, providing company,
calming, and pain easement (see Figure
2) (Sobo et al., 2006).
In a quasi-experimental study in
3- to 17-year-old hospitalized children
who had AAT with a dog, a significant
decrease in pain reports was found
among subjects (Braun, Stangler,
Narveson, & Pettingell, 2009). Group
selection to the AAT intervention
group (N = 18) was determined by eligibility requirements (including ability to use FACES pain scale, 3 to 17
years age range, not fearful or allergic
to dogs, not in isolation) along with
PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2
Figure 2.
Animal-Assisted Activities with Handler at National Pediatric Hospital
Source: Photograph courtesy of Children’s Medical Center of Dallas, Texas. Used
with permission. The author allows reprint permission and copyright release.
the dog being present when child was
hospitalized. Designation to the control group (N = 39) was mainly dictated by a child’s fear or allergy to dogs.
AAT sessions were 15 to 20 minutes
each. The AAT intervention group reported significant decrease in pain
level compared to the control group
(p = 0.006).
An earlier study focusing on children hospitalized on a pediatric
oncology unit found 89% of the children who received canine therapy
had increased independence and
appetite, as well as decreased fear and
pain from treatment and procedures
(Gagnon et al., 2004). A descriptive
pilot study in hospitalized post-operative 5- to 18-year-olds showed a significant decrease in physical pain and
emotional distress as measured on a 1
to 10 scale with happy and sad faces
on a ruler strip (p = 0.01) (Sobo et al.,
2006). The AAT intervention in this
study involved a therapy dog spending time with the child postoperatively. Activities included watching televi-
sion with the child, being petted by
the child, and doing tricks on command for the child. Researchers
referred to this AAT intervention as
“canine visitation therapy.” Limitations to the study include a small
convenience sample size (N = 25).
This research involved post-intervention interviews and the investigators
also analyzed the qualitative data
obtained. Emerging themes reported
by researchers included 1) the animal
providing a distraction, pleasure, or
entertainment; 2) the animal reminding the child of home; 3) snuggling;
4) providing company; and 5) easing
pain (Sobo et al., 2006).
Anecdotal evidence from child
psychologists show that AAT is especially useful in helping children who
have been abused or neglected with
subsequent insecure attachments
(Parish-Plass, 2008). Clinical examples show that using AAT with these
children helps foster trust and increases communication in children
who otherwise have a strong distrust
PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2
in adults (Parish-Plass, 2008). No experimental studies have been published to further explore these clinical
exemplars in this population.
A case study of a 12-year-old boy
with autism reported increased participation in the presence of a therapy
dog (Silva, Correia, Lima, Magalhaes,
& de Sousa, 2011). The autistic child
was exposed to two treatment conditions: a 1:1 structured activity with a
therapist and certified therapy dog,
and a 1:1 structured activity with the
same therapist without the dog. On
videotaped review, researchers and
the therapist noted improvement was
found when the child was with the
therapy dog. These positive behaviors
included smiling, increased positive
physical contact, and less frequent
and shorter durations of negative
behaviors, such as aggression or outbursts (Silva et al., 2011).
An additional benefit reported
from one study was improved staff
moods on an inpatient unit. A pediatric oncology study using AFT on an
inpatient floor also collected self-administered questionnaires from hospital staff. These results not only
showed a change in the mood for the
patients, but found reported improvements in hospital morale and motivation of the registered nurses on the
floor (Gagnon et al., 2004).
Additional Benefits
To Patients
Although many research studies
and prior literature show the importance of AAT with therapeutic goals
and a more regimented visit, animalassisted activities (AAA) also benefit
patients. A randomized control trial
conducted in a large psychiatric institution with participants diagnosed
with schizophrenia showed significant improvements (p = 0.005) in selfesteem, self-determination, positive
psychiatric symptoms, and emotional
symptoms after an 8-week animalassisted activity intervention (Chu et
al., 2009). Investigators noticed that
the touching and accompaniment of
dogs had positive effects on the
patients’ health (Chu et al., 2009).
Therefore, the therapeutic benefit of
animals on the human patient should
not be disregarded if the interaction
was not formally presented in the
AAT format.
Studies conclude that individuals
report improvement in social interactions with dogs. In individuals with
69
The Role and Impact of Animals with Pediatric Patients
disabilities, service dogs not only help
their owner, but also normalize interactions with other people (Guest,
Collis, & McNicholas, 2006; Wells,
2009). An earlier study on self-esteem
in adolescents showed that teenagers
ranked a companion animal, or pet,
below parents but above other social
acquaintances when listing what
made them feel satisfaction or good
about themselves (Juhasz, 1985).
Contraindications to AFT
In some cases, the child may not
be interested in dogs or might even be
allergic to certain animals (Rossetti &
King, 2010). Some children may have
conditions that are agitated in the
presence of certain animals, such as
asthma or a pet-dander allergy
(Morrison, 2007). Some children or
families may actually be fearful of
dogs or other animals. Therefore,
individual assessment of the patient
and possible contraindication to
using an animal to facilitate therapy
or treatment should be considered.
Most facilities have policies not allowing AAT visits with patients who are
colonized with methicillin-resistant
Staphyloccocus aureus or Clostridium
difficile (Marcus, 2012).
Clinical Nursing
Implications
The nursing profession is often
noted for seeking out additional interventions to help patients reduce
symptoms and treatment-associated
stress as well as facilitate healing and
wellness beyond traditional medical
treatment plans. Complementary
therapies are of continued interest to
the nursing community. Most studies
completed in the pediatric population
report both physical and psychological benefits or emotional benefits to
the patients. Research studies show
systematic benefits of animal-facilitated therapies to reduce pain, decrease
psychological distress, and decrease
anxiety (Braun et al., 2009; Gagnon et
al., 2004; Sobo et al., 2006). The use of
an animal to facilitate conversation,
lead discussion, or break communication barriers has been demonstrated
through both research and anecdotal
reports (Chu et al., 2009; Gagnon et
al., 2004; Parish-Plass, 2008; Silva et
al., 2011; Sobo et al., 2006).
Optimal pain management in
patients, especially in pediatrics, is of
continued interest to the health care
70
provider. Exploration of interventions
for pain relief remains a primary goal
for pediatric nurses and researchers.
Nurse researchers have explored complementary therapies to potentially
provide evidence of pain reduction
through areas of CAM, including AFT.
Although further research is needed
that involves the role of AFT in children, decreased pain reports and
decreased anxiety related to pain both
seem to be surfacing as outcomes
from canine-assisted therapies and
activities.
Some facilities and hospitals have
policies on pet visits that AAT programs must follow. For example,
requiring hand sanitizer use by the
patient and the handler before and
after visits, placing a clean towel or
fresh linen on the bed before the visit,
or discouraging feeding treats to the
dog during visits (Fine, 2006; Marcus,
2012). Some facilities that allow animal service or therapy visits require
parents to sign a canine consent form
for the dog to visit while the child is
hospitalized (Sobo et al., 2006).
Nurses should be familiar with infection control policies as it relates to
animal visits at their facilities.
Areas for Additional
Research
Although there has been a recent
surge in literature related to AFT and
benefits to pet companionship over
the last 10 years, further study of AAT,
especially in teens and youth, is indicated. For example, several pilot studies explored AAT in children with
cancer. Studies exploring the usefulness and comparison of similar outcomes, such as decrease in stress or
anxiety, would be useful in pediatric
participants with different disease
states and diagnoses. Additional outcomes, such as self-esteem, activities
of daily living, or the overall impact
of AFT visits, could also be explored in
different pediatric populations. Further, most experimental and research
designs have focused aims on the use
of canines in AFT with children.
Explorations of AFT with the use of
cats, rabbits, or even birds as a therapeutic milieu for children have yet to
be explored heavily in research.
There is also a lack of scientific
data defining a specific protocol for
these animal-facilitated intervention
procedures. Delivery of animal interventions may differ from study to
study, and specific details of the ther-
PEDIATRIC NURSING/March-April 2015/Vol. 41/No. 2
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The Role and Impact of
Animals with Pediatric
Patients
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Goal
The purpose of this activity is to enable the
learner to understand the use of animalfacility therapy (AFT) in pediatric patients.
Objectives
1. Define animal-facilitated therapy (AFT),
including its alternative terms animalassisted therapy (AAT) and animalassisted activities (AAA).
2. Discuss the possible benefits of using
AFT.
3. Explain possible limitations to using
AFT.
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contact hour credit by Rosemarie Marmion,
MSN, RN-BC, NE-BC, Anthony J. Jannetti, Inc.,
Education Director; and Judy A. Rollins, PhD,
RN, Pediatric Nursing Editor.
apeutic procedure are often not
reported. When evaluating outcome
data from experimental studies,
analysis of the animal interaction
between the animal and child should
be recognized.
A widespread belief exists that
the child-animal interaction is beneficial to children’s development on
both a social-emotional and cognitive
level (Melson, 2003). However, there
is a lack of rigorous and peer-reviewed
published studies showing this connection. The human-animal bond continues to be explored across multiple
disciplines, such as veterinary medicine
and clinical psychology with a variety
of variables under investigation.
Finally, due to lack of financial
support for most experimental studies
evaluating AAA or AAT, many studies
are done with small convenience
samples. Further, no longitudinal
studies have been completed with
AAT in pediatrics. Many studies that
have been done with animals have
been conducted in the adult or geriatric population. Therefore, a broad
and general need for experimental
studies examining the influences,
role, and different psychosocial variables that AFT interventions can contribute to the pediatric population are
warranted. In conclusion, rigorous
intervention studies that examine the
role and impact of animals with children are needed as we strive to alleviate children’s symptoms and treatment-associated stress.
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