Abstract

Background

 

Literature Review

 

Research Aims

 

Methods

 

Results

 

Discussion

Summary

References

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Animal-Assisted Therapy: Analysis of Patient Testimonials

Jennifer M. Stoffel
Carie A. Braun Ph.D., RN
College of St. Benedict/St. John’s University


Abstract

Animal-assisted therapy (AAT) is an intentional healing modality involving a patient, a trained animal therapist, and handler with the intent of facilitating specific therapeutic goals (Barker & Dawson, 1998; Devi, 2000). This secondary data analysis examined the written accounts of patients undergoing AAT at one Midwest regional hospital. Thematic analysis was used to examine written testimonials (n=65). A qualitative text analysis program (ATLAS.ti) was used to manage the data. Chi-square tests of independence were then applied to determine differences in the reported frequencies of certain key terms between adult and pediatric patients.

The most prevalent theme was the induction of relaxation, calmness, and peace (85%). Thirty-two patients (49%) reported a reduction of pain during the AAT session.  In addition, 19 (29%) indicated a positive change in attitude and 18 (28%) reported that they became sleepy.  The pediatric patients were more likely to describe a feeling of calm and relaxation when exposed to animal assisted therapy as compared to the adult patients (χ2=8.615, df=1, p=.003).   This study supports previous assertions that AAT can improve physical, emotional, and psychological well-being.


Key Words: animal-assisted therapy, pet therapy, complementary therapies, alternative therapies.

Background

Throughout history, animals have played an important role in the lives of humans (Netting, Wilson, & New, 1987). In 1860, Florence Nightingale commented on the positive impact of small animals on those with chronic illness (Nightingale, 1860/1969). Over 100 years later, the human health benefits from exposure to companion animals, or pets, both psychological and physical, have been well-documented (Allen & Blascovich, 1996; Barker & Dawson, 1998; Davis, 1988; Friedmann & Thomas, 1995; Siegel, 1990; Thoma, 1984).

Animal-assisted therapy (AAT) differs from common interaction with companion animals. AAT is considered an intentional and distinct healing modality (Devi, 2000). AAT involves a patient, a trained animal as therapist, and the human owner or handler with a goal of facilitating the patient success in achieving therapeutic goals (Barker & Dawson, 1998). Such goals can include improvement in physical, social, emotional, and cognitive functioning (Jorgenson, 1997). Animal therapists are most commonly dogs or cats but can also include birds, guinea pigs, fish, horses, and dolphins. The aim is to match the patient’s needs with the animal best suited to meet that need (Hooker, Freeman, & Stewart, 2002). The animal is highly trained and has a clear therapeutic goal; the relationship terminates when the therapy is complete.

Literature Review

The interest in AAT has been fueled by studies supporting its health benefits (Barker & Dawson, 1998). Animal-assisted therapy has proven a useful adjunct in a variety of settings including mental health facilities (Holcomb & Meacham, 1989), nursing homes (Darrah, 1996; Kogan, 2000), and hospitals (Barba, 1995; Cole & Gawlinski, 1995; 2000). In these studies, AAT resulted in significant reductions in anxiety, agitation, and fear for patients with psychotic and mood disorders or dementia (Barker & Dawson, 1998; Richeson, 2003). Musculoskeletal posture and balance improved in patients with movement disorders after hippotherapy, or therapeutic horseback riding (Weber et al., 1994). In children, AAT dogs have been associated with increased attention and positive behaviors in children with pervasive developmental disorders (Martin & Farnum, 2002). Dolphins have been shown to increase attention and language skills among children with autism over and above traditional classroom interventions (Nathanson & deFaria, 1993). Wells (1998) found that the presence of a dog during a potentially painful medical procedure reduced the child’s level of distress. Some reports of the AAT experience go beyond the explainable. In one ethnographic study, the pet therapy dog exhibited a “sixth sense” and would pace outside the room of an adolescent boy just minutes before onset of a seizure (Bardill & Hutchinson, 1997).

Research Aims

The aim of this study was to further describe the AAT experience by analyzing and summarizing written testimonials of adults and pediatric patients using a qualitative data management tool. More specifically, the study examined the differences between the reports of the children and the reports of adult AAT recipients. A secondary aim was to detect commonly occurring patient responses to AAT in order to generate an experimental study on the impact of AAT in treating a specific patient problem.

Methods

This secondary data analysis examined the written accounts of patients undergoing AAT at one Midwest regional hospital.  A trained dog therapist was accompanied by a handler and performed the AAT for all patients at this facility. The therapeutic goals for treatment were variable and ranged from socialization to promotion of an increased level of consciousness, greater mobility, or pain management. The AAT intervention began when the dog settled in next to the patient and matched the patient’s rate of breathing. The patient would sometimes pet the dog during this time. The intervention ended when the dog jumped down from the patient’s bed.

After an experience with AAT, patients (n=83), a family member, or health care provider were asked to document the experience in narrative format. The patients were asked to write down what he or she experienced during the AAT session. Parents or guardians assisted young children or those otherwise unable to document the AAT experience. There was not a strict research protocol to standardize how the individuals were asked to perform this task. These testimonials were collected for purposes of documenting the AAT experiences in the hospital. The AAT handler was responsible for collecting the data and did so between 1998 and 2004. The data were stored in a ring binder in the AAT coordinator’s office. The appropriate Institutional Review Board approval for performance of this secondary data analysis was obtained prior to accessing and analyzing the previously collected testimonials. Identifying information was removed from the testimonials with the exception of age in order to categorize subjects as pediatric (<18 years of age) or adult (> 18 years of age) patients.

Each testimonial was transcribed into the ATLAS.ti (Version 5.0) software program for the purposes of analysis (Friese, 2004). Each transcript was then assigned a code number within the ATLAS.ti program. The key terms were identified by the program and were coded as recurring select words or phrases that best captured the essence of the testimonial statement.  Those generated by children and adolescents were distinguished from those generated by adult patients. Chi-square tests of independence were then applied to determine differences in the reported frequencies of certain key terms between adult and pediatric patients.

Results

Initially, 83 written statements regarding the experience with AAT were obtained from the hospital’s AAT coordinator for this study.  Of these, 18 (22%) were removed due to irrelevance, as indicated by a lack of information about the AAT experience for that patient. Sixty five (78%) were approved for use in this analysis and were focused on pediatric patient (n=40) and adult patient (n=25) testimonials.

Study findings were based on which key words were repeated throughout each of the patient testimonials.  A total of 43 key terms were identified.  These were further combined into 16 major categories (Table 1).  

Relaxation. The most prevalent theme was related to the induction of relaxation, calmness, peace, stillness, and quiet (85%). This theme was repeatedly demonstrated throughout the testimonials and is illustrated by one parent of an adolescent patient who wrote:

Shortly into the visit it was clear to me that this was more than a social visit.  I saw [my son] slowly start to relax and calm down.  His breathing became deeper and his face and body relaxed. 

 

Pain reduction. Thirty-two patients (49%) reported a reduction of pain during the AAT session as observed and documented by children, adults, family members, and health care providers. Many of the testimonies illustrated that the AAT dog appeared to “take on” the patient’s pain. For example, one parent indicated:

 

My son was brought to the [hospital] due to a bicycle accident.  He was listed in critical condition.  He had a head concussion and severe road rash on his face.  [The dog] came to visit him.  His pain was at a 5 when [the dog] came in.  [The dog] brought my son’s pain down to a 4 in a short period of time.  My son also said he could feel [the dog] in his body. [The dog] brought his pain down to a 2 and also put him to sleep for a good part of the day.  I believe [the dog] is a miracle and helped to make my son heal very fast. 

Another family member wrote: 

The [handler] asked him, do you feel any pain?  The dog’s neck started to twitch – my son said “some in my neck”.  [The dog] moved his front leg. My son said it hurt some in his shoulder too. Then [the handler] took the dog off the bed.  [The dog] seemed to be tired and weak.  The man laid him on the floor and massaged the dog and rubbed him down.  My son’s pain was gone. I have never seen anything like this before. 

A reduction is pain was also illustrated by this adolescent’s story: 

I was injured in a snowboarding accident.  I ruptured my spleen and lacerated the bottom third of my kidney.  I met [the dog] for the first time on Friday, the day after my surgery, when I was hurting a lot.  [The dog] took away all of the pain.  The next visit I started to bond with [the dog].  She got into me quicker.  She started to take away the pain faster.  I felt a draining feeling when she was lying there, like she was draining away all the pain.  My stomach unclenched and my whole body cooled down.  When she wasn’t there I could think about her and the pain would go away.  Each time she started taking the pain away faster.  The last visit she got into me in ten seconds.  I think that [the dog] is better than Tylenol with codeine because she takes the pain away better and works faster. 

 

Positive affect. In addition, 19 patients (29%) indicated a positive change in attitude or improved affect and 18 patients (28%) reported that they became sleepy.  The spouse of an adult patient indicated:

 

I see a change in him when [the dog] comes to visit.  His nausea lessened, he relaxed and his attitude changed for the better.  The two of them seem to be quite comfortable with each other. 

Another parent wrote: 

[My son’s] spirits were deflated, he was angry with the news he had just received and he was tired of being poked with needles.  He was instantly comforted by [the dog] when she laid by him in bed.  The smile on his face was such a welcome sight.

 

Physiologic changes. Other predominant phrases included the experience of slowed breathing or matched breathing and heart rate pattern between the therapy dog and the patient (34%), as well as feeling a sense of warmth (14%), arousal/energy (11%), or a decrease in temperature or coolness (8%) during the therapy. Some of these phenomena were interspersed within the previous examples but are further illustrated by the following: 

 

[The dog] lay on [my son’s] arm to get comfortable and close.  [The handler] told [my son] to close his eyes and think about [the dog] and leave everything else go. Take a deep breath. [The dog] was breathing the same time as my son. [My son] immediately became relaxed and said his left leg was feeling warm from his foot up to his knee. Then after he and [the dog] laid together for about 5 more minutes, he said his whole body felt relaxed and warm.

Chi-square tests of independence were then applied to key phrase clusters where at least five adults and five pediatric patients identified the specific phenomenon. These included “breathing/heart rate changed to match the dog” (pediatric=38%, adult=28%), “calm/relaxed/ peaceful” (pediatric 95%, adult 68%), and “reduced pain” (pediatric 50%, adult 48%).  There was no statistically significant difference between the adults and children with regard to changes in heart rate and breathing patterns (χ2=.620, df=1, p=.431) or with a reduction of pain (χ2=.025, df=1, p=.875). However, there was a statistically significant difference in reports of calmness and relaxation between the children and adults. The pediatric patients were much more likely to describe a feeling of calm and relaxation when exposed to animal assisted therapy as compared to the adult patients (χ2=8.615, df=1, p=.003).

Discussion

 

The analysis of patient testimonials contribute to the growing evidence that animal-assisted therapy improves the physical, emotional, and psychological well-being of individuals (Barba, 1995).  Common physiologic and psychological experiences, such as relaxation and a reduction in pain, were described by the study participants. The experiences appeared similar between adults and children with the exception of the instillation of calmness and relaxation, which was more frequently reported by the pediatric patients. AAT appears a highly effective method of inducing relaxation in children based on these data.

 

This study is limited by a small convenience sample of solicited testimonials at one facility utilizing one AAT dog and cannot be generalized to the entire population of patients receiving AAT. Also, the data were not validated by observations from health care providers and exclusively reflect the perceptions of participants. Since there was not an established interaction protocol for data collection, the participants may have been influenced by parents/guardians and even the animal-assisted therapy handler in the outcomes reported. The intended therapeutic goal was not documented, so it is difficult to determine if that specific goal was met. Further research should include randomized sampling procedures that include patient perception as well as valid and reliable psychologic and physiologic measures to determine the efficacy of AAT.

 

The contributions that animals make in enhancing the quality of human life cannot be ignored (Heimlich, 2001). Given the mounting evidence of patient satisfaction with AAT, nurses are in an ideal position to advocate for the safe use of AAT to assist in achieving therapeutic goals (Jorgenson, 1997; Wu et al., 2002).  Animal-assisted therapy is emerging as a viable adjunct to patient care.

 

References

 

Allen, K. & Blascovich, J. (1996). The value of service dogs for people with severe ambulatory disabilities: A randomized control trial. Journal of the American Medical Association, 275, 1001-1006.

 

Barba, B. (1995). The positive influence of animals: Animal-assisted therapy in acute care.  Clinical Nurse Specialist, 9, 199-202.

Bardill, N. & Hutchinson, S. (1997). Animal-assisted therapy with hospitalized adolescents. Journal of Child and Adolescent Psychiatric Nursing, 10, 17-24

Barker, S. & Dawson, K. (1998). The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients.  Psychiatric Services, 49, 797-801. 

 

Cole, K. & Gawlinski, A. (1995). Animal-assisted therapy in the intensive care unit. Nursing Clinics of North America, 30, 529-537.

Cole, K. & Gawlinksi, A. (2000). Animal-assisted therapy: The human-animal bond. American Association of Critical-Care Nurses Clinical Issues, 11, 139-149.

Darrah, J.  (1996). A pilot survey of animal-facilitated therapy in southern California and South Dakota nursing homes.  Occupational Therapy International, 3, 105-121.

Davis, J. (1988). Animal-facilitated therapy in stress mediation. Holistic Nursing Practice, 2, 75-83.

Devi, S.  (2000). Beyond words: Animals as healers.  Alternative Medicine, 38, 31-39.

Friedmann, E. & Thomas, S. (1995). Pet ownership, social support, and one year survival among post myocardial patients in the Cardiac Arrhythmia Suppression Trial (CAST). American Journal of Cardiology, 76, 1213-1217.

Friese, S. (2004). User’s manual for ATLAS.ti (Version 5.0, 2nd edition) [Computer software]. Berlin: Thomas Muhr, Scientific Software Development.

Heimlich, K.  (2001). Animal-assisted therapy and the severely disabled child: A quantitative study.  Journal of Rehabilitation, 67, 48-54.

Holcomb, R. & Meacham, M. (1989). Effectiveness of an animal-assisted therapy program in an inpatient psychiatric unit. Anthrozoos, 2, 259-264.

Hooker, S., Freeman, L., & Stewart, P.  (2002). Pet therapy research: A historical review.  Holistic Nursing Practice, 16, 17-23.

Jorgenson, J.  (1997). Therapeutic use of companion animals in health care.  Image: The Journal of Nursing Scholarship, 29, 249-254.

Kogan, L. (2000). Effective animal-intervention for long term care residents. Activities, Adaptation, and Aging, 25, 31-45.

Martin, F. & Farnum, J. (2002). Animal-assisted therapy for children with pervasive developmental disorders. Western Journal of Nursing Research, 24, 657-70.

Nathanson, D. & deFaria, S. (1993). Cognitive improvements to children in water with and without dolphins. Anthrozoos, 6, 17-27.

Netting, F., Wilson, C., & New, J. (1987). The human-animal bond: Implications for practice. Social Work, 32, 60-64.

Nightingale, F. (1969). Notes on nursing. New York, NY: Dover Publications (originally published in 1860).

Richeson, N. (2003). Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia: an evidence-based therapeutic recreation intervention. American Journal of Recreation Therapy. 2(4), 9-16.

Siegel, J. (1990). Stressful life events and use of physician services among the elderly: The moderating role of pet ownership. Journal of Personality and Social Psychology, 58, 1081-1086.

Thoma, L. (1984). Physiological effects in the hypertensive individual of petting bonded versus unbonded dogs. Unpublished Ph.D. Thesis, University of Nebraska Medical Center, Nebraska.

Weber, A., Pfotenhauer, M., David, E., Leyerer, U., Rimpau, W., Aldridge, D., Reissenweber, J., & Faschner, J. (1994). Registration and evaluation of effects of hippotherapy with patients suffering from multiple sclerosis by means of electromyography and acceleration measurement. In Proceedings of the 8th International Therapeutic Riding Congress (pp. 231-241). Levin, New Zealand: National Training Resource Center.

Wells, M. (1998). Dog presence effects on children’s stress responses during medical procedures. Presented at the Delta Society 17th Annual Conference. Seattle, WA.

Wu, A.S., Niedra, R, Pendergast, L., & McCrindle, B.  (2002). Acceptability and impact of pet visitation on a pediatric cardiology inpatient unit.  Journal of Pediatric Nursing, 17, 354-362.


Table 1

Key Terms Described after AAT Experience

Key Terms/Phrases

Pediatric (n=40)

Adult (n=25)

Total (%)

Alert/aroused/aware/energized

6 (15%)

1 (4%)

7 (11%)

Attitude/happy/smiling

15 (38%)

4 (16%)

19 (29%)

Breathing and/or heart rate changed/matched dog

15 (38%)

7 (28%)

22 (34%)

Calm/relaxed/peaceful/still/quiet/restful

38 (95%)

17 (68%)

55 (85%)

Connected/loved/hopeful

3 (8%)

1 (4%)

4 (6%)

Decreased agitation/anxiety/stress

5 (13%)

2 (8%)

7 (11%)

Decreased nausea

0

3 (12%)

3 (5%)

Decreased temp/cool

5 (13%)

0

5 (8%)

Increased oxygen saturations

1 (3%)

0

1 (2%)

Reduced pain

20 (50%)

12 (48%)

32 (49%)

Sleepy

14 (35%)

4 (16%)

18 (28%)

Strength

0

1 (4%)

1 (2%)

Stroking/petting

1 (3%)

2 (8%)

3 (5%)

Tingling

0

2 (8%)

2 (3%)

Troubles go away

1 (3%)

0

1 (2%)

Warmth

6 (15%)

3 (12%)

( Return )

 

Correspondence:

Carie A. Braun, Ph.D., RN
Assistant Professor of Nursing
College of St. Benedict/St. John’s University
Department of Nursing
37 College Ave. South
St. Joseph, MN  56374
Phone: 320-363-5223
Email: cbraun@csbsju.edu
Fax: 320-363-6099

Copyright© by The University of Arizona College of Nursing; All rights reserved.