1. Animal Assisted Therapy
Jennifer Edgell
Kimberly Holden
Vanessa Gonzolez-Lopez
Amy Wirick

2. Why are we interested?
Over the past several years Animal Assisted Therapy (AAT) has gained widespread support and application.
It is an interdisciplinary approach to care that can promote quality of life and positive health benefits.
Those in our group have a love for animals and have noticed a therapeutic effect in our own lives.
We wanted to prove, through research and evidence that animals have a place in healthcare.
(Young and Koopsen, 2011)
Animal assisted therapy is directed or delivered into a patients care plan by those with specialized training. Benefits include increased nutritional intake, stress relief, comfort, reduced feelings of loneliness. It is also noted that interacting and caring for pets increases a client’s strength, endurance, ROM, balance, mobility and sensation. (Young and Koopsen, 2011)

3. Question
Does Animal Assisted Therapy improve healthcare outcomes?”

4. Definition and History
Animal-assisted therapy (AAT) is a therapeutic patient interaction with a domestic “pet-type” animal that is not one’s own pet. (Nahm, et al., 2010)
Animals that can be used in AAT include: dogs, cats, horses, rabbits, guinea pigs, ferrets.
Pet therapy dates as far back as 1699 and was first used in the U.S. in the 1940’s. (Parshall, 2003)
John Locke advocated “giving children dogs, squirrels, birds, or any such thing as to look after as a means of encouraging them to develop tender feelings and a sense of responsibility for others” (as cited in Serpell, 2000, p. 12) (4) In 1792, Quakers used farm animals at a retreat for the mental health benefit of residents. The US first used animals therapeutically in the 1940’s at an Air Force Convalescent Hospital in New York City. The reason was for the well-being of the patients. They observed the animals, took care of them, and were able to touch them. (citation)

6. Study Therapy Dogs in the Emergency Department
This study was done to examine acceptance by staff and patients of a therapy dog in the emergency department.
Setting: a large, Midwest, urban teaching hospital. 2 therapy dogs were used. Quincy, a mixed-breed Labrador retriever, and Brinkley, a Burmese Mountain Dog.
Participants: 125 patients (included actual patients and their visitors), and 105 staff members. All were older than 18 years of age.
Circumstances: Patients were asked if they would like a visit from the therapy dog. People could then pet the dog, have the dog do tricks, talk about the dog, and sometimes throw a treat to the dog.
Methods: Immediately after visits by a therapy dog in a University Hospital ED, all available ED staff, patients, and their visitors were invited to complete a survey. The survey asked about the respondent’s attitudes toward dogs in general, and about dogs in the ED.

7. Results 87 patients and 73 staff visited with the therapy dog.
93% of the patients and 95% of the staff thought that therapy dogs should visit the ED.
Four patients and one staff member felt the therapy dog could be dangerous.
Eleven patients and 11 staff members strongly agreed that therapy dogs made the ED less sanitary.
8.6 % of the staff and 4.2% of the patients worried that the TD interfered with the work of the ED.
There were several limitations to this study: potential survey duplicates, animal bias, immediacy, scheduling, and the individual dogs’ personalities. The dogs did not visit any critically ill patients. One of the handlers was an emergency physician, therefore the Hawthorne effect was unavoidable. The dogs were both also large. Attitudes toward smaller dogs may have been different.

8. Conclusions
This is the first study of AAT in an ED. Acceptance by patients and staff was excellent. The specific benefits of AAT in EDs should be further studied.
Although therapy dogs are uncommon in the ED, they can help improve patient satisfaction by decreasing perceived waiting time. Therapy dogs can lower stress and help patients to relax.

9. Study: Animal-assisted therapy in patients hospitalized with heart failure
Introduction: This study was done to see if a 12 minute visit in the hospital by a therapy dog improved hemodynamic measures, lowered neuro-hormone levels, and decreased anxiety in patients with heart failure.
Setting: A cardiac care unit and a cardiac observation unit.
Participants: “76 patients with a diagnosis of admitted to the cardiac care unit or cardiac observation unit” (Cole, Gawlinski, Steers & Kolterman, 2007, p. 577) Certain criteria for participation were required.

10. Methods and Data Collection Procedures
Methods: A group of heart failure patients was randomly placed in 3 groups. One group received a visit from a volunteer with a dog for 12 minutes, another group received a visit from a volunteer for 12 minutes and a control group received the usual care. Data was collected three times; a baseline was established, then at 8 and 16 minutes. Each group was evaluated 3 times.
Data collection procedures: Randomly selected patient were assigned to 3 groups. Patients in the experiment group were received a visit from a volunteer and dog. The dogs were not controlled for and included 1 extra large, 6 large, 5 medium and 2 small dogs. Patients in the volunteer only group received a visit from a volunteer-only. Patients in the control group were asked to lie quietly. For all groups data was collected immediately before the visit, 8 minutes after the intervention started and at 16 minutes, which was 4 minutes after the visit ended.
Limitations: This study had several limitations. The data collection occurred during a short time period of 12 minutes.
The patients in the volunteer-dog group that had higher baseline measurements might have had a more intense intervention than the other two groups.
There were no medication changes; however some of the neurohormones may have been influenced by IV drug administration during the visits.
Due to the short exposure of the patients to the AAT, it is not known if longer exposure would have impacted other hemodynamic changes.
The study was done at a single facility.

11. Results and Conclusions
Compared to the control group, the volunteer-dog group had significant decreases in systolic pulmonary artery pressure and pulmonary capillary wedge pressure during and after the visit.
Compared to the volunteer-only group, the volunteer-dog group had decreases in epinephrine levels and in norepinephrine levels during and after the visit.
After the visit, the volunteer-dog group had the greatest decrease in anxiety compared with the volunteer-only and the control groups.
Conclusions: In patients hospitalized with heart failure, AAT improved cardiopulmonary pressures, neuro-hormone and levels of anxiety.

12. Study: Pain Medicine Impact of Animal Assisted therapy for outpts with Fibromyalgia
Introduction: Fibromyalgia is an often disabling widespread chronic pain condition affecting about 2–3% of adults in the Americas and Europe, with no currently available curative treatment. (Marcus, Berstein, Constantin, Kunkel, Breurer & Hanlon, 2012
Setting: An outpatient pain clinic setting
Participants: 133 participants were part of this study. All participants were > than 18 yrs old and had a diagnosis of fibromyalgia.
Circumstances: The study wanted to look at the advantages of having a therapy dog present in a pain clinic waiting room.
Purpose: The idea was to determine if the therapy dog would have a positive impact on the patient’s levels of pain, stress, fatigue and anxiety levels.
This was an open label study.
An open label study is the opposite of a double blind study- the researcher and the participant in the study know the treatment the participant will be receiving)

13. Methods of Data Collection and Conclusions
Participants were divided into two groups. They were randomly selected to either be in a group that would sit in a clinic waiting room with a therapy dog present and the control group would sit in a waiting room without the therapy dog present. The participants of the dog therapy group were introduced to the dog handler and the therapy dog. Participant interaction with the therapy dog averaged 12 minutes.
All participants were asked to fill out a survey before and after their appointments. The surveys asked them to rate their levels of anxiety, pain, stress and fatigue.
Overall, pain severity was significantly reduced after a brief therapy dog visit, with clinically meaningful pain relief reported in 34% of fibromyalgia patients after the dog visit vs 4% in the waiting room control. (Marcus et al., 2012)

14. Study: Natural healers: a review of animal assisted therapy and activities as complementary treatment for chronic conditions A Literature Review
Introduction: The primary objective of this review is to synthesize the existing literature on the use of animal-assisted therapy and activity (AAT/A) as complementary treatment among people living with chronic disease and to discuss the possible application of this practice among children living with HIV.
Methods: Relevant databases were searched between March 10 and April 11, 2011, using the words: animal assisted therapy or treatment and chronic conditions or diseases. Thirty-one articles were found and 18 followed the inclusion and exclusion criteria.
definition of AAT for the purpose of this review was: any type of regular interaction with animals with the intention of creating positive behavioral, emotional or physical changes related to chronic disease.
Relevant databases: Science Direct, Medline, Pubmed, PsychInfo, Ebsco, Cinhal and SAGE
Inclusion criteria were established as original research articles, case studies, clinical trials, pilot studies or meta analyses, written in
English or Spanish, published in the past 10 years, since 2001, related to animal assisted therapy as previously
defined, among participants living with chronic disease, including mental illness.
Exclusion criteria included studies with samples, which considered elderly participants and geriatric diseases, in order to see the application of AAT in other fields.

15. Results
According to the results of this integrative review, three areas were identified
the first area was the social effects of AAT/A
---- Animal visitation was reported as both a good
distraction and normalizing experience of the
hospital environment for the children.
----AAT increased social interaction in an occupational therapy program for
children with autism spectrum disorders.
----Adults with various medical conditions have also been reported to benefit
from working with therapy animals socially, emotionally and
psychologically.
the second area was the physical effects of AAT/A
----several of the studies showed a decrease in anxiety during hospital
stays in children and provided pain relief described to be comparable
to the child taking acetaminophen.
Studies showed that among adult cancer patients AAT helped relieve anxiety and were a good distraction. a qualitative study examined use of AAT among cancer patients, which revealed that participants living with cancer often preferred AAT to interaction with human visitors.

16. Results and Conclusions
The third area was the perspective of caregivers.
----Staff was open to having AAT in place but were originally concerned
with safety and infection risk.
---- After implementation, staff reported feeling more open to the
program and that the animals created a friendlier atmosphere.
Conclusions:
* the potential benefits of implementing more AAA/T programs in
medical centers and hospitals are numerous.
* more research must be done to determine the function AAA/T may
have in complementary therapy for chronic conditions in children and
adults.
The opinions of health professionals and administrative staff regarding the incorporation of an AAT program in their hospital’s pediatric ward were studied both before and after the program’s implementation. Staff stated being more open to the program after implementation than they were I the planning phases. There was much discussion and many concerns about safety and infection control.
Limitations *The studies included used therapy dogs and no other kinds of animals. There have not been many large clinical trials--- Much of the information about people living with chronic diseases is gathered from people who own pets. More research needs to be done with participants that do not own pets and participate in AAT to see if the same results are achieved.

17. Conclusions and Implications for Practice
Young and Koopsen(2011) along with the authors of the articles we reviewed listed many benefits of AAT. Among those are stress reduction, alleviating loneliness, reducing anxiety, instilling a sense of responsibility, reduction of depression and ongoing comfort. There were physiologic benefits as well, such as lowering heart rate and blood pressure. As nurses providing holistic care to individuals, we have come to understand through this project the importance animals can add to traditional therapies.
Conclusions and Implications for Practice
There are many potential benefits for the use of Animal Assisted Therapy and Activities.
More research and clinical trials need to be conducted to prove these benefits occur.

18. References
Cole, K. M., Gawlinski, A., Steers, N., & Kolterman, J. (2007, November). Animal-assisted therapy in patients hospitalized with heart failure. Am J Crit Care, 16(6), Marcus, D.A., Bernsteirn, C.D., Constantine, J.M., Kurkel, F.A. (2012). Impact of Animal Assisted Therapy for Outpatients with Fibromyalgia. Pain Medicine. Wiley Periodicals, Inc. Retrieved from x/full Nahm, N., Lubin, J., Lubin, J., Bankwitz, B. K., Castelaz, M., Chen, X., Shackson, J. C., Aggarwal, M. N., Totten, V. Y., (2010). Therapy dogs in the emergency department. Western Journal of Emergency Medicine. 13(4),

19. References
Parshall, D. (2003). Research and reflection: animal-assisted therapy in mental health settings. Counseling And Values, 48(1), Reed,R., Ferrer, L., Villegas, N., (2012). Natural healers: a review of animal assisted therapy and activities as complementary treatment for chronic conditions. Rev. Latino-Am. Enfermagem May.-June;20(3): Young, C., Koopsen, C., (2011) Spirituality, Health, and Healing An Integrative Approach. (2nd Edition) Sudbury: MA . Jones and Bartlett Publishers