When patients are ill or injured, the associated stress can lead to anxiety, depression, and decreased satisfaction with the care they receive. Pet therapy—the use of trained animals to benefit patients and improve outcomes—is a way to effectively address patients' stress while in healthcare settings. Pets have been documented since as early as 3000 BCE, with a long history of benefitting the humans interacting with them in a variety of different ways. A quick internet search yields myriad articles on the benefits of pets, such as decreased BP, stress, and anxiety. This article discusses pet therapy, including its history, benefits, related concerns, and implementation of pet therapy programs.
What's pet therapy?
Pet therapy can be used in a variety of settings from pediatrics to geriatrics. Therapy animals visit patients in hospitals, long-term-care settings, hospice centers, and schools. Animals that may be used in pet therapy programs include cats, dogs, birds, guinea pigs, fish, rabbits, horses, and dolphins. Although these animals are the most frequently used in pet therapy, there are many other animals that can be used in a therapeutic way.
Of the animals listed, many can be brought to healthcare facilities, whereas others, such as horses and dolphins, require an outpatient appointment. Patients can enter these programs on their own or with a referral from a healthcare provider. In some instances, patients need to pay for these programs out of pocket but often donations and grants offer financial support, making it possible for individuals to benefit without a huge financial burden. When discussing outpatient pet therapy with patients, make sure to educate them about finding reputable programs.
With pet therapy, the human-animal bond is essential. Components of pet therapy include the animal, handler/owner, and the patient. Pet therapy can be used in a variety of ways, from meet-and-greet sessions to physical therapy, occupational therapy, and distraction. The types of pet therapy include visitation, animal-assisted therapy (AAT), and facility therapy.
With visitation therapy, pets are bought into a healthcare facility by their owner and interact with patients in different ways. For example, an interaction with a dog or cat may include petting, holding (when appropriate), or talking to the animal. Dogs can also be used to assist with and encourage walking in some patients. As part of the interdisciplinary team, the animal's handler works to find interactions that are beneficial for the patient. It's important for the patient to interact with the animal in a meaningful way. Research studies have shown that pet visitation programs in healthcare settings have been linked to improved patient satisfaction and outcomes.
AAT is therapy provided by specially trained animals, including activities such as walking, range-of-motion exercises, and distraction. This type of therapy is completed with nurses, physiotherapists, occupational therapists, and other healthcare professionals. The use of horses and dolphins could fall under this category. Often, dolphin therapy involves swimming with the dolphins and horse therapy involves riding the horses, which can be beneficial to the patient both physically and mentally.
Facility therapy involves the use of animals that live in a facility with the patients/residents. In some instances, the animals' handler will utilize them for targeted therapy. In other instances, the animals will live in the facility as a pet. When animals are integrated into the environment as pets, they aren't necessarily used for targeted therapy. For example, some residential care facilities have cats that move around the facility as they wish and interact with residents and staff randomly. These interactions can be comforting for patients and staff.
Although not called pet therapy until the 1960s, animals have been used to help humans heal for centuries. In fact, in the 1700s, dogs were used for patients with psychiatric disorders. The documented use of therapy pets began in the US in 1919, starting with psychiatric patients.
In 1962, child psychiatrist Dr. Boris Levinson began documenting his use of pet therapy, which led to it being considered as a legitimate type of therapy. Dr. Levinson used dogs in his treatment of children and found that they helped improve communication and build rapport with his patients. In the 1970s, Dr. Levinson's work was expanded to include adolescents and adults. Animals were first used in the care of patients in the hospital setting in the 1970s, and in 1975 this type of therapy moved to long-term-care settings.
It wasn't until the 1980s that the nursing literature began to focus on pet therapy. The 1990s brought a renewed interest in research on pet therapy and this trend has continued.
Over the course of history, pet therapy has been shown to decrease stress and BP, as well as a variety of other factors associated with patient satisfaction and health. It's interesting to note that in her book, Notes on Nursing, Florence Nightingale refers to the therapeutic use of animals in nursing.
Pet therapy has been shown to have multiple benefits for patients in healthcare settings. It can effectively help patients cope with an injury or illness. In some patients, pet therapy can decrease:
- stress levels
Pet therapy has also been shown to improve patient satisfaction, energy levels, self-esteem, and mood, as well as decrease depression. Additional benefits include increased motor skills and movement, improved social skills and verbal communication, decreased boredom, and a more positive outlook. Pet therapy can promote social interaction and encourage exercise and playfulness. It may also have a beneficial effect on physiologic processes, such as reducing cardiovascular disease and stroke risk. Research has shown that children who interacted with animals in the healthcare environment were able to participate in procedures such as an MRI without the need for anesthesia. The reduction of medications such as anesthesia can have a beneficial effect on patients.
Pet therapy can also be beneficial for family members and other visitors. Family members and visitors, like patients, are under a significant amount of stress. The implementation of pet therapy programs may help address their stress in addition to the patient's stress. Not only does pet therapy positively affect patients and their visitors, it's also been shown to decrease stress levels for staff members who interact with the animals, including nurses.
The effect of pet therapy on healthcare workers should be considered when implementing these programs in healthcare settings. Although research has been conducted on the effects of pet therapy on family members, visitors, and healthcare workers, more research needs to be conducted (see From the animal's viewpoint).
The national, standardized, and publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patient perceptions of hospital care. This tool is beneficial because it allows for comparisons of hospitals based on topics that are important to patients, encourages hospitals to improve, and holds hospitals accountable. It also provides financial incentives for hospitals. Patients are randomly selected to answer HCAHPS survey questions after they've been discharged from the healthcare setting.
Research studies have shown increased patient satisfaction scores after the implementation of pet therapy, and patients who received pet visits reported being more satisfied with their healthcare providers. With this in mind, it isn't unreasonable to assume that pet visits may positively impact HCAHPS scores. Nurses wishing to implement pet therapy programs in hospitals can use the HCAHPS survey as a selling point when discussing the implementation with administrators and managers, as well as other stakeholders.
Individuals within healthcare settings may have concerns about pet therapy, such as infection control issues, noise, fear of animals, and disruption to the daily workflow. An additional concern may be allergic reactions to the animals. Although these are valid concerns, research studies have shown that pet therapy doesn't correlate with increased incidents of infection or disease development when implemented properly. When trained appropriately, animals brought into the healthcare setting don't increase the noise level. Animals that behave inappropriately in the healthcare setting, such as dogs who bark, shouldn't be brought into these settings.
Infection prevention tips include the use of sanitizing handwipes before and after pet visits. Additionally, asking pet handlers to avoid placing pets on patient beds decreases the risk of infection and injury. To identify patients with fears of the animals being brought into the healthcare setting or those with allergies, proper screening should be in place. Patients identified as being fearful of animals should be removed from the pet therapy visit list. If a patient is identified as having an allergy to an animal, it's essential to determine the severity of the allergy and any expected signs and symptoms. If a patient is identified as having a severe allergy, it may not be appropriate to initiate pet therapy on the same unit or in the same facility as him or her.
Implementing a pet therapy program
When implementing a pet therapy program in a healthcare setting, it's important to ensure that policies and guidelines are carefully written, in place, and followed. Policies and guidelines should include vaccination and training requirements, in addition to screening for inappropriate patients such as those with allergic reactions to animals. Any animal entering a healthcare setting should receive the appropriate training and be tested for temperament and obedience. It should be clear that pet therapy includes appropriate animal handlers because they play a role in improved patient outcomes. In fact, the interaction that handlers have with patients may be just as therapeutic as the pet visits.
To ensure strict adherence to policies and guidelines, staff members will need to be properly educated about the pet therapy program. Failure to educate staff could result in misunderstandings and adverse outcomes.
Looking ahead, more research on the benefits and potential uses of pet therapy in healthcare settings is needed. With this being said, the research that's been conducted is positive. Nurses wishing to implement pet therapy in their facilities should seek out these research studies and present them to administrators, managers, and stakeholders within their organization. If pet therapy is something that you're interested in, do the research and don't be afraid to ask. Take that first step and pioneer a pet therapy program at your facility.
From the animal's viewpoint
At this time, there's been little research on the effect of pet therapy from the animal's viewpoint. With that being said, research has been conducted that shows some benefits for the animals. In some instances, shelter animals may be used for pet therapy. For example, military veterans have worked with shelter animals on obedience training, which has been beneficial for both the animals and the individuals working with them. After participating in a pet therapy program, these animals may be more easily adopted. It's important to understand that working with shelter animals may carry increased risk because they aren't trained therapy pets. Any implementation of these types of programs should be done carefully and with the appropriate patients in mind.
You're working with Mrs. M, an 80-year-old woman in a rehabilitation center. Mrs. M was admitted after she fell, broke her hip, and had a subsequent surgery. Since arriving at the rehabilitation center, Mrs. M has shown a decline in her physical and emotional health. She cries frequently and is nonadherent with most care. The only time that she seems happy is when talking about her pet dog at home. How might pet therapy help Mrs. M improve her physical strength and emotional health?
did you know?
In her book, Notes on Nursing, Florence Nightingale refers to the use of animals in patient treatment. According to Nightingale, small pets made good companions for the sick. She believed that animals could be a source of pleasure for ill patients. Additionally, she believed that patients should be encouraged to care for animals when they were able.