Puppy Power
Patient care 'goes to the dogs,' as more hospitals and nurses discover benefits of animal-assisted activities and therapy

By Cathryn Domrose
November 11, 2002

The 12-year-old cancer patient had just been told that her leukemia had returned, and she was angry. She slammed the door on her parents, her nurses and her doctors, refusing to see or talk to any of them. She threw things across her hospital room and sobbed in frustration.

One of the girl's nurses at Loyola University Medical Center in Maywood, Ill., contacted Becky Jankowski, MS, RN, program coordinator for Pawsitive Therapy Troupe, the hospital's animal-assisted activity and therapy program. "Would you try?" the nurse asked. "Maybe she'll see the dog."

Jankowski arrived at the girl's room with her sheltie Rosie, a certified therapy dog. As Jankowski opened the door, Rosie peeked around the corner.

"Would you like to see Rosie today?" Jankowski asked. The girl, her face puffy and tear-streaked, said yes. Jankowski put Rosie on the girl's bed. The girl stroked the sheltie's soft fur. She talked to the dog and to Jankowski about what a difficult time she was having and how upset she was.

After about 20 minutes, Jankowski asked if the girl wanted to see her mother. She said she did, and eventually she was ready to face the doctors and nurses as well.

"It really made me feel like I had made a difference that day," said Jankowski, who owns two therapy dogs she uses in her work at Loyola and nearby Edward Hines Jr. VA Hospital. "Patients will tell the dog things they won't tell people. They will hug her and rock her and tears will stream down their faces. She touches people in ways that humans can't."

In the last decade, a growing number of hospitals have been using animals, especially dogs, to calm, reassure, motivate and help rehabilitate patients.

At Northern California Shriners Hospital, dogs, cats and even potbellied pigs stroll the halls and help distract nervous kids in clinic waiting rooms and hospital rooms. Nurse researchers in Texas have shown how dogs calm agitated Alzheimer's patients when staff members at long-term care facilities cannot.

Amazing response

Nurses who work with animal therapy programs, whether as researchers, program coordinators, handlers or frontline caregivers with patients who might benefit from an animal visit or therapy, say the response from patients and staff is amazing.

"It's a wonderful thing for us as nurses," said Norine Hemphill, RN, a clinical director in neurosurgery, orthopedics and neurotrauma rehabilitation at The Children's Hospital in Denver. Her hospital's program, Prescription Pets, was launched 17 years ago, one of the first in the country. Dogs of all shapes and sizes roam the halls with their handlers, carrying "business cards" so young patients can remember their names.

"They're chilled-out dogs," Hemphill said. "They just sit there and let these kids pet them. We love to see what it does for the kids. When a kid is hurting, it's a distraction. It helps them forget" why they're in the hospital.

Studies have shown that petting animals can reduce blood pressure and lower stress levels in some patients. One study has shown improved recovery rates for cardiac patients who have pets at home. Depressive, psychotic and demented patients have shown considerably less anxiety when dogs are present at therapy sessions.

Program coordinators, handlers and researchers distinguish between animal-assisted activities-visits to entertain or distract patients or residents in a health care facility-and animal-assisted therapy, in which a health care professional uses an animal to achieve a specific goal, like getting a patient to walk, throw a ball, talk to a therapist or socialize with other people.

An important part of successful physical therapy is motivation, researchers and therapists say. Jankowski said she has seen patients who wouldn't take a step for a therapist walk down the hall in a walker with a dog.

"If it were me, I'd rather go home and pet my dog than work on a biofeedback machine," said Mara Baun, DMSc, FAAN, assistant professor of nursing at the University of Texas-Houston Health Science Center. Baun has authored a number of studies on the benefits of animal visits and therapies.

Some of her studies looked at children who received a routine examination by a nurse practitioner. Those who had the examination with a dog next to them at the examining table showed considerably fewer signs of stress.

In other work, Baun has focused on nursing homes, perhaps the most popular places for animal visits because rules about infection and disease control are not as stringent as in hospitals. Baun found that Alzheimer's patients were more socially interactive and less agitated with a dog present.

But Baun said she does not know if the mental benefits would continue once residents became accustomed to having the animals around. "Certainly in the short term, the effects are positive," Baun said, "but we really need to know what the long-term effects are."

Therapeutic connection

Mental health practitioners also have used animal therapy successfully. Linda Porter, MSN, MA, RN, assistant professor in the department of chronic care nursing at the University of Texas Health Science Center at San Antonio, teaches classes in animal-assisted therapy at the school of nursing and uses animals in her work as a private practice psychotherapist.

Clients lie on the floor and hug her golden retrievers or walk in the park with her and the dogs, then sit on a log and talk. Porter also brings adolescent girls who have been in violent situations to her ranch to work with trained horses.

The girls learn that "if they can control a horse, they can control their situation," Porter said.

Whether in a hospital or in a therapist's office, animals often help ease tensions for people who are uncomfortable or unhappy, she said. "There's less anxiety in the room when there's an animal there. There is more connection with the people."

This connection led cardiac nurse Kathie Cole, MN, RN, to start the People-Animal Connection program at UCLA Medical Center in 1994. Cole, a dog owner, thought that dogs might help cheer up heart-transplant patients while they waited for >> donor organs. She has expanded from 12 cardiac dogs to 50 volunteer dog-and-handler teams who visit 37 units in the hospital.

Volunteer teams must go through a training program based on one created by the Delta Society, a Seattle-area-based nonprofit organization that screens dogs for personality, obedience and hospital training.

By the end of the training, dogs must be able to endure everything from yanks on their ears and tails to people screaming and moaning to wheelchairs whirling down corridors. Handlers learn hospital protocol, how to place dogs on beds, how to encourage them to interact with patients and how to look for signs of stress that show the animal has had enough.

In hospitals with animal visitation programs-about 10 percent of all hospitals in the country, according to the Delta Society-patients who are allergic to dogs, afraid of dogs or just plain don't like dogs have this information posted in their charts. Because hospital rules are so complicated, a successful animal-assisted therapy program must be carefully designed, those who run the programs say.

"I think that having a nursing background is a wonderful thing for an animal-assisted therapy program," Jankowski said. "If you're going to bring dogs into a hospital, you have to be darn sure you know what you're doing."

A nod from nurses

Nurses who run animal-assisted therapy programs say volunteers follow special protocols for bathing and grooming the animals before they come to the hospital. Handlers brush their dogs' teeth and clip their nails. Although many hospitals have balked at animal visits, voicing concerns about infection and sanitation, hospitals with the programs say they have had no incidents of patients being infected or bitten by an animal.

"The principles of infection control are the same" as for humans, said Paul Maxwell, MA, RN, manager of infection control and employee health at Shriners Hospital in Sacramento. "It's just commonsense stuff."

Whenever Maxwell brings in his own certified therapy dog, a yellow Lab named Bubba, he gets calls to visit not just patients but staff as well. Managers of animal-assisted therapy programs say they tell their volunteers to allow at least an hour extra for time to spend with hospital workers.

"Pet therapy is a real boost for employee health," Maxwell said, particularly a hospital staff that deals with high levels of stress. "I think there's a whole human-animal bond that you see under stressful times."

Cole would like to see more nurse involvement in animal-assisted therapy. "Nurses have so many things to do, it doesn't matter whether they include animal-assisted therapy into their care. Other than that, most nurses are so compassionate, they see a need for it."

She expects more nurses will become involved as evidence showing the benefits of animal-assisted therapy increases. Some nurses are already discovering new ways to use animals.

At The Children's Hospital in Denver, oncology nurse Anne Ingalls has started a program with the Veterinary Referral Clinic of Colorado that matches dogs and children who are both cancer survivors. The dogs in Jankowski's program put on a full-costume performance of the Nutcracker ballet for patients at Loyola and Hines.

"The nurses really appreciate the service the dogs provide and they really become a part of the team," Hemphill said. "They're a part of the care we deliver. A fun part of the care, not a bad part of the care."

Contact Cathryn Domrose at kaguilar@well.com