CHAPTER TEN
CANINE PARTNERS IN HEALTH CARE
Leslie Himot, Tanya Gordon, Rhonda L. Harrison, and Mary de Chesnay
PURPOSE
The purpose of the following case studies is to explain the process of employing animals in therapy and to document the health and mental health benefits of animal-assisted therapy (AAT). Two animals and their handlers were participants as well as an orthopedic surgeon who brings his dog comfort patients in his waiting room. With a lack of literature describing the use of therapy dogs in rehabilitation facilities and physician’s offices, these qualitative data lend insight into how beneficial AAT can be and what it means to nursing. The results may relate to outpatient settings and clinics where advanced practice nurses or clinic nurses may use animals as a part of therapy.
LITERATURE REVIEW
AAT or “pet therapy” has had an increased presence in literature with a surge in recent research methodologies exploring this complementary alternative medicine (CAM) intervention; however, the use of therapy dogs with patients undergoing rehabilitation and in other therapeutic milieu’s (physician offices) is mostly anecdotal and lacking in rigorous research. 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 (O’Haire, 2010). According to Horowitz (2010), AAT has a vast array of benefits for patients including relaxation, reduction in pain, improved hemodynamic measures, reduced anxiety and agitation, and reported improvement of overall quality of life by patients. Studies carried out in nursing care facilities have shown a decrease in loneliness (Banks & Banks, 2002; Chu et al., 2009). Therapy dogs have been shown to reduce anxiety scores in patients waiting for appointments (Kelly et al., 2011; Ruchman, Ruchman, Jaeger, Durand, & Kelly, 2011). Other literature reports that AAT enhances socialization and has been used with child victims of sexual abuse, and used to enhance the general well-being in adults with mental health diagnoses, such as dementia and with the elderly (Himot & deChesnay, 2016; Wilson & Netting, 1983).
Facility dogs are trained to work with a handler in health care and educational settings (Facility Dogs, 2015). These dogs may simply provide comfort measures for patients or may actively participate in physical therapy sessions. Therapy dogs often participate in therapy sessions or perform episodic visits, and many of their handlers are either therapists or volunteers. Nurses as therapy dog handlers is an under-researched role within current literature as is the use of animals in other therapeutic milieus. With the use of facility therapy dogs becoming more abundant, the experience of a facility dog and his nurse-handler at a rehabilitation facility is worthy of exploration.
The perspective of studying AAT from the point of view of owners who use their dogs in their own practice was inspired by one of the author’s (de Chesnay) experiences as a psychotherapist treating child sexual abuse during the 1970s (Himot & de Chesnay, 2016).
The mother of a young child requested my help because she was sure her estranged husband had molested their daughter during one of his custody weekends. In working with the child to elicit her story of what the father had done to her, nothing worked to get her to talk. I decided to terminate therapy and to take my Airedale with me to the last session because the child told me she wanted to be a veterinarian and loved animals. We went for a walk and I asked her to tell the dog what happened. To her mother’s and my amazement, she did! And, indeed, the father had molested her.
Although the aforementioned story was not part of the case study, it documents a long tradition of an alternative therapy.
METHODOLOGY
Design
The design is case study. Case study research is generally considered a qualitative design but may involve mixed methods, either qualitative or quantitative. In this study, qualitative methods were used. A semi-structured interview guide was combined with participant observation to document how AAT works. Interviews and observation sessions were conducted at the nurse’s, physician’s, and dog’s workplace to observe the team on duty.
Sample
A purposive sample of one nurse-handler and her facility dog was chosen for this case study. In addition, an orthopedic surgeon and his dog were also chosen by a separate investigator. Pseudonyms are used for the nurse, the physician, and the dogs. Grace, the nurse-handler, is employed at a rehabilitation facility. Travis, the dog, has been in her care for more than 3 years, and has served as a certified facility dog for more than 3 years. This team has worked together since he was obtained from an organization that trains and places therapy and service dogs. The expertise achieved by this team is adequate to provide detailed information regarding facility dogs and other stated areas of interest. The orthopedic surgeon has been in practice for more than 15 years and has taken his dog, Chips, to work with him for 4 of those years. Written informed consent was obtained, and the Kennesaw State University Institutional Review Board provided approval for this case study.
Settings
The interviews occurred in both a rehabilitation facility while the team was on duty and in the physician’s office while the canine was present. See the interview guide in Table 10.1. The interview for the rehabilitation facility was conducted in a private area away from patients by request and for the comfort of the participants. The rehabilitation facility is a large spinal cord injury and traumatic brain injury hospital located in the southeastern United States. The interview was also conducted in a private environment to facilitate the observation of the dog’s behavior while in an off-duty stance. The physician’s office is located in a suburb of Atlanta, Georgia, and sees approximately 18 patients per day as orthopedic follow-up.
Table 10.1 Semi-Structured Interview Guide
1. Tell me about how you came to do this work. |
2. How did you acquire this animal? |
3. Tell me about the animals training and how you work with the animal with a patient. |
4. Tell me a story about the animal interacting with a patient. |
5. What kinds of patients would not work well with this animal? |
6. What challenges have you faced in doing this work? |
7. What else would you like me to know about your work? |
Instruments and Data Analysis
Semi-structured interviews and participant observation comprise the methods used for the study. In case study research, content analysis was used to develop a typology of key concepts, which are then analyzed for themes. The primary tool is a semi-structured interview guide consisting of a short set of questions designed to elicit stories about what they do in practice. The secondary tool is a period or periods of participant observation; that is, seeing the animal in action.
Both investigators participated in the interview and observation processes. Time was maximized by preparing known inquiries before our interview. The researchers are nursing professionals; one is employed at the same facility as the nurse-handler, enabling the investigators to connect with the participant on a professional level, establishing a rapport that allowed for information to flow freely without hindrance because of a lack of trust between the interviewee and interviewers. The interviewer for the physician’s office canine is a certified nurse educator and senior lecturer at a metropolitan Atlanta University.
RESULTS
Structure—Physician’s Office
Dr. Jennings, a practicing orthopedic surgeon in Marietta, Georgia, takes his dog, Chips, to work every Wednesday. What began as a way to get his Labrador retriever out of the house one day a week, changed the way this physician looked at AAT in his own practice. The physician noticed that his patients and families were less anxious when his dog, Chips, was present in the waiting room and in the exam room.
The investigator was interested in qualitative data with participant observation to document how AAT was used in a physician’s office. Through a period of two separate Wednesdays, the investigator, observed the canine in action.
Dr. Jennings did not start out thinking his dog, Chips, would be any more than a companion to his office staff during the day. His desire was to get his dog out of the house, which generally consisted of long hours alone. What transpired was a different way of building a sense of rapport with his patients. Dr. Jennings now feels Chips has become an “extension” in his ability to make patients feel at ease and serve as a distraction to those who often come in with a great deal of pain from orthopedic fractures and other disabling conditions.
One patient in his late seventies, who was accompanied by his son, was obviously in a great deal of pain following an open reduction, internal fixation of the right forearm, which had been fractured in a fall 1 week previously with the resultant surgery. The patient was in the office for his first follow-up visit. The son did all the talking for his father, stating that he was “withdrawn and not his usual self” acknowledging that the surgery had taken a lot out of him. As Dr. Jennings was explaining the role of anesthesia in the elderly and its effects in delayed clearing of the sensorium, Chips made his appearance in the cubicle where the elderly man had not said one word. At that moment, the patient spoke and asked, “What kind of dog is that?” Dr. Jennings stated later that at this moment he realized he should be engaging the patient rather than the son in conversation. Chips was a transitional object facilitating the relationship between the physician and his elderly patient.
The physician also noted a change in his staff’s mood on Wednesdays when Chips came to work.
Staff morale was improved when Chips was around. The staff would perform their routine tasks but often with a greater positive behaviors such as smiling and giving physical contact to the dog. Staff often strived to be the one to take Chips for a walk.
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