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Hospitals can be distressing environments for children undergoing surgery or medical treatment. So, researchers are exploring interventions that could bring comfort to reduce stress and aid a child’s recovery. One such innovative example is Animal Assisted Intervention (AAI), where animals are included in care services to help people physically and mentally.

Although it has become a relatively common intervention in healthcare, its effectiveness and long-term impact are not yet fully understood. To examine the evidence base, a team of researchers from University College Dublin (UCD) are exploring how the human-animal bond impacts children’s wellbeing in a children’s hospital. The Principal Investigator of this PhD study is Rachel Howe, an Assistant Professor in Children’s Nursing, UCD, a qualified children’s and general nurse with over 25 years of clinical experience, as well as a nurse tutor.

In this blog post, Rachel tell us more about AAI, the potential benefits of therapy animals for children and parents, and discusses the UCD group’s Study Protocol to determine where and why animal interventions take place.

Hospitalisation can cause stress and upset to a child. I have seen how challenging it is, not only for the child, but for parents and family members too. Children and parents often think of their pet as a family member and naturally miss them when they are in hospital but perhaps more importantly, they miss the comfort and routine they would normally have with their pet at home.

Innovative therapies, such as pet therapy, may ease anxiety and distract a child from pain and promote better coping mechanisms for the child. As a pet owner myself, I find great comfort from a close bond with them, which is why I became interested in researching this topic within the context of paediatrics and the children’s hospital setting.

An unconventional therapy

While we all are familiar with companion animals as pets, we are not so familiar with AAIs which are goal oriented and structured interventions used within formalised healthcare settings (IAHAIO, 2018). My research will focus on AAIs specifically which is important to point out as there are differences in other terms and therapies that are referred to interchangeably within the scientific literature. 

International studies have demonstrated that AAIs can decrease stress and improve children and parents’ morale in an inpatient cardiac children’s hospital (Niedra, Pendergast & McCrindle, 2002). Another study by Sobo, Eng & Kassity-Krich (2006) showed significant decreases in both physical and emotional pain in post-operative paediatric surgical patients following visits by a pet therapy dog. Alleviating a child’s anxiety or pain through non-pharmacological interventions, such as AAI, should be considered as many medicines can cause unwanted side effects.

We care about the health and wellbeing of the animal involved, which is why I am collaborating with Dr Sandra Nicholson a veterinarian and lecturer in the Veterinary School in UCD. We will be careful to observe the animal’s behaviour and consider the welfare of the animal in whatever animal intervention is implemented. 

Building new foundations

There is a new children’s hospital being built in Ireland at the moment. This impacted my decision to ensure that innovative therapies such as AAIs are based on evidence and of benefit to children and their families. 

The new hospital site promises a green space located centrally where children can go outdoors with their parents and siblings to enjoy normal family time. I envisage this space may include small animals or facilitate an animal programme on a larger scale for all patients eligible to participate.

Reducing stress and delighting children

Research has shown that complementary therapies such as AAI can improve a child’s morale while in hospital as they look forward to the visit and enjoy petting or brushing an animal such as a dog or horse. These simple and often normal interactions lower the child’s physiological stress response which means they are relaxed. Some animals would have clear therapeutic functions such as rehabilitation after surgery and would promote movement. 

Healthcare professionals have reported improvement in the child’s mood and behaviour after the visit which also creates an improved hospital environment for staff exposed to the intervention. More research is required to demonstrate any links to improved mood and coping of children discharged home. There have been reports of children being more open to contact with dogs and other animals as a result of their positive exposure to them in the hospital.

Mapping the evidence

The scoping review will enable a deep exploration of the scientific literature on how AAI might contribute to the child’s wellbeing during and after hospitalisation. This will help to focus the research on a more specific area within paediatrics such as elective orthopaedics. We will map where and how previous research was undertaken and help to determine which area of paediatrics would benefit most from implementation of the initiative.

Giving children a voice to be co-designers and contributors

It is important to involve children as the service user in any changes or new initiatives as they may think and see things differently from adults or healthcare professionals. The next phase of my research will involve participatory research with children and young people who have experienced hospitalisation. This means that the children will co-design an animal assisted intervention and contribute to the implementation phase of the research. They will know if a dog accompanying a child to the operating theatre will be of benefit over a dog visiting the child post-operatively on the ward for example. 

Choosing openness to share and develop research

I was delighted to have my manuscript published on HRB Open Research as it is freely available to members of the public as well as those in academia.  My research hopes to involve the charities of Peata, Irish Therapy Dogs and Cian’s Kennels, as well as children and young people from the representative bodies such as the Youth Advisory Council (YAC) and the Ombudsman for Children’s Office. Therefore, it was important to me to have my research available in the public domain. 

I have had a very positive experience of submitting my Study Protocol for open peer review on HRB Open Research. I was genuinely surprised with the speed of acceptance and support from the editorial board. It did take a while to obtain my two reviews, but it was worthwhile as the constructive feedback helped improve my protocol. This critique from colleagues at the planning stage was beneficial for guiding my research and completing my study. I would encourage other researchers to submit to HRB Open Research.

Read the Study Protocol and the review reports via HRB Open Research, ‘Animal assisted interventions in the children’s hospital: protocol for a scoping review’ >>