Canine Motivation in Pediatric CVICU Patients

Monday, 17 September 2018

Madeline Claire Tucker, SN
School of Nursing, University of Central Arkansas, Conway, AR, USA

This potentially life-saving therapy stemmed from the desire to find a way to decrease the mortality rate of children with chronic cardiac conditions. According to Almond et al the mortality rate for children under the age of 18 out of a group of 3098 with chronic cardiac conditions included; 17% dying before ever receiving transplantation, 63% receiving transplants, 8% recovering, and 12% remaining listed. There are many surgeries and corrections to defects that can be made, however alternative therapies are becoming more and more popular in the healthcare setting as a means of supplementing medical procedures.

This study explores the use of animal-assisted therapy as an additional form of therapy for pediatric cardiac patients. The study begins with specific criteria selecting the patients; they must be between the ages of six and nineteen, diagnosed with a chronic cardiac condition and in need of heart transplantation in the Arkansas Children’s Hospital CVICU. Participants experience two different sessions, one with the canine and one without. The sessions are randomized for each individual, so the participant never knows which session will come first. Before the canine session the participant is encouraged to groom the canine and play games in order to form a bond. For both the canine session and the session without the canine, the team is responsible for measuring the blood pressure and respirations prior to beginning, the distance walked in 30 minutes, and the patient’s heart rate and pulse oximetry every 2 minutes throughout each walk. Each session begins once the patient crosses the threshold of their room. After each session, the team presents the participant with a quiz asking about the patient’s pain and anxiety levels throughout their walk via 1-10 scales, 1 being low anxiety and pain and 10 being the highest level of anxiety and pain. At the end of the canine session, the patient receives a picture of him/her with the canine and a certificate of participation that thanks them for their cooperation in the study.

To determine the effectiveness of therapy on the heart itself, we are looking at cardiopulmonary pressures, neuro-hormone levels, pain, and anxiety levels. The results of a study done at UCLA showed that each of the above levels were significantly lower than patients who were visited by a volunteer only or received usual care and rest (Cole et. Al 582-583). The hope is that the patients’ levels trend down with the canine, as apposed to their typical high vital sign measures without the canine.

We not only are looking at the physical aspects that improve with having the canine present, but the patient’s social and emotional wellbeing. A study from the Journal of Pediatric Nursing states that “35% of the children and 48% of the parents reported that the presence of the dogs helped normalize their hospitalization experience, and 61% of the children and 40% of parents thought that the pet visitations were a pleasant distraction from the reality of hospitalization” (Wu et al 33). After being in the hospital for years, many of these young patients lose the feeling of being a normal kid. Bringing a dog for the child to groom, play with and then walk allows for a sense of normalcy. Another study used for reference is one done at the Phoenix Children’s Hospital called “Petsmart Paws Can Heal Animal-Assisted Therapy”. This study indicated that there was a 96% increase in overall mood after participating in animal assisted therapy. The patients we are working with are awaiting life-saving heart transplant surgery. According to “Caring for children awaiting heart transplantation: psychosocial implications” from the textbook Pediatric Nursing by L.B. Hanton the patient and family may experience increased, “feelings of isolation, depression, boredom, hopelessness, helplessness, exhaustion, lack of privacy, financial burdens, role strain, and family disruption” (Hanton 215). They are agonizing through a wait period, so presenting both the patient and family with a healthy distraction that will potentially help their situation is a win-win for both emotional and physical well-being.

The team conducting this project consists of researchers, nurses, doctors, two students, and a Child Life Specialist. Many children’s hospitals are beginning to adopt the mindset that kids with chronic conditions who are stuck inside the hospital walls need more than just a playground on the hospital grounds to feel like a “normal” kid. There is now a push for individuals who are play specialists to aid the sick children. Play is how children grow, learn and develop. Years ago, play used to consist of hospital volunteers that would come in and play with children in playrooms. It has expanded even further into a discipline that involves connecting with the child on a psychological level to help them understand why they are hospitalized and what they will face. According to, Play for Sick Children: Play Specialists in Hospitals and Beyond by Catherine Hubbuck, “when supporting a child through a difficult medical procedure, the play specialist’s aim should therefore always be in the first instance to give adequate, accurate and clear information to the child, and then to follow this up with appropriate and effective emotional support, including distraction during the procedures” (Hubbuck 160). The Child Life Specialists at Arkansas Children’s Hospital are well trained and very helpful when it comes to daily life for the kids. The team of Specialists immediately grew passionate about the idea of using canines to connect with the children. The project has continued to grow in its popularity with not only the medical professionals and Child Life Specialists, but also with the young patients themselves.