Discussion 250 words minimum and 3 references

Discussion#3 – All Complete (Answer all questions)

• Why and how did you determine the design?
• What are the independent, dependent, and/or other variables identified?
• Did the author’s discussion IRB approval for the study?
• How was the sample obtained for the study?
• What instruments were used to collect the data? Were the instruments valid and reliable methods to use in data collection?
• How was the data analyzed?  Statistical tests used?

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

By Morgan Yordy, DNP, RN-BC, ACNS-BC;
Amy Brandon, MSN, RN, CCRN-K, ACNS-BC, NEA-BC;
and Lisa Harmon, BSN, RN, NE-BC, PCCN

Animal-assisted
therapy:

A
nimal-assisted therapy (AAT) has the
potential to benefit employees, as well as
patients, in the healthcare environment;

however, there can be misconceptions about AAT
that may create barriers to implementing this
strategy. Negative stereotypes include perceptions
that animals in the healthcare environment cause
disruptions, such as barking, biting, or infection
risk. This may lead to a mismatch between beliefs
about the effectiveness of AAT and using it to
provide support for the healthcare teams who
work in high-stress environments. The primary
purpose of this study was to gauge the care team’s
perceptions of AAT in the inpatient and outpatient
healthcare setting before and after exposure to AAT
experiences to provide nurse leaders with evidence
to support AAT as a coping strategy to address
staff stress and burnout.

National
Therapy
Animal
Day

Promoting a
healthy work
environment

www.nursingmanagement.com Nursing Management • April 2020 25

April 30

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Animal-assisted therapy

26 April 2020 • Nursing Management www.nursingmanagement.com

Background and significance
Stress is a commonly cited fac-
tor associated with job reten-
tion, with many nurses willing
to leave the profession due to
workplace stress.1-3 In addition,
nurses may have an increased
risk of obesity, anxiety, and
depression and may even
exhibit symptoms of posttrau-
matic stress disorder.4-7 This
heightened level of stress links
nurses to declining health,
dependence on medications
and caffeine, and injuries
related to overexertion and
burnout.8-10 Nursing is a high-
stress profession that may lead
to negative psychological

effects. Nurse managers and
administration need to focus on
affordable and attainable meth-
ods to decrease workplace
stress to retain a resilient work-
force.

Animal-assisted intervention
(AAI) is a broad term used to
describe the goal-oriented use
of animals in settings such as
health, education, and therapy.
AAT is a type of AAI in which
health service professionals use
licensed animals to assist indi-
viduals to reach their specific
goals.11 Current evidence has
demonstrated the positive effects
of AAT for patients and health-
care personnel in a multitude of
settings, such as clinics, hospital
units, schools, and behavioral
health programs.

Healthy work environment
tactics using pets can minimize
absenteeism, decrease staff
turnover, and promote moral
resilience.12 This can lead to
improved care delivery, fewer
medical errors, and increased
patient satisfaction scores.6 One
qualitative study noted that more
relaxation and happiness was
experienced by hospital staff
when interacting with dogs on
the unit.13 In another study, staff
members reported higher job sat-
isfaction and enrichment when
dogs were present. Dogs allowed
a break in the daily serious and
stressful events occurring on the
unit.14

Specific characteristics, such
as gender and pet ownership,
impact attitudes toward AAI.
More positive perceptions of
AAI were seen in women and
pet owners.15,16 Even if a dog isn’t
owned by the person, individu-
als who are pet owners are more
favorable toward programs with
animals incorporated into the
therapy.17

Methods
Design. Research provides
evidence on the effect of ani-
mal interactions with patients,
yet there are limited studies
relating to the benefits of ani-
mals used in other ways in
a hospital or clinic setting.13
Medical staff members have
indicated positive effects on

individuals/patients (physical
and psychological) in various
organizations and mentioned
staff involvement, but only as
a participant facilitating the
intervention with patients.13
Research has also focused
on concerns about AAI and
accepting the animal assistance
program, but little is available
regarding staff perceptions
and feelings of comfort gained
from working with animals
on the nursing unit.14 We
hypothesized that clinical
staff members would be more
accepting and receptive to
therapy dogs on the unit after
exposure to an AAT experience.

The research pilot study con-
sisted of cross-sectional surveys
of staff members either working
on a cardiovascular step-down
unit (CVSU) in an inpatient
hospital setting or at a medical
clinic located on a university
campus in the Southeastern US
to include a representation of the
organization’s workforce. Insti-
tutional Review Board approval
was granted by both the univer-
sity and the medical center (the
medical center owns both the
hospital and medical clinic where
the intervention took place).
Institutional Animal Care and
Use Committee approval was
also obtained from the university
for the research project. The first
survey took place 2 weeks before
program implementation. The

The results of this study reveal that
AAT can serve as a source of energy and positivity for staff members.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

www.nursingmanagement.com Nursing Management • April 2020 27

second survey was administered
at the conclusion of the 5-week
program intervention.

Survey instrument. A modi-
fied Brisbane AAT Acceptability
Test (BAATA Test) was used
to measure the perceptions
and attitudes of staff members
toward AAT on nursing units in
the hospital or clinic setting.18
The BAATA Test is a 21-item
Likert-scale survey. Staff mem-
bers who participated in the
survey chose a response to each
question based on agreement
or disagreement with the ques-
tion asked, with the score of 1
being strongly agree and 4 being
strongly disagree.18 Participants
in the first survey were asked
to mark items regarding their
expectations of the program;
in the second survey, partici-
pants responded based on their
experience with the program.
A confirmatory factor analysis
conducted by the BAATA Test
authors indicated high reliability
with factor one (alpha = 0.87)
and acceptable reliability with
factors 2 (alpha = 0.70) and 3
(alpha = 0.78).18

The principal investigator
and coinvestigators modified
the survey verbiage to be in line
with terms often used in the
Southeastern US. For example,
the term “ward” in the origi-
nal tool was changed to “unit/
clinic.” In addition, the BAATA
Test was used to evaluate staff
members and not children as
the original authors intended;
therefore, questions 6, 8, 9, 10,
and 17 were altered by replacing
the term “children” with “staff.”
Lastly, the term “illness” from the
original tool was replaced with
“stress” in question 8. The word-
ing change didn’t alter the intent

and purpose of the questions or
the scoring method.

Sample. All clinical staff
employed full time, part time, or
per diem by the CVSU (n = 29)
or medical clinic (n = 50) were
invited to participate in the pilot
study. (See Table 1.) The organiza-
tion’s management information
system sent an intranet email
with study information, a demo-
graphic sheet, and a link to the
electronic survey to all employ-
ees. Completion of the pre- and
postintervention surveys and
demographic sheet indicated
consent to participate. There
were 27 completed responses to
the preintervention survey and
30 completed responses to the
postintervention survey. Results
were reported as deidentified
aggregated data. For both sur-
veys, most respondents were
female (89%, 90%), Caucasian
(78%, 77%), and current or previ-
ous dog owners (96%, 87%).

Program implementation
A meeting took place between
the hospital’s director of critical
care, the university medical clin-
ic’s nurse manager, and a faculty
member of the university’s
school of nursing trained in AAT.
This collaboration resulted in

identifying a need to support
staff members with stress relief
and comfort measures by bring-
ing a trained AAT dog to the unit
during working hours. This
would also provide valuable data
to inform hospital administrators
regarding future staff support
programs. Hospital and medical
clinic administrators supported
the pilot program.

A visitation schedule was
developed for a 5-week period
and approved by hospital man-
agers, nurse leaders, and the
dog-handler team. Visits were
set at normal low patient-need
times during the shift. The
dog-handler team consisted of a
faculty member with over 8 years
of AAT experience and a 2-year-
old Goldendoodle named Daisy
who had been tested for tempera-
ment and was free from diseases,
up-to-date with vaccinations,
cleared by a veterinarian, and
groomed before each visit.

Over the course of 5 weeks,
the dog-handler team conducted
seven visits to the inpatient
CVSU unit on the day shift
(beginning at 2 p.m.), six visits on
the night shift (beginning around
3 a.m.), and six visits to the uni-
versity medical clinic (beginning
at 11 a.m.). The scheduled visits

Table 1: Survey responses by profession
Preintervention Postintervention

Clinical nurse 10 15

Nurse assistant 4 7

Nurse practitioner 2 0

Unit secretary 4 5

Physician assistant 1 1

Other* 6 2

*Those selecting “other” could serve in the role of phlebotomist, lab technician, or radiology technician
or in the financial department at the university medical clinic.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Animal-assisted therapy

28 April 2020 • Nursing Management www.nursingmanagement.com

occurred on all days of the week and, depending
on staff need, patient acuity, and Daisy’s disposi-
tion, lasted anywhere from 30 minutes to 2 hours
(the average visit lasting around 1 hour). Daisy
remained leashed at all times during the scheduled
visits and was allowed access on the unit and in
the breakroom of the CVSU and into all parts of the

nurses’ station at the medical clinic. The handler
didn’t interact with staff unless the staff members
asked questions or engaged the handler in conver-
sation. All staff members were encouraged to fully
interact with Daisy if desired regardless of whether
they agreed to participate in the research study and
have their data recorded.

Results
The data were compiled and analyzed using statis-
tical software. Items were analyzed by item and
subscale: factor 1 (adverse impact), factor 2 (unit/
clinic climate), and factor 3 (dog acceptability). (See
Tables 2 and 3.) An independent t-test was conducted
for each of the subscales to determine pre-/post-

Table 2: Item analysis

Item Mean
Standard
deviation t P

The staff work-
load will be
decreased

Pre

Post

3.15

2

.82

.46

.79

1.91 .062

Visiting dogs will
benefit the medi-
cal center’s image

Pre
Post

2.06

1.53

.81

.82

2.41 .019

Visiting dogs
will take staff
members’ minds
off stress

Pre
Post

2.24

1

.55

.76

.74

3.47 .001

Visiting dogs
will help staff
members relax

Pre
Post

2.33

1.48

.78

.75

4.19 .000

Hospital admin-
istrators will
accept the dog
visiting program

Pre
Post

2.44

2.1

.64

.55

2.19 .033

Visiting dogs will
make the unit/
clinic a happier
place

Pre
Post

2.07

1.05

.87

.68

2.78 .007

The unit/clinic
will be a more
interesting place
to work

Pre
Post

2.3

1

.67

.82
.76

3.01 .004

Visiting dogs will
help make the
staff members
more relaxed

Pre
Post

2.26

1.53

.86

.73

3.45 .001

The new program
is a worthwhile
activity for the
hospital to pursue

Pre
Post

2.15

1.45

.91

.65

3.37 .001

Nurses will
accept the dog
visitation program

Pre
Post

2.11

1.53
.75

.57

3.29 .002

Visitors will
accept the dog
visitation
program

Pre
Post
2.3

1.77

.78
.68

2.75 .008

Item Mean
Standard
deviation t P

Dogs are likely to
bark in the unit/
clinic

Pre
Post

2.59

3.23

.89

.63

3.17 .002

Dogs are likely
to urinate or
defecate in the
unit/clinic

Pre
Post

2.7

3.37

.82
.67

3.35 .001

A hospital or
clinic is no place
for visiting dogs

Pre
Post

2.89

3.37
.89
.67

2.3 .025

Dogs are likely
to increase staff
members’ stress
levels

Pre
Post

2.93

3.45

.92

.70

2.44 .018

Allergies to dogs
will be a problem

Pre
Post

2.37

2.88

.69

.76

2.66 .010

Dogs are likely to
bite staff

Pre
Post

3.13

3.4

.74

.66

1.46 .151

Visiting dogs will
bring fleas and/
or ticks

Pre
Post
2.89
3.37

.85

.67

2.38 .021

Dogs will spread
infection, such as
worms, bacteria,
and fungi

Pre
Post

3.04

3.4

.71

.68

1.98 .052

Dogs are likely to
damage hospital/
clinic equipment

Pre
Post
3.04

3.57

.71

.50

3.28 .002

Dogs are likely to
scratch staff

Pre
Post

2.94

3.47

.71
.57

3.07 .003

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

www.nursingmanagement.com Nursing Management • April 2020 29

changes. All three factors showed
significant changes, with unit/
clinic climate and dog acceptabil-
ity significantly improved.

Discussion
Results indicated that most staff
members noted an overall posi-
tive impact of the AAT program
within the hospital and clinic set-
ting. The results and experiences
of this pilot program will help
guide further discussion about
whether to implement the ther-
apy dog program hospital- and
clinic-wide.

Factor 1 (adverse impact). Fac-
tor one was concerned with the
adverse characteristics of dog
behavior, such as barking, flea
and tick infestation, biting, and
scratching, potentially occur-
ring on the unit. Staff members
anticipated few negative impacts
before program implementation,
which was in line with other
research regarding staff views.14,18
After program implementation,
staff members indicated that
the experience was positive and
there was a significant reduction
in adverse attitudes, consistent
with published research.14

Factor 2 (unit/clinic climate).
Similar to other research find-
ings, unit/clinic climate demon-
strated significant improvement
after program implementation.18
AAT has been shown to reduce
stress and enhance overall well-
being.19,20 Staff members were
receptive to the program due to
the sense of well-being that the
dogs provided.

Factor 3 (dog acceptability).
Previous research findings sug-
gested improved dog accept-
ability among allied health staff
and nonclinical staff as compared
with nurses.18 However, in our

study, all staff members regard-
less of role were more positive
about the program following
implementation. In addition,
research indicates that women
and pet owners are more recep-
tive to AAI.15,16 Our results are
consistent with these reports as
our sample consisted primarily
of women and current or previ-
ous pet owners, which could
help explain the positive accept-
ability of dogs on the unit and in
the clinic.

Limitations
Limitations are acknowledged in
this pilot study, which relied on
self-report responses with no
objective measures. We also had a
relatively low response rate. In
addition, the data for pre-/post-
surveys weren’t linked. Therefore,
we can’t assume that the results
are comparable. Another possible
limitation is the use of only one
breed of therapy dog. Participants
may feel differently if presented
with a different breed. Lastly, han-
dler interaction could’ve influ-
enced study results.

Energy and positivity
Evaluating staff perceptions of
AAT can be useful for organiza-
tions interested in implement-

ing an AAT program. It’s imper-
ative that nurse leaders inten-
tionally create and sustain work
environments that promote
wellness for the healthcare team
providing care, as well as the
patients and families receiving
care. The results of this study
reveal that AAT can serve as a
source of energy and positivity
for staff members. In addition
to the positive staff impact, the
therapy dog encounters also
significantly improved miscon-
ceptions associated with AAT,
such as negative animal behav-
ior and infection risk. Further
research to correlate AAT’s
impact on decreasing anxiety,
depression, and burnout among
the nursing workforce would
be beneficial for hospitals and
clinics that are focused on pro-
moting the health of employ-
ees working in high-stress
environments. NM

REFERENCES

1. Turner SB. The resilient nurse: an
emerging concept. Nurse Leader.
2014;12(6):71-73,90.

2. Wright K. Alleviating stress in the
workplace: advice for nurses. Nurs
Stand. 2014;28(20):37-42.

3. Yoder L. Nursing: the balance of
mind, body, and spirit. Medsurg
Nurs. 2017;26:75.

Table 3: Subscale analysis
Item Mean Standard deviation t Sig.

Adverse impact Pre

Post

17.3

20.2

3.9

3.3

3.05 .002

Unit/clinic climate Pre

Post

1

5.4

10.7

5.2

4.5

3.64 .001

Dog acceptability Pre

Post

6.9

5.4

1.8

1.4

3.38 .001

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Animal-assisted therapy

30 April 2020 • Nursing Management www.nursingmanagement.com

4. Fang L, Hsiao LP, Fang SH, Chen BC.
The associations with work stress,
social support and overweight/
obesity among hospital nurses: a
cross-sectional study. Contemp
Nurse. 2018;54(2):182-194.

5. Kendall-Raynor P. Nurses with
health problems receive too little
support. Nurs Manage. 2018;25(4):6.

6. Oates J. What keeps nurses happy?
Implications for workforce well-being
strategies. Nurs Manag (Harrow).
2018;25(1):34-41.

7. Czaja AS, Moss M, Mealer M. Symp-
toms of posttraumatic stress disorder
among pediatric acute care nurses.
J Pediatr Nurs. 2012;27(4):357-365.

8. Crane PJ, Ward SF. Self-healing
and self-care for nurses. AORN J.
2016;104(5):386-400.

9. Ruff A, Hoffman J. Self-care for the
nurse entrepreneur: finding time and
balance. Beginnings. 2016;36(5):8-9,
24-25.

10. Speroni KG, Williams DA, Seibert DJ,
Gibbons MG, Earley C. Helping nurses
care for self, family, and patients
through the Nurses Living Fit interven-
tion. Nurs Adm Q. 2013;37(4):286-294.

11. American Veterinary Medical Asso-
ciation. Animal-assisted interven-
tions: definitions. www.avma.org/
KB/Policies/Pages/Animal-Assisted-
Interventions-Definitions.aspx.

12. O’Haire M. Companion animals and
human health: benefits, challenges,
and the road ahead. J Vet Behav.
2010;5(5):226-234.

13. Abrahamson K, Cai Y, Richards E,
Cline K, O’Haire ME. Perceptions of
a hospital-based animal assisted
intervention program: an exploratory
study. Complement Ther Clin Pract.
2016;25:150-154.

14. Hediger K, Hund-Georgiadis M.
Animal-assisted therapy in the view
of staff members before and after
implementation in a rehabilitation
clinic. Hum Anim Interact Bull. 2017;
5(2):61-73.

15. Pinto A, De Santis M, Moretti C, Farina
L, Ravarotto L. Medical practitioners’
attitudes towards animal assisted
interventions. An Italian survey. Com-
plement Ther Med. 2017;33:20-26.

16. Matchock RL. Pet ownership and
physical health. Curr Opin Psychiatry.
2015;28(5):386-392.

17. Delgado C, Toukonen M, Wheeler C.
Effect of canine play interventions as a
stress reduction strategy in college stu-
dents. Nurse Educ. 2018;43(3):149-153.

18. Moody WJ, King R, O’Rourke S.
Attitudes of paediatric medical ward
staff to a dog visitation programme.
J Clin Nurs. 2002;11(4):537-544.

19. Owenby BE. The potential of animal-
assisted therapy within the super-
visory alliance. J Creativity Mental
Health. 2017;12(1):146-159.

20. Kamioka H, Okada S, Tsutani K, et
al. Effectiveness of animal-assisted
therapy: a systematic review of ran-
domized controlled trials. Comple-
ment Ther Med. 2014;22(2):371-390.

In Ala., Morgan Yordy is an assistant pro-
fessor at the Auburn University School
of Nursing, Amy Brandon is the director
of critical care services at East Alabama
Medical Center in Opelika, and Lisa Har-
mon is a nurse manager at the Auburn
University Medical Clinic.

The authors have disclosed no financial
relationships related to this article.

DOI-10.1097/01.NUMA.0000657248.63754.fc

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.