"Giving voice to the voiceless": An exploration of the grieving ritual for a therapy dog.

The use of animal-assisted therapy with children who have experienced trauma is receiving increasing attention in the literature. However, there is a lack of attention given to the death of therapy animals. The scholarship on the death of animal companions highlights a varying depth of acknowledgment of children's grief. This article draws on the clinical experience of one therapy center's approach to the death of a therapy dog. Knowledge gained from this experience highlighted the necessity of acknowledging the death, the need for clear communication with children and young people, and the importance of involving children in a memorial ritual.

The Impact of Therapy Dogs on Prelicensure Baccalaureate Nursing Student Test Anxiety.

AIM: This study examined the impact of a therapy dog intervention on baccalaureate nursing student test anxiety. BACKGROUND: Nursing student test anxiety may hinder academic performance and program outcomes. Considering this negative impact, it is essential to implement anxiety-reducing strategies. Interaction with therapy dogs is linked with test anxiety reduction; however, minimal studies have explored this topic. METHOD: A pretest/posttest quasi-experimental design was used to examine the impact of a therapy dog intervention on test anxiety. Repeated measures included the State-Trait Anxiety Inventory, heart rate, and cortisol levels. The multisite convenience sample included 91 junior-level prelicensure BSN students. RESULTS: The intervention had a statistically significant impact on test anxiety reduction, noted by a decrease in State-Trait Anxiety Inventory scores, heart rate, and salivary cortisol levels ( p = .00). CONCLUSION: Therapy dog interactions are an effective strategy to reduce test anxiety. The findings from this study may assist educators to implement future interventions.

Care of Patients with Service or Therapy Animals.

ABSTRACT: Animals have long been used in the service of people with various disabilities and provide more than companionship. This article synthesizes current literature and recommendations regarding service and therapy animals in healthcare settings and explains how nurses can help accommodate care of service or therapy animals during outpatient care and acute inpatient admissions.

Therapy Dog Presence in an Undergraduate Nursing Program.

ABSTRACT: Research supports the use of animal-assisted interactions and pet therapy in various settings. Undergraduate nursing students experience high levels of stress and anxiety which often continue as they become professional nurses. Entering the workforce equipped with positive coping strategies may help newly licensed nurses to combat stressors. This qualitative descriptive study examined the experiences of undergraduate nursing students with the presence of a therapy dog. Four major themes regarding the role of therapy dogs were identified: as a coping strategy, as a mood moderator, as a positive distraction, and for community building.

Effect of animal assistant therapy on quality of life in older adults: A meta-analysis.

This meta-analysis was conducted to determine the effect of animal-assistant therapy on the quality of life of older adults. This research systematically searched electronic databases (CINAHL, Cochrane Central, Medline/PubMed, Web of Science, Science Direct, and the National Thesis Centre and ULAKBIM of the Council of Higher Education) for studies published between April - June 2021. Seven studies with experimental design were used, three were quasi-experimental and four were randomly controlled studies. The total sample size in the meta-analysis was 375 (experimental group: 177 and control group: 198). The mean duration of animal-assistant therapy was 38.5 ± 12.4 min. Animal-assistant therapy had a significant effect on the quality of life of older adults (mean difference: -4.59 p: 0.03, Z:2.23). Therefore, animal assistant therapy is an effective method to improve older adults' quality of life.

Treating Agitation in Patients with Dementia with a Therapy Dog in a Milieu Therapy Setting on a Geropsychiatric Ward.

BACKGROUND: Animal-assisted intervention has become a common therapeutic practice used for patients with dementia in home-dwelling and institutions. The most established procedure is a visiting service by specially trained dogs and their owners to improve social interactions and reduce symptoms of agitation. OBJECTIVES: The study aims to investigate the effects of a therapy dog on agitation of inpatients with dementia in a gerontopsychiatric ward. MATERIALS AND METHODS: The severity of agitation was assessed by a rater blinded for the presence of the dog via the Overt Agitation Severity Scale (OASS). The scale was conducted on 1 day with the dog and his handler present (resident doctor on the ward) and on another day with only the handler present. Each patient was his/her own control. Heart rate variability (HRV) and serum level of brain-derived neurotrophic factor (BDNF) of the patients were measured on both days. 26 patients with the Mini-Mental Status Examination (MMSE) score <21 and the diagnosis of dementia were included in the study. RESULTS: A significant reduction of agitation in the OASS could be shown when the dog was present (p = 0.006). The data neither demonstrated a difference in the HRV for the parameters mean heart rate (p = 0.65), root mean square of successive differences (p = 0.63), and high frequencies (p = 0.27) nor in serum BDNF concentrations (p = 0.42). DISCUSSION: Therapy dogs can be implemented as a therapeutic tool in a gerontopsychiatric ward to reduce symptoms of agitation in patients with dementia. The study was registered in the German Clinical Trials Register (DRKS00024093).

Emotional support animals are not like prosthetics: a response to Sara Kolmes.

Sara Kolmes has argued that the human 'handlers' of emotional support animals (ESAs) should have the sorts of body-like rights to those animals that people with prosthetics have to their prosthetics. In support of this conclusion, she argues that ESAs both function and feel like prosthetics, and that the disanalogies between ESAs and prosthetics are irrelevant to whether humans can have body-like rights to their ESAs. In response, we argue that Ms Kolmes has failed to show that ESAs are body-like in the ways that paradigmatic prostheses are and that, even if they were, these similarities would be outweighed by a crucial dissimilarity that she underestimates.

Are emotional support animals prosthetics or pets? Body-like rights to emotional support animals.

Many philosophers have argued that prosthetic limbs are the subjects of some of the same rights as traditional body parts. This is a strong argument in favour of respecting the rights of users of prosthetics. I argue that all of the reasons to consider paradigm prosthetics the subjects of body-like rights apply to the relationship between some emotional support animals (ESAs) and their handlers. ESAs are integrated into the functioning of their handlers in ways that parallel the ways that paradigm prosthetics are integrated into the functioning of their users. ESAs are also phenomenologically integrated into their handler's lives in ways that parallel the phenomenological integration that prosthetic users experience. These parallels provide a strong reason to take the rights of ESA handlers much more seriously than we do now. I will highlight that the current treatment of ESA handlers presumes that they have no rights to ESAs at all. Even if ESAs are the subject of very minimal body-like rights, ESA handlers are having their rights violated. There are of course disanalogies between ESAs and paradigm prosthetics. Most notably, ESAs are alive and separate from their handlers. However, none of these disanalogies are relevant to the question of body-like rights. The differences between ESAs and paradigm prosthetics are in terms of what treatment is owed to them, not in terms of what rights their handlers and users should have. ESAs are not prosthetics, but they deserve some of the rights prosthetics do.

2021 AAHA Working, Assistance, and Therapy Dog Guidelines.

The guidelines are the first comprehensive consensus report on veterinary healthcare recommendations for working, assistance, and therapy dogs. This category of canine patients includes a broad assortment of animals, some with well-defined functions and others that provide a more generalized support role. The guidelines discuss recommendations for dogs trained for protection, odor/scent detection, service functions for people with diagnosed disabilities or physical limitations, emotional support, and therapeutic intervention. Although the term is often used to describe dogs providing animal-assisted activities, true therapy dogs provide goal-directed therapy, often under the supervision of a healthcare professional such as an occupational therapist or psychologist. Many working dogs undergo extensive training and have rigorous physical demands placed upon them. These factors make working, assistance, and therapy dogs inherently valuable and impose a need for a high level of primary veterinary care as described in the guidelines. Because working dogs have a particularly close relationship with their handlers, a trust relationship between the practice team and the working-dog client is imperative.

Dogs' social susceptibility is differentially affected by various dog-Human interactions. A study on family dogs, former shelter dogs and therapy dogs.

When pre-treated with social stimuli prior to testing, dogs are more susceptible to human influence in a food preference task. This means, after a positive social interaction they are more willing to choose the smaller amount of food indicated by the human, as opposed to their baseline preference for the bigger amount. In the current study we investigate if and how various forms of social interaction modulate choices in the same social susceptibility task, testing dogs with varying early life history (pet dogs, therapy dogs, former shelter dogs). In line with previous studies, dogs in general were found to be susceptible to human influence as reflected in the reduced number of "bigger" choices in the human influence, compared to baseline, trials. This was true not only for pet dogs with a normal life history, but also for dogs adopted from a shelter. Therapy dogs, however, did not uniformly change their preference for the bigger quantity of food in the human influence trials; they only did so if prior to testing they had been pre-treated with social stimuli by their owner (but not by a stranger). Pet dogs were also more influenced after pre-treatment with social stimuli by their owner compared to ignoring and separation; however after pre-treatment by a stranger their behaviour did not differ from ignoring and separation. Former shelter dogs on the other hand were equally influenced regardless of pre-treatment by owner versus stranger. In summary these results show that dogs' social susceptibility is modulated by both interactions immediately preceding the test as well as by long term social experiences.

The Use of Therapy Dogs in the Pediatric COVID-19 Vaccination at the University of Puerto Rico Medical Sciences Campus.

Pet ownership and therapy dogs as companion animals and emotional support have potential health benefits. We report the experiences at a COVID-19 vaccination center after authorizing children's vaccines. When the Pfizer-BioNTech vaccine for children aged 5 to 11 years was authorized for emergency use, we adapted the center's space to receive children, adding cartoon posters and balloons and using children's adhesive bandages, among others. Located at a Campus with six health professional schools, medical students dressed as storybook or movie characters. Children were asked to make drawings during the post vaccination observation period. We incorporated therapy dogs as part of our strategy for a child-friendly center during vaccination activities. Parents expressed that the COVID-19 immunization seemed to be better accepted by children as the dogs in the center entertained them. Many children were in close contact with the dogs while receiving the shots, caressing them, or having the small dogs on their laps. Children's drawings reflected colors, flowers, families, images of happiness, dogs with their names, their own pets, and superhero characters. There were no negative images of syringes, injections, or germs. To our knowledge, this was the only vaccine center in Puerto Rico that implemented therapy dogs as a strategy to create a friendly environment for COVID 19 immunization efforts targeted for children. Based on this experience, we encourage the use of therapy dogs in other immunization activities and will further gather prospective data in the future.

Considerations for the Writing of Certification Letters Endorsing Use of Emotional Support Animals.

Emotional support animals (ESAs) are different from service animals, therapy animals, and other disability-related assistance animals. Although pet ownership may confer psychological benefits, limited research has supported the use of ESAs to realize such benefits. If clinicians are asked to write a letter of support for use of an ESA, they need to be familiar with relevant federal, state, and local laws that regulate ESAs and with the essential components of an ESA evaluation. This article provides an overview of terminology; federal, state, and local laws related to ESAs; and clinical and ethical considerations for clinicians who decide to write these letters. The authors also review liability issues related to writing these letters, including those related to ESA aggression.

Understanding the Role of Therapy Dogs in Human Health Promotion.

Dogs may provide humans with a range of physical, mental and social benefits. Whilst there is growing scientific evidence of benefits to humans, there has been less focus on the impact to canine health, welfare and ethical considerations for the dogs. The importance of animal welfare is increasingly acknowledged, indicating that the Ottawa Charter should be extended to include the welfare of non-human animals supporting the promotion of human health. Therapy dog programmes are delivered across a variety of settings including hospitals, aged care facilities and mental health services, highlighting the important role they play in human health outcomes. Research has shown that that there are biomarkers for stress in humans and other animals engaged in human-animal interactions. This review aims to assess the impact of human-animal interactions on therapy dogs engaged in providing support to human health. While challenging, it is paramount to ensure that, within the framework of One Welfare, the welfare of therapy dogs is included, as it is a key factor for future sustainability. We identified a range of concerns due to the lack of guidelines and standards to protect the wellbeing of the dogs engaged in these programmes. Extension of the Ottawa Charter to include the welfare of non-human animals with leveraging through a One Welfare approach would promote animal and human health beyond current boundaries.

The Impact of Campus-Based Therapy Dogs on the Mood and Affect of University Students.

University students experience a high level of stress, which could potentially affect how they manage stressful situations beyond university, such as when entering the workforce. Although universities offer counseling services and various health promotion programs, there is reluctance and negative perceptions about utilizing these from students. Further research is needed to explore the effectiveness of therapy dog interventions in human interactions that is quantifiable and embraces the elements of health promotion. This study aimed to investigate the impact of therapy dog interventions on students' moods across a multi-campus university during a 2-week final examination period. Two hundred and sixty-five students participated in the study involving a multi-campus university. The intervention group and control group completed a questionnaire involving the positive affect negative affect schedule (PANAS), a 20-item scale that measures a person's affect at the time. The intervention group (n = 170) had a higher average of total PANAS scores (mean = 77.63, standard deviation = 10.975) compared to the control group (n = 95) (mean = 69.41, standard deviation = 13.442). The results were statistically significant (mean difference = 8.219, 95% CI = 5.213-11.224, p < 0.05) with a t-score of 5.385. Students who engaged with therapy dogs on campus during the examination period were more likely to have a more positive affect. The results suggest that universities should include therapy dog programs within their health promotion programs for students, as these may help improve their mood and reduce the stress associated with university examinations.

"Dogs on Call": A Community-Engaged Human Subjects Training with Hospital Based Therapy Dog Teams.

Problem: As community-engaged research (CER) methods evolve, Institutional Review Boards (IRBs) must adapt policies to facilitate CER research. This paper describes a novel collaboration between hospital-based therapy dog volunteer teams (CERs), academic faculty, and an IRB. Subjects: CER volunteers delivered a canine-assisted intervention to hospitalized adults in a clinical trial. Methods: IRB members and faculty developed a human subjects protections training tailored to the volunteer handlers' role as study interventionists including an interactive video- and discussion-based training with a knowledge assessment. Findings: Fourteen volunteer handlers were trained. The expedited IRB review period was similar to national average rates (18 days.) Volunteer handlers have conducted 107 research visits with little patient attrition. Conclusion: Tailored human subjects trainings facilitate research with interventions delivered by people who are not typically involved in research. Bespoke CER human subjects training requires collaboration between researchers and IRBs and flexibility in IRB policy regarding CER.

Service and emotional support animals in pediatrics.

There is a growing body of evidence of the positive psychological and social impacts animals can have on individuals with chronic conditions and disabilities. Service animals have been used primarily in the adult population. Recently they have become more prevalent in pediatric care to improve the quality of life and emotional well-being of children with physical and mental health challenges. Studies have shown that both service animals and emotional support animals (ESAs) improve physical, psychological, and social health of children with chronic medical conditions and neurodevelopmental disabilities. Due to the increasing use of service animals and ESAs in pediatrics, providers need to be aware of which children may benefit from having a service animal or ESA, the process to obtain them and recognize the practical, financial, and ethical considerations or challenges children and their families may encounter. This article aims to provide guidance on the differences between service and emotional support animals and considerations for their use in pediatric care.

Remotely and collaboratively evaluating a campus-based therapy dog program during the COVID-19 pandemic.

The COVID-19 pandemic adversely affected the wellbeing of university students and adults in general, emphasizing the need for mental health programming that was compliant with physical distancing mandates. The present evaluation investigated mental health and social connection within the context of COVID-19 by remotely evaluating a virtual animal-assisted activity at the University of Saskatchewan - PAWS Your Stress. The purpose of this article is to outline our evaluation methods and findings, while calling specific attention to the collaborative strategies that were implemented within a remote, time-sensitive context. The evaluation findings revealed that remote animal-assisted programming can facilitate connections with humans and animals, and promote multiple mental health benefits, despite the lack of physical interaction with the animals. Our lessons learned indicate that remote program logic modelling workshops are feasible when suited to audience demographics. Further, our experience suggests that the Most Significant Change technique (a qualitative, participatory, storytelling method that elicits outcome data) can be useful in time-restricted evaluations, and the necessity of central steps in the process may vary depending on evaluation goals. This project has implications for future evaluation work, by demonstrating the effective use of remote methods that allowed for successful stakeholder collaboration.

Intraoral clinical examinations of pediatric patients with anticipatory anxiety and situational fear facilitated by therapy dog assistance: A pilot RCT.

OBJECTIVE: To evaluate whether the presence of a certified therapy dog specially trained for working in a dental setting may facilitate dental care of anxious pediatric patients. METHODS: The Norwegian Regional Committee for Medical and Health Research Ethics approved a randomized cross-over trial with a study sample of n = 16 children aged between 6 and 12 years. The trial was registered on clinicaltrials.gov. Pediatric patients referred to specialist care at the Public Dental Service Competence Center of Northern Norway (TkNN) because of anxiety were invited to partake in the trial. Study participants met twice for an intraoral examination by a specialist pediatric dentist. Per random allocation, a therapy dog team was present in the clinic operatory during the clinical examination on the first or the second visit. The primary outcome was the assessment of patient compliance during the intraoral examination (yes/no). Secondary outcomes were measurements of child satisfaction and anxiety using the CFSS-DS scale (Dental subscale of Children's Fear Survey Schedule) completed by a parent/guardian. Supplementary outcomes were salivary cortisol level, heart rate variability, and skin conductance. RESULTS: Ten boys and six girls (mean age 8.5) were recruited. All completed both clinical visits and demonstrated full compliance while undergoing a dental examination. All study participants and guardians reported great satisfaction. The salivary cortisol level reduction during the clinical examination on the first visit decreased by 30% in the presence of the therapy dog and 20% without, while the decrease during the clinical examination on the second visit was 29% in the presence of the therapy dog and 3% without. Within the limitations of the experimental setup, the electrophysiological measurements were unreliable in the current study population. CONCLUSION: Dog-assisted therapy in a dental care setting appears to have a positive effect on children with dental anxiety or children that avoid dental care.