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https://www.infirmiere-canadienne.com/blogs/ic-contenu/2022/03/28/la-zootherapie-canine-reduit-la-crainte-des-inject

Dogs provide ‘welcome distraction’ and help alleviate anxiety and distress

By: Colleen Anne Dell, Maryellen Gibson, Benjamin Carey, Holly McKenzie, Stephanie Peachey, Linzi Williamson, & Darlene Chalmers
March 28, 2022

Vaccine hesitancy among adults, youth and children is a challenge to controlling the SARS-CoV-2 (COVID-19) pandemic in Canada. One reason for this hesitancy is needle fear. A Canadian study found that 24 per cent of adults and 63 per cent of children report some level of needle fear, and 7 per cent of adults and 8 per cent of children do not get vaccinated because of it (Taddio et al., 2012). There is a pressing need for more research and practice on interventions to address needle fear, including nursing interventions. In the meantime, the COVID-19 pandemic has forced the implementation of real-time interventions for needle fear. One of these interventions is the incorporation of St. John Ambulance therapy dog teams into vaccination clinics, including a mass vaccination clinic in Saskatoon, Saskatchewan.

About the dogs

St. John Ambulance therapy dogs are friendly family pets that visit with individuals alongside a human handler in environments where dogs typically do not have access, such as hospital emergency departments and mental health facilities. The goal of therapy dog visits is to offer the humans they are visiting comfort and support. Research over the past decade in health-care facilities and other similar settings indicates that this goal is being met (Dell et al., 2016).

St. John Ambulance therapy dogs have fulfilled various behavioural and health requirements, including passing an evaluation process, to visit the Saskatoon mass vaccination clinic. They are assessed as to whether they enjoy visiting in the high-stress environment and are calm in their interactions with diverse, high-needs populations. The dogs are required to be up to date on their canine vaccinations. Additionally, their handlers are vaccinated for COVID-19 and masked, and issue hand sanitizer to patients before and after individual visits. The handlers also do a pre-visit rapid COVID-19 test, and the dogs are groomed prior to visits and monitored regularly for atypical health indications (e.g., cough).

Overcoming needle hesitancy

In August 2021, 10 therapy dog teams were introduced at the ongoing mass vaccination clinic in Saskatoon, partially in response to nurses’ and other health-care professionals’ growing challenges with vaccine-resistant patients. Increased patient resistance was due in part to workplace vaccination requirements and provincewide implementation of vaccine passports as of October 1, 2021. Initially, the therapy dog teams were available to youth (12 to 17 years old) and adults who felt fearful, hesitant, anxious and/or angry about being vaccinated. This has since expanded to children (5 to 11 years old) receiving their COVID vaccination as well as anyone 6 months of age and older receiving their influenza vaccination at the same clinic.

The visiting therapy dog teams have worked closely with nursing and other clinic staff to support patients’ vaccination experiences. The therapy dog teams visit with individuals waiting in line, are available during the injection, and are accessible in the 15-minute post-injection area. To date, the therapy dog teams have collectively visited over 250 hours. Their availability is advertised on the Saskatchewan Health Authority’s and others’ social media platforms.

Dogs help create a calming environment

Needle fear interventions available to nurses have traditionally focused on the use of localized anesthetic, patient education and exposure therapy. A new evidence-based intervention was recently implemented by the Centre for Addiction and Mental Health in Canada. It focuses on the creation of a calming and barrier-free environment for patients and includes four distinct phases: Comfort, Ask, Relax, and Distract (CARD system) (Duong, 2021). The therapy dog teams’ experiences at the vaccination clinic align with each of CARD’s phases:

• Comfort: The therapy dog teams, and the dogs specifically, appear to offer comfort through their perceived non-judgmental and undivided attention, physical presence and touch, and promotion of fond pet memories among patients.
• Ask: Patients are asked if they would like a therapy dog present during an injection, in turn supporting patient self-efficacy. They are also asked questions about dogs and animals generally while waiting, wherein they are allotted the opportunity to direct the conversation in a situation where they may not feel in control.
• Relax: It is suggested to patients that they can attempt to relax before and during their injection by focusing on the dog. They are encouraged to focus on petting the dog in unison with their own breath and in some cases hug the dog. Information is often shared with patients on research suggesting that petting a dog can release the feel-good connection hormone, oxytocin, and lower the stress hormone, cortisol, in humans.
• Distracted: All of the above can distract patients, including the novelty of having a therapy dog at the clinic, hearing handlers’ stories about the dogs and patients and handlers asking dog-specific questions. Often, immediately prior to the injection, a handler will ask a patient a direct question, such as “Do you think therapy dog Anna-Belle the bulldog can run as fast as a rabbit?” as an immediate way to redirect their focus. Therapy dog stickers and trading cards are also used as a distraction on an as-needed basis with children.

Nurses have shared at length how the dogs lighten the mood at the clinic.

Making “the jab” a better experience

Getting “the jab” has generally been a positive experience for patients attending the mass vaccination clinic. That said, the therapy dog teams’ presence has been identified by nursing and other staff and patients as reducing patients’ anxiety and distress, increasing their comfort and satisfaction, serving as a welcome distraction, and even bringing a sense of joy to the clinic. Handlers have also witnessed countless ways in which the incorporation of a therapy dog has made getting a vaccine possible for some patients. Examples include supporting a child who is hiding under a chair and comforting adults who are at risk of fainting.

The therapy dog teams’ presence at the vaccination clinic has allowed nursing and other medical professionals to witness first-hand how therapy dog visits enhance patients’ experiences. Nurses have also experienced the positive impacts of the therapy dogs themselves. Nurses have shared at length how the dogs lighten the mood at the clinic, make their job easier when working alongside them with vaccine-hesitant patients, offer them comfort, and support their well-being in a stressful work environment.

Big demand, limited supply

A key limitation of the therapy dog teams’ involvement in the vaccination clinic to date has been that the demand cannot be met. The COVID-19 vaccination clinic operates 12 hours a day, and staff would like to have multiple therapy dogs present on a continual basis. Therapy dog teams cannot meet this need since they are community members who are able to volunteer once or twice a week. The visits are no more than two hours in length to ensure the therapy dogs’ welfare. In order to support patients’ access to therapy dog visits when teams are unavailable at the vaccination clinic, our team introduced banners in the clinic advertising our website, therapydogs.ca, where individuals can access videos, photos and stories of Saskatoon therapy dogs. In partnership with Scholastic Canada, this site also includes recordings of therapy dogs being read children’s books by their handlers.

One possible framework explaining why the therapy dogs are beneficial in this mass vaccination clinic is One Health. One Health proposes that the health of animals, humans and the natural environment is interlinked. This framework is mainly applied to explaining zoonosis, the transmission of disease from animals to humans, but zooeyia is also a component of One Health. Zooeyia accounts for the benefits of human-animal interaction. Chalmers and Dell (2015), for example, shared how therapy dogs who work in tandem with humans (in this case, handlers, nurses and other health-care professionals) can bring comfort and support into a social and built environment, such as a vaccination clinic.

Next steps

The overwhelming positive reception to the therapy dog teams visiting at the mass COVID-19 vaccination clinic in Saskatoon will hopefully lead to more in-depth discussions about their continued integration into the clinics and expansion to support nursing professionals in other medical settings. A suggested next step is for research to assess how the CARD system is experienced and understood by patients who visit with a therapy dog team. Vaccination clinic research also needs to attend to the impacts of therapy dog visits for nursing staff welfare. This understanding will grow in importance as children and youth return for their second dose of the COVID vaccination and further booster shots become available to all patients.

Acknowledgment: Thank you to the St. John Ambulance therapy dog handlers (Taunia Arthur, Jeanette Halpape, Lori McGeary, Jane Smith, Gwendolyn Stoeber, Jasmine Streisel) and Saskatchewan Health Authority employees (Jennifer Cushon, Monique Harmon-Atkinson) for contributing to this practice article.

References

Chalmers, D., & Dell C. A. (2015). Applying One Health to the study of animal-assisted interventions. EcoHealth, 12(4), 560-562. doi:10.1007/s10393-015-1042-3.

Dell, C. A., Stempien, J., Broberg, L., Husband, A., Jurke, L., Rohr, B., … Fele-Slaferek, L. (2016). A case study of the patient wait experience in an emergency department with therapy dogs. Patient Experience Journal, 6(1), 115-126. doi:10.35680/2372-0247.1306

Duong, D. (2021). Closing Canada’s COVID-19 vaccination gap. CMAJ, 193(38): E1505-E1506. doi:10.1503/cmaj.1095963

Taddio, A., Ipp, M., Thivakaran, S., Jamal, A., Parikh, C., Smart, S., … Katz, J. (2012). Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine, 30(32), 4807-4812. doi:10.1016/j.vaccine.2012.05.011

Colleen Anne Dell is a professor and research chair in One Health and Wellness at the University of Saskatchewan in the Department of Sociology and a St. John Ambulance therapy dog handler.

Maryellen Gibson is a researcher coordinator with One Health and Wellness.

Benjamin Carey is the PAWS Your Stress therapy dog program coordinator at the University of Saskatchewan.

Holly McKenzie is a Banting post-doctoral Fellow with One Health and Wellness.

Stephanie Peachey is the St. John Ambulance therapy dog program Saskatchewan evaluator and a therapy dog handler.

Linzi Williamson is a Canadian Institutes of Health Research post-doctoral fellow in the Transition to Leadership Fellowship program with One Health and Wellness.

Darlene Chalmers is an associate professor at the University of Regina, Faculty of Social Work, and a therapy dog handler.

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#covid-19
#infection-prevention-and-control
#nurse-patient-relationship
#nursing-practice
#patient-experience
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