Integrating Animal-Assisted Therapy into Self-Care Support for Medical Professionals Who Care for Critically Ill Children and Their Families

ACLP Bulletin | Fall 2019 | VOL. 37 NO. 4

Ali Spike, MS, CCLS
Mount Sinai Kravis Children's Hospital, New York, NY

Hospitals have been bringing dogs into pediatric patients’ rooms for years, and as it turns out, patients are not the only ones who look forward to and benefit from these visits. Hospital staff on pediatric intensive care units can benefit immensely from interacting with dogs in the clinical setting.

The Child Life and Creative Arts Therapy Department at Mount Sinai Kravis Children’s Hospital launched the “Paws & Play” facility dog program in March 2017 to provide Animal Assisted Therapy (AAT). Facility dogs can provide a unique form of AAT as they work with trained clinical handlers to address clinical goals in the hospital setting. This effective modality, designed to help patients, families, and staff cope and heal, is a goal-directed intervention in which an animal meeting specific criteria is integrated into the treatment process. Working alongside a professional, the dog is recognized as a therapeutic form of treatment. Facility dogs and handlers are referred by physicians and other clinicians to engage patients around movement after surgery, pain management, procedural support, anxiety, and socialization during extended admissions. As part of Paws & Play programming, three facility dogs were brought onto the child life and creative arts therapy team and paired with handlers to provide a variety of therapeutic interventions, including critical staff support interventions.

Professor with PICU staff members during his office hours.

Identified Staff Needs in the PICU and PCICU

The pediatric intensive care unit (PICU) and pediatric cardiac intensive care unit (PCICU) at Mount Sinai Kravis Children’s Hospital contain 25 beds located within a larger medical institution and treat a wide range of medical diagnoses, including organ transplant, metabolic and genetic disorders, cardiology, and many other diagnoses requiring intensive care. The Critical Care Societies Collaborative issued a statement recognizing medical professionals’ burnout syndrome as relevant, and called for action to increase awareness, conduct research, and find strategies to improve job satisfaction and mental health of intensive care staff (Moss, Good, Gozal, Kleinpell, & Sessler, 2016).

Furthermore, studies have found nurses in intensive care units and pediatrics are at high risk for emotional exhaustion, burnout, and stress due to exposure to environmental stressors such as pain, suffering, death, and challenging ethical dilemmas (Kravits, McAllster-Black, Grant, & Kirk, 2010; Maytum, Howard-Ruben, & Whitaker, 2004; Verdon, Merlani, Perneger, & Ricou, 2008).

Child life specialists working in critical care settings, as well as staff members from other disciplines such as social work and spiritual care, often play a unique role in offering staff support in the context of working with critically ill children and their families (Brown, 2009). The child life skillset can offer much needed support for medical staff using creative and therapeutic tools, such as AAT. Research has shown that the presence of dogs in the workplace may impact employees’ stress level in a positive manner (Randolph, Knisely, Barker, Cobb, & Shubert, 2012) when done with careful considerations to address potential challenges (Foreman, Glenn, Meade, & Wirth, 2017).

Professor’s Office Hours

In an attempt to support staff working in stressful intensive care units, the child life team implemented, “Professor’s Office Hours,” a pilot program designed to provide ICU staff self-care through AAT, from November 2017 through January 2018. Two Certified Child Life Specialists facilitated bi-weekly AAT staff support sessions with a Paws & Play facility dog named Professor, in the PICU/PCICU nurses’ lounge and at the workstations on the unit to provide opportunities for unit staff to partake in play, as well as pet and interact with Professor. The child life specialists also engaged with staff around their current mood and coping, self-care techniques, and general rapport-building conversations.

Two nurses enjoy a few moments with Professor during their busy shift.

The child life specialists solicited feedback utilizing a written survey at the beginning, middle, and end of this 3-month pilot program. The first survey asked about timing of staff AAT sessions, and results revealed a general preference to have AAT sessions on the unit, in the afternoons, and on a bi-weekly basis. The second survey asked if AAT sessions were having a positive impact on staff members’ day, how likely they were to recommend that a co-worker access AAT for self-care, and the frequency at which they would like to have AAT for staff on their unit. Staff responded overwhelmingly positively, with 87% of respondents saying that AAT had a positive effect on their day, 80% indicating that they would recommend it to a coworker, and 86% stating they prefer weekly sessions. The final staff survey at the end of the 3-month pilot asked similar questions and resulted in similar responses.

Over the 3-month period, 75 staff members participated in Professor’s Office Hours. There were six planned group sessions, 15 individual sessions with staff, and four unplanned group sessions based on staff need. Participants included nurses, residents, attending physicians, fellows, respiratory therapists, physicians’ assistants, and pharmacologists. Stressful days, end-of-life situations, critical patient caseloads, and general staff business were primary reasons for seeking or participating in AAT. When asked to describe their time with Professor, staff responded with positive feedback, using words such as “relaxing,” “wonderful,” “joyous,” “peaceful,” “the best,” and “very pleasurable when I am having a bad day.” When asked about Professor’s impact on the work environment, staff said, “He removes all stress in a stressful environment,” “His presence makes us smile,” and “He lightens the environment.”

According to Dr. Howard Seiden, then Director of Pediatric Cardiac Critical Care and Inpatient Services at Mount Sinai Kravis Children’s Hospital, “The Paws & Play program has had a meaningful and positive impact on the PCICU.” He added that seeing children smiling and enjoying Professor’s company is “very gratifying for the staff.” Doctors and nurses, he continued, also relish their time with Professor. “Even healthcare professionals need the occasional calming diversion from the stressful environment of an intensive care unit.”

Professor and his child life handler greet a PICU nurse in the hallway.

Outcome of Pilot and Future Growth of Staff Support for Paws & Play

The feedback from healthcare professionals who participated in Professor’s Office Hours indicated that this pilot program achieved its goals. The theme of the comments that emerged from the surveys included relief from stress, relaxation, and increased communication with others in playful and joyful contexts. Almost all staff who participated in one AAT session made use of this distinctive support multiple times. The overall success of this program lies in both the therapeutic aspects of AAT and the recognition of medical staff’s self-care needs.

While the impact on the care of patients and families is not directly measured in this program, it does effectively recognize the role that a child life specialist and AAT program can play in providing self-care opportunities for multidisciplinary team members. This impact on staff self-care does, in turn, have the potential to shape patient care.

The results of this pilot program have led to significant facility dog program expansion for staff support through AAT. Professor’s Office Hours has expanded to cover other units in addition to the PICU/PCICU. With the addition of the program’s second dog, Amos, in November 2017, the team introduced “Amos’s Cookie Break” which models Professor’s Office Hours on the inpatient medical/surgical unit. Due to the overwhelming success of the program in providing staff support to pediatric units, our program received combined hospital and grant funding in 2019 to onboard a new fulltime facility dog, as well as a creative arts therapist handler, to provide staff support on the adult units.

Moby, the program’s first dog dedicated exclusively to staff support, now provides therapeutic sessions to staff throughout the Mount Sinai Hospital system. The team is planning to do research assessing the impact of AAT sessions on coping and resilience for medical professionals.

Overall, the implementation of this pilot program led to a large increase in AAT staff support sessions at Mount Sinai led by child life department staff; in 2018, the team provided AAT to 447 staff members. The facility dog teams have become a vital part of patient debriefs, end-of-life processing sessions, and a valued resource for responding to critical events on patient units.

REFERENCES

Brown, C. (2009). Working with grieving children and families. In R. Thompson (Ed.), The handbook of child life (pp. 238- 256). Springfield, IL: Thomas.

Foreman, A. M., Glenn, M. K., Meade, B. J., & Wirth, O. (2017). Dogs in the workplace: A review of the benefits and potential challenges. International Journal of Environmental Research and Public Health. 14, 498-519.

Kravits, K., McAllster-Black, R., Grant, M., & Kirk, C. (2010). Self-care strategies for nurses: A psycho-educational intervention for stress reduction and the prevention of burnout. Applied Nursing Research, 23, 130-138.

Maytum, J. C., Howard-Ruben, J., & Whitaker, E. (2004). Compassion fatigue and burnout in nurses who work with children with chronic conditions and their families. Journal of Pediatric Health Care, 18, 171-179.

Moss, M., Good, V. S., Gozal, D., Kleinpell, R., & Sessler, C. N. (2016). A Critical Care Societies Collaborative statement: Burnout syndrome in critical care health care professionals. A call for action. American Journal of Respiratory and Critical Care Medicine, 194(1), 106-113.

Randolph, T., Knisely, J. S., Barker, S. B., Cobb, R. K., & Shubert, C. M. (2012). Preliminary investigation of employee’s dog presence on stress and organizational perceptions. International Journal of Workplace Health Management, 5(1), 15-30.

Verdon, M., Merlani, P., Perneger, T., & Ricou, B. (2008). Burnout in a surgical ICU team. Intensive Care Medicine, 34(1), 162-156.

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