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RN coordinates canine therapy program at Children's Hospital Los Angeles

Four-legged friends visit patients, help with physical therapy and ease patient pain

Thursday October 24, 2013
Ann Brunner (L) and her dog Barrett visit with Debbie Jury, RN, who oversees the canine therapy program at Children's Hospital Los Angeles .
Ann Brunner (L) and her dog Barrett visit with Debbie Jury, RN, who oversees the canine therapy program at Children's Hospital Los Angeles .
(Photos courtesy of CHLA)
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By Linda Childers

When children spend time in the hospital, help in easing their anxieties is welcome. At Children's Hospital Los Angeles, registered therapy dogs have helped calm young nerves for years.

One recent evening when Debbie Jury, RN, MSN, PNP-PC/AC, CNS, program oversight coordinator for the canine therapy program at the hospital, asked the owner/handler of Barrett, a registered therapy dog, if he could visit a young patient who was anxious about undergoing surgery.

It's scene that's played out often at CHLA. Barrett, a Cavalier King Charles Spaniel, is one of more than 50 dogs in the Amerman Family Foundation Dog Therapy program, helping young patients to manage their pain and navigate therapy. At the inception of the dog therapy program, the Amerman Family Foundation lent support through a grant. The foundation has continued annual donations, CHLA renamed the program in its honor in 2008.

The initial program started in the hospital's 30-bed pediatric rehabilitation unit in 2001, with three dogs visiting three times a week to provide comfort to children after a hectic morning of therapy sessions. One year later, Jury and members of the Magik Pain Service decided to expand the program to the rest of the hospital campus after seeing the positive effects the therapy dogs had on the children.

Jury is no stranger to creating programs from scratch. In 1998 she began CHLA's Magik Pain Service as the sole PNP, and she continues as a full-time PNP there.

Her work with the dog therapy program includes ensuring that visitation data is collected and tabulated, developing and maintaining the program's budget, evaluating outcomes and potential dog issues and integrating the volunteer/handlers into the hospital team. She is responsible for interacting with the hospital foundation and donors and writing the yearly report. Assisting Jury with the program are Dianne Lahti, the program's administrative assistant, and Kate Buhrmaster, program coordinator.

"Many people think a hospital dog therapy program involves bringing in volunteers with their well-behaved dogs and allowing them to go to the patient's bedside; but in reality it requires much more," Jury said. "We are the only children's hospital that goes beyond the standard bedside dog visitation by involving dog therapy into physical therapy, pain management and palliative care. The dogs are incorporated into comfort, pain management and distraction techniques for children throughout the hospital campus."

After the program's initial success, the program was expanded to all 16 hospital units,10 outpatient clinics and recently the pediatric, cardiothoracic and neonatal ICUs.

"The nurses in the PICU and CTICU are very receptive to ensuring that equipment, including ventilators, chest tubes and arterial lines are positioned to both protect the child and to ensure a close-up and personal experience during the dog therapy session,"ť Jury said. "The dogs do not provide bedside visits in the NICU, but instead, like the rest of the ICUs, are there for the staff nurses and family members to take a moment to relax, decrease their stress and elevate their mood by interacting with the dogs."

Pain relief benefits

With a background in pediatric pain management, Jury has seen firsthand how the therapy dogs can help decrease pain in young children. Before any intervention, CHLA nurses ask patients to rate their pain level, and then repeat the questioning after the intervention has taken place. After dog visits, Jury said nurses see pain and stress levels in many patients go down by three to four points on a zero to 10 scale.

A study published in the January 2012 issue of the journal Pain Medicine reported that therapy dog visits provided chronic pain patients with a significant reduction in pain and emotional distress. In addition, the study showed the dog visits also significantly improved emotional distress among the patient's family and friends.

At CHLA, the therapy dogs and their handlers visit with children from five to 20 minutes per visit, seven days a week. Patients and parents may request more frequent visits.


Children's Hospital Los Angeles patient Samantha McClurg visits with therapy dog Addie, owned by Joe Katich.
Steps to joining the program

"Dog therapy is an integral part of providing pain management, distraction and making the hospital a more comfortable, less fearful place for the pediatric patients,"ť Jury said. "In order to have a successful dog therapy program, you need to build a strong foundation. This begins with background checks and health screenings of all volunteers and their dogs."

To be considered for the program, dogs must complete a basic obedience course. The owners/handlers then must complete a course by the Pet Partners Therapy Animal Program and train their dogs to pass an evaluation to become registered.

CHLA has four evaluators on its oversight board who test the dogs. The testing evaluates the dog's temperament, obedience, reliability and predictability. All these traits are necessary for a dog to enter the unfamiliar environment of the hospital with its equipment, noises, smells and activities.

The next step is to develop specific policies regarding dog visitation, safety and infection
control procedures.

Our goal was to protect the volunteer/handler, therapy dog, patients and staff from nosocomial infections which could be freely passed on if there was not appropriate pet grooming before a visit and hand sanitizing both before and after petting the dog," Jury said.

"We wanted to provide a safe environment where the dog and children could interact up close by ensuring that equipment was positioned properly, that extra linen was placed on the bed prior to the dog being allowed to sit next to the child so that it could be easily removed after the visit, and that children with infections or dog allergies did not intermingle."

Staff input important

Jury also sought feedback from nurse managers and unit nurses to ensure the dog program was something they wanted to participate in and could incorporate into their daily plan of care.

"I worked to educate the staff about what was involved in a dog visit, infection control procedures and how to ensure the visit was beneficial to patients,"ť Jury said. "In addition, I immediately saw the importance of staff interaction with the dogs. A handler and dog would visit a unit on a rough day, and we would have nurses requesting to pet the dogs."

She said the canine visits have proven to be a valuable tool for nurses when they need to distract young patients during painful procedures.

"We might have a dog and handler on one side of the bed and while the child is petting the dog, the nurse is on the other side of the bed inserting an IV line or changing a child's wound dressing,"Jury said.

The nurses truly treat the dog handlers and dogs as a member of our team and an important component to decreasing pain and fear [in patients] while making the hospital a more nurturing environment.

The nurses in the dialysis and ambulatory infusion center often request the dogs spend extra time in their units because the children are there for three [or] four hours each day. It has been a real asset to patient care, patient satisfaction and nurse satisfaction.

The next phase in the dog program was to allow the dogs to work directly with physical therapists. The therapist develops interventions that will improve the child's functioning while incorporating the dog assistance, making it a more pleasant experience while also meeting therapeutic goals.

"Our physical therapists incorporate dog therapy into their treatment plan by having the child throw a ball to the dog, brush the dog's fur or walk with a dog to improve gross motor skills," Jury said. "The children put stickers on the dog's scarf or put costumes, involving Velcro, buttons or zippers, on the dogs to improve fine motor skills. The nurses on the unit then continue to work on these skills during bedside dog visitation."

Dog therapy in action

Phan Dang, RN, nurse manager in the division of pediatric rehabilitation medicine at CHLA, has seen how the dogs can break down barriers and transform young patients.

"We had a patient who was in a car accident and suffered a traumatic brain injury," Dang said. "In the beginning, he was quite agitated, but that changed when one of the therapy dogs visited him. He calmed down and then proceeded to call it the name of his dog. This was a great sign because it showed his memory was slowly improving."

Dang said the dogs provide a valuable service to patients and staff.

"The dogs help to create a fun and positive environment where the kids often forget that they are at the hospital, Dang said. "As nurses, we love it when our patients are happy and it's also therapeutic for us. Every time you see a dog in the hospital hallway, you see people pausing to smile at them."

LEARN MORE, CHLA.org.