1. Yordy, Morgan A. DNP, RN-BC, ACNS-BC, FCNS
  2. Kartovicky, Leah MEd, CRC, NCC
  3. Pope, W. Stuart DNP, DMin, RN

Article Content

Animal-assisted therapy (AAT) is a form of complementary medicine used to promote holistic patient healing. It is based on the human-animal bond theory, which emphasizes the universal, emotional, and mutually beneficial bond that exists between humans and animals. In health care, AAT as a complementary and alternative medicine (CAM) is rising due to the benefits observed in patients during and after AAT visits that promote patient progress and holistic healing. Benefits of AAT are seen in not only patients with diverse medical conditions but also in their caregivers, because interactions with the canine's handler provide patients and caregivers additional support, indicating the canine-handler team as a whole impacts the effectiveness of AAT.1 The increased implementation of AAT in health care settings and the growing understanding of the positive impact of AAT emphasize the need for nurse educators to provide opportunities for students to explore CAMs and develop their skills through experiential means such as in laboratories and simulations, as well as through traditional didactic strategies.2 The aim of this article is to discuss an AAT elective nursing course, which includes AAT simulations as feasible means for students to explore applications of AAT in hospital and home settings.


AAT Elective Course

A baccalaureate nursing program developed an AAT elective course designed to discuss the benefits of AAT and the human-animal bond, the impact of AAT on quality of life for recipients and caregivers, the training methodology necessary for AAT, how this training relates to the nursing process, and how to organize and conduct AAT visits in various settings, while continually assessing patients' reactions and monitoring for any signs of patient or animal distress. The AAT elective course is a 2-credit course, which meets weekly in a classroom setting and engages students in didactic teaching methodologies to assist them in developing a foundational understanding of AAT and the human-animal bond before providing students with simulations on AAT visits in nursing settings. To accomplish these objectives, students first learn the history and health benefits of AAT, how the human-animal bond maximizes quality of life for recipients and caregivers, and AAT best practices. Next, to ensure handler, animal, and recipient safety during simulations, students discuss fundamentals of animal behavior, effects of stress on therapy animals, and practice positive reward training methodologies necessary in developing characteristics required for successful AAT implementation. Students also learn to assess recipients' reactions to therapy animals and potential signs of animal and recipient distress during AAT visits. Once an understanding of the basic tenets and best practices of AAT is developed, learners review the language of dogs and explore evaluation methods to ensure effective implementation of AAT in diverse settings, with an emphasis on applications of AAT in nursing. Finally, by organizing and conducting a simulated AAT visit, students connect AAT and the nursing process (assessment, diagnosis, planning, implementation, and evaluation) to understand the benefits of AAT in health care.


Teaching Strategy

Initially, the AAT elective course had low enrollment and students organized and conducted AAT visits in local nursing homes. As course enrollment grew, however, faculty transitioned to using simulations for students to practice AAT skills and best practices. The simulations allow students to gain hands-on experience with psychomotor aspects of AAT visits, which includes handling a canine on a leash, positioning the canine within reach of a patient, and the communication and interpersonal techniques often utilized during an AAT visit. The simulated site visits provide students the opportunity to achieve course objectives and apply their skills and knowledge in practical settings. Students complete 10 weeks of the didactic material in the classroom setting prior to the scheduled simulation, as previously described.



The aim of the simulations is to conduct AAT visits for patients in hospital and home settings. Students do not portray the role of nurses during simulations but, instead, learn about the canine-handler role. Students are allotted 1 hour per scenario, with 2 simulation experiences per group scheduled within a day (eg, 1 hospital simulation and 1 home setting simulation). The simulation suites, located within the school of nursing simulation center, represent a medical-surgical hospital room and a home health room (eg, an efficiency apartment) and provide students diverse environments to conduct AAT visits. Between the simulation rooms is a control room, allowing for supervision of students.


AAT Canines

The canines used in the AAT elective are part of the school of nursing CAREing Paws (canines assisting in rehabilitation and education) program. The CAREing Paws program was established in 2011, with support from individual school of nursing donors and a private trust. Each canine is a part of a certified canine-handler team, and the primary handlers for each canine also serve as faculty leads for the AAT elective course. The university's Institutional Animal Care and Use Committee approved the utilization of the canines for education, simulation, and community outreach.



Two separate scenarios are applied to the AAT course simulation. Scenario 1 involves a hospitalized patient with left-sided weakness, whereas scenario 2 simulates a patient with limited mobility in their home (see Supplemental Digital Content, Table, available at:, for the 2 scenarios). To successfully engage in the simulations, students must first assess the recipient, determine their deficit, and then plan a visit to maximize the benefits of AAT for the given recipient. After the AAT visit, students evaluate their performance to improve their skills in the future. Two students are first instructed to portray the role of canine-handler team (1 for each scenario), whereas the other 2 students represent patients. Those not participating in the scenario observe the simulation in the control room alongside the faculty leads. Simulation experiences last approximately 10 minutes, during which students conduct a simulated AAT visit and practice their psychomotor and communication skills. Students are encouraged to handle the canine on the leash, position the canine within reach of the patient, engage the patient in petting the canine, and participate in a patient-led conversation. After 10 minutes, the simulation concludes and students in the control room, faculty leads, and students in the scenario engage in a debriefing inside the simulation suite before participating in scenario 2. Students in scenario 1 "clear the air" and discuss their performance, including challenges faced. Students in the control room add any further insight into what they witnessed in the control room, and faculty leads provide tips and guidance for the next scenario. Once this debrief concludes, students switch roles and the second scenario is conducted, followed by a debriefing similar to scenario 1.



The AAT elective course is a popular course within the school of nursing that enables students to learn the theoretical concepts of AAT and then apply their knowledge during simulations. Students report they enjoy working with the canines to learn the methods of conducting AAT visits in various nursing settings. Situational experiences, such as the AAT simulations described in this article, should be incorporated throughout undergraduate nursing curricula to allow students to apply their knowledge and best practices in controlled, educational environments before implementing techniques with patients, allowing for more successful and effective implementation of CAMs in health care settings.3




1. Ginex P, Montefusso M, Zecco G, et al Animal-facilitated therapy program outcomes from caring canines: a program for patients and staff on an inpatient surgical oncology unit. Clin J Oncol Nurs. 2018;22(2):193-198. doi:10.1188/18.CJON.193-198 [Context Link]


2. Chan RR, Schraffrath M. Participatory action inquiry using baccalaureate nursing students: the inclusion of integrative health care modalities in nursing core curriculum. Nurse Educ Pract. 2017;22:66-72. doi:10.1016/j.nepr.2016.12.003 [Context Link]


3. Sofer D. The value of simulation in nursing education. Am J Nurs. 2018;118(4):17-18. doi:10.1097/01.NAJ.0000532063.79102.19 [Context Link]