Parents’ Perceptions of Pediatric Surgical Patients regarding Animal-Assisted Therapy: A Qualitative Study

1. Introduction

In recent years, pet therapy, also known as Animal-Assisted Therapy (AAT), has gained increasing recognition as a complementary approach in healthcare, particularly in hospital settings [1]. Recent systematic reviews have shown the efficacy of AAT in reducing fear, anxiety, and stress in patients through both physiological and subjective mechanisms [2,3,4]. These effects are particularly relevant in pediatrics, where hospitalization is often a cause of discomfort and distress for children and families, as highlighted in these reviews. In the context of pediatric surgery, AAT has shown auspicious outcomes. Sobo et al. [5] provided one of the first pieces of evidence that pet therapy, particularly visits by trained dogs, can significantly reduce perceived pain in pediatric patients during the postoperative period, likely through cognitive distraction mechanisms, suggesting its potential as a valuable complement in pediatric pain management. Similarly, Calcaterra et al. [6] observed that children who interacted with therapy dogs after surgery demonstrated improved emotional regulation and reduced pain perception. Ávila-Álvarez et al. [7] also confirmed that even short AAT sessions can enhance children’s mood and increase parents’ satisfaction with hospital care.

Nurses play a pivotal role in implementing pet therapy interventions, as they maintain constant, often 24-hour, contact with both patients and their families throughout hospitalization. Indeed, pet therapy is identified under code 4320 in the Nursing Interventions Classification (NIC) system, reflecting its integration into standard nursing care practices [8]. The NIC is a standardized nursing terminology that defines and categorizes nursing interventions, supporting evidence-based practice, interdisciplinary communication, and integration into individualized care plans. The inclusion of pet therapy in this classification reflects its relevance in holistic, person-centered, and outcomes-driven nursing care. This approach aligns with the principles of the Family-Centered Care model, which emphasizes the active involvement of families in all aspects of the care process. In pediatric settings, where emotional security and relational continuity are vital, AAT can serve as a relational tool that strengthens the bond between children, families, and healthcare professionals [9,10,11].

Within this approach, nurses’ involvement is crucial to ensure safe and therapeutic interactions, as well as to support the emotional and physical benefits of AAT. Moreover, London et al. [12] emphasized the importance of parental perspectives in evaluating therapeutic outcomes. Their qualitative study on AAT for children with autism spectrum disorder highlighted improvements, according to caregivers, in communication, behavior regulation, and social participation.

AAT may also contribute to reducing work-related stress among healthcare professionals. Ginex et al. [4] evaluated an AAT program in an adult surgical oncology unit, finding improvements in patients’ quality of life indicators. Staff reported high job satisfaction and low burnout levels. These findings underscore the dual benefits of AAT for both patients and healthcare providers.

Despite the growing body of scientific evidence, qualitative research focusing specifically on parents’ perspectives of AAT in pediatric surgical settings remains limited. This study aims to fill this gap by exploring the perception of parents whose children underwent surgery and participated in AAT programs. This research seeks to offer valuable insights into how parents perceive the impact of pet therapy on their child’s surgical experience and overall well-being.

2. Materials and Methods

2.1. Study Design

This study employed Interpretative Phenomenological Analysis (IPA) as a qualitative research methodology to explore the perceptions of parents of pediatric surgical patients regarding pet therapy. This approach was selected for its capacity to deeply investigate participants’ lived experiences, allowing for an in-depth understanding of their interpretations, beliefs, and perspectives through a phenomenological lens focused on the meanings individuals ascribe to specific phenomena.

To ensure methodological rigor and clear, structured reporting of results, the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [13].

2.2. Sampling and Recruitment

Between February and March 2025, participants were recruited using convenience sampling from the Pediatric and Neonatal Surgery Unit at the University Hospital of Sassari (Italy). Recruitment continued until data saturation was reached. No recruited individuals refused to participate, and each participant was assigned an alphanumeric code to ensure anonymity.

Eligible participants met the following inclusion criteria: (1) being of legal age; (2) being the mother of a child aged between 1 and 16 years; (3) willingness to provide written informed consent. Exclusion criteria included: (1) not being a native Italian speaker; (2) being the mother of a child undergoing urgent/emergency surgery.

2.3. Data Collection

Participants were interviewed on the day of their child’s surgery. Interviews were conducted in a dedicated patient room to ensure participant privacy and confidentiality. None of the participants declined the interview.

Prior to data collection, the researchers performed bracketing by recording their assumptions, beliefs, and preconceived ideas regarding the phenomenon under investigation. By applying this reflective technique before data collection and analysis, researchers aimed to minimize potential bias and enhance objectivity in the interpretive process [14].

Data were collected through in-depth, face-to-face, semi-structured individual interviews. Semi-structured interviews are the most commonly used method in IPA studies, as they elicit rich, first-person accounts of participants’ experiences with the phenomenon of interest. This format provides a consistent framework for exploring specific topics while allowing for the collection of rich, reliable, and comparable qualitative data [15].

An interview guide (Appendix A) was used flexibly to support a natural flow of conversation and to encourage participants to elaborate on their perceptions while systematically exploring various aspects of the main topic. The initial question served as an entry point to introduce the topic. Interviews lasted between 20 and 30 minutes. In addition to the interviews, participants completed a short questionnaire to collect sociodemographic information essential for analysis and for describing the general characteristics of the study sample.

2.4. Data Analysis

Data analysis was conducted by the principles of IPA, as outlined by Smith et al. [16].

All interviews were listened to multiple times and transcribed verbatim. Each transcript was read and reread to allow researchers to become fully immersed in the content. Subsequently, two researchers (FC and GG) independently conducted a detailed analysis of each transcript. Descriptive, linguistic, and conceptual comments were annotated in the left-hand margin, while emerging themes were recorded in the right-hand margin, reflecting both the transcript and the initial notes. These emergent themes were then interrelated to construct a coherent and organized thematic account of the phenomenon. Multiple connections were established, resulting in the development of a set of superordinate themes that spanned the entire dataset.

2.5. Rigour

To minimize the influence of researchers’ preconceptions during category extraction, the process of bracketing was initially undertaken. This technique, described by Cohen et al. [17], involves critical reflection aimed at ensuring analytical rigor.

The trustworthiness of this study was ensured through adherence to high standards of dependability, confirmability, credibility, and transferability, as proposed by Streubert and Carpenter [18]. Rigorous and precise methods were employed at every stage of the inquiry—from data collection to analysis and interpretation, including peer review procedures to minimize interpretative errors.

Interview data were transcribed, incorporating participants’ direct quotations, and analyzed through a thematic approach, thereby safeguarding the authenticity of the participants’ perspectives. Clear inclusion/exclusion criteria, contextual descriptions, participant characteristics, and detailed procedures for data collection and analysis were provided. To reduce confirmation bias, findings were discussed among the research team and shared with participants for validation. These measures enhance the validity, relevance, and rigor of the findings, contributing to a comprehensive understanding of the phenomenon under investigation.

2.5. Ethical Considerations

This study was conducted in accordance with the ethical guidelines outlined in the Declaration of Helsinki [19], the Italian Privacy Law (Legislative Decree No. 196/2003), and the EU General Data Protection Regulation (GDPR 2016/679). Ethical approval was obtained from the hospital’s director.

All participants were fully informed, both verbally and in writing, about the purpose of the study. Prior to the interviews, each participant signed an informed consent form, acknowledging their understanding of the study objectives, the voluntary nature of their participation, and their right to withdraw at any time without consequence.

To ensure privacy, all data were anonymized using alphanumeric codes and securely stored in encrypted files accessible only to the research team.

3. Results

3.1. Participant Characteristics

The sample included 20 mothers of children scheduled for elective surgery. The mean age of participants was 39.6 years (SD ± 6.98). Most participants had completed secondary education. Table 1 provides a detailed overview of the demographic characteristics of the participants.

3.2. Emerging Themes

The qualitative analysis of the interviews identified five main themes that represent the experiences and perceptions of parents regarding the introduction of pet therapy in pediatric surgical hospital settings:

• General perception of pet therapy
• Parental expectations about benefits for their children
• Expected behavioral impact on the child
• Emotional repercussions on caregivers
• Preferences regarding animals and organizational aspects

3.2.1. Theme 1: General Perception of Pet Therapy

Across all interviews, parents expressed a largely positive view of pet therapy. This approach was frequently described as an emotional support tool capable of providing relief to children during vulnerable moments such as hospitalization and surgery. The presence of an animal was associated with a calming and reassuring effect, helping to distract from fear and reduce anxiety:

“It is a form of support provided by the animal to relieve anxiety, fears, or worries” (P_1),

“It helps to emotionally and even physically support the child’s well-being” (P_3).

Several parents emphasized that the presence of an animal, especially before admission, could make the hospital environment feel more welcoming and less impersonal. Pet therapy was seen as a means to transform the hospital setting into a more emotionally responsive and familiar space for the child: “A space that is not just hospital-like, but closer to you” (P_5).

Even among parents with limited prior knowledge of pet therapy, interest and openness were evident:

“I do not know how to describe it well, but I think it is a good thing” (P_7),

“I had not heard much about it, but I think it is useful. Animals help, they keep you company, they distract you” (P_11).

The affective and empathetic nature of animals emerged repeatedly in parents’ narratives. Animals—especially dogs—were seen as capable of establishing deep emotional bonds with people and responding sensitively to human emotions. Some parents used expressions that highlighted this belief:

“To me, a dog is a human being on four legs” (P_14),

“Sometimes, they understand you better than people do” (P_17).

3.2.2. Theme 2: Parental Expectations About Benefits for Their Children

Many parents acknowledged animal-assisted therapy as a valuable support in managing preoperative stress, attributing to it the ability to distract and calm the child during the most critical phases of hospitalization.

Interaction with the animal was perceived as an opportunity to shift attention away from anxiety-provoking thoughts associated with surgery and the clinical environment, thus reducing emotional tension: “To distract and calm him down… to take his mind off what he is about to undergo.” (I_1). In this sense, the presence of the animal not only fosters a more serene approach to the hospital experience but also improves the child’s willingness to undergo medical procedures: “It would relax him. It would help him experience the surgery better.” (I_16).

In addition to the immediate benefits related to distraction and relaxation, some parents highlighted a positive impact on social and relational dynamics, viewing the animal as a stimulus for openness and communication: “It would redirect his thoughts and help him open up, even socially.” (I_20). This underscores the added value of AAT in supporting the child not only in coping with the hospital environment but also in reinforcing social skills in a delicate context.

Finally, there emerged the perception that AAT might be more effective than traditional distraction strategies such as digital games, given its more tangible and emotionally engaging nature: “It would be better than giving him a game… more real, closer to his world.” (I_5). This observation reinforces the idea that the animal can serve as an authentic bridge between the child and the hospital setting, making the experience more human and less alienating.

3.2.3. Theme 3: Expected Behavioral Impact on the Child

Parents attributed profoundly beneficial effects to the interaction with animals, particularly in children experiencing emotional distress, agitation, or hyperactivity. Animals were perceived as capable of inducing a greater state of calm and serenity, even in children who are particularly active or emotionally fragile: “He would be calmer, more serene. Animals can do that.” (I_16) and “My son is very energetic, but if there is a dog near him, he immediately settles down.” (I_14).

The emotional bond created with the animal was, in some cases, described as intense enough to trigger immediate reassurance and emotional stabilization: “My daughter calms down as soon as she sees an animal—she adores dogs.” (I_19).

Beyond the direct benefits for the child, AAT was also seen as a valuable tool to improve interaction with healthcare staff. Some parents emphasized how the presence of an animal could break down relational barriers and help make children more receptive to physical contact and care: “The dog helps to break barriers… it calms them so they can be touched.” (I_6). This suggests the mediating potential of AAT, extending beyond emotional comfort to impact the broader therapeutic context.

However, one parent expressed caution, raising doubts about the intervention’s effectiveness in the presence of neurodevelopmental disorders and highlighting the variability in individual responses: “My son is autistic, maybe he would have reacted differently—I am not sure it would have helped him.” (I_15).

3.2.4. Theme 4: Emotional Repercussions on Caregivers

The perceived well-being of the child directly influenced the parent’s emotional balance, creating a strong link between the child’s emotional state and that of the caregiver. Several parents highlighted how their child’s serenity brought them a sense of relief and personal tranquility: “If he is calm, I am calm. Seeing him smile reassures me.” (I_11). In this context, AAT was not experienced solely as a tool to support the child, but also as an indirect resource for the parent, capable of providing emotional comfort and psychological support.

Some parents recognized in animals a form of shared companionship, capable of alleviating anxiety and reducing feelings of helplessness, as expressed by one participant: “It would help me manage anxiety, like companionship—for both of us.” (I_20). Even in moments of physical absence, the knowledge that the child could benefit from the presence of an animal served as a source of reassurance: “When I cannot be there, knowing he has support makes me feel better.” (I_5).

Furthermore, the role of the animal was described not only in terms of individual benefit but also as a potential facilitator of relationships within the family unit. Some parents emphasized the relational value of the animal, offering a form of consolation that complements and enhances parental care: “It is a different kind of comfort than what I can give as a parent.” (I_4).

3.2.5. Theme 5: Preferences Regarding Animals and Organizational Aspects

Almost all parents identified the dog as the most suitable animal for AAT, due to its ability to establish a genuine, empathetic, and communicative relationship with the child. The dog’s sensitivity and the perception of a kind of “humanity” in its behavior make it, in the eyes of many parents, an ideal companion in therapeutic settings: “The dog is the only animal that truly has human feelings.” (I_19). However, a degree of flexibility also emerged regarding the choice of animal, depending on the child’s specific preferences and needs.

Some parents expressed openness to other species such as rabbits or fish, recognizing their potential calming or emotional benefits: “Even a little bunny would be fine, if the child likes it.” (I_18), and “A fish in the room would calm him down—he already has one at home.” (I_17).

Another theme that emerged from the interviews was the reference to the horse as a therapeutic animal. Despite parents’ awareness of the logistical challenges associated with bringing a horse into a hospital setting, it was described as a highly empathetic animal capable of forming deep emotional bonds and making a significant contribution to children’s emotional well-being. As one parent put it: “The horse connects on a deep level with the person.” (I_3), and “The horse is very respectful.” (I_6). Nonetheless, it was recognized that, for structural and organizational reasons, the presence of a horse is more appropriate in outdoor contexts or specific rehabilitation programs rather than within a hospital ward: “It would be the dog, because a horse in the hospital would not work.” (I_1).

Regarding safety and hygiene, most parents expressed confidence in the hospital’s procedures, showing little concern or resistance. The prevailing perception was that the presence of animals in the hospital is subject to rigorous protocols that ensure appropriateness and safety: “I assume that if it is allowed in the hospital, it must be safe.” (I_7). In some cases, greater concern was expressed about people than animals themselves: “I worry more about people than about animals.” (I_6).

Finally, many participants considered the availability of AAT a significant factor in choosing a healthcare facility, to the point of becoming a decisive criterion when the quality of care was otherwise equal: “I would choose the one with pet therapy, no doubt.” (I_17), and “If the healthcare teams were equal, I would choose the one with pet therapy.” (I_1, I_5, I_9).

4. Discussion

This study aimed to explore the perceptions of parents of pediatric surgical patients regarding the introduction of AAT in hospital settings, with a particular focus on its emotional, behavioral, and organizational impacts. The findings reveal a broadly positive perception of AAT among parents, who describe it as a valuable source of emotional support and an effective tool for distracting children during hospitalization. Regarding the first emergent theme, the presence of an animal is perceived as reassuring and capable of diverting the child’s attention from fears and concerns related to surgery and the hospital environment. These perceptions align with the broader literature, which has recognized the potential of the human–animal bond in promoting well-being for centuries [20]. Interviewed parents emphasized that AAT can transform anxiety-filled waiting moments into experiences of serenity, helping to make the hospital setting more humane and welcoming.

AAT in hospitals is recognized as an effective intervention for reducing anxiety and enhancing emotional well-being in both children and adults. Recent studies have shown that even brief encounters with animals lead to significant reductions in anxiety among pediatric patients, with high satisfaction levels also reported among parents, who perceive the hospital environment as more humane and comforting thanks to these activities [1,21].

A particularly relevant finding concerns the perception of animals as relational mediators, capable of facilitating communication between the child and healthcare professionals. This element emerged strongly from the interviews and is supported by evidence from Vagnoli et al. [22], which demonstrates that the presence of animals encourages greater acceptance of medical procedures, such as venipuncture.

Another key theme was the expectation that AAT might serve as a healthier and more developmental alternative to traditional forms of entertainment, such as electronic devices. Several parents noted that interaction with animals supports emotional and relational development in children, going beyond mere distraction. These insights are consistent with the scientific literature, which confirms the effectiveness of AAT in reducing preoperative anxiety and promoting more adaptive coping strategies among hospitalized children [21].

Parents described a positive anticipation of the animal’s ability to instill calm and tranquility in their children, thus facilitating their adaptation to the hospital environment and medical procedures. However, they also acknowledged that responses to AAT may vary significantly in children with neurodevelopmental disorders, such as autism spectrum disorder, by the findings of London et al. [12] and Berry et al. [23], which emphasize the need for tailored interventions in this population. Nevertheless, as Beetz et al. [24] report, animals can support emotional and behavioral regulation in children, especially those with heightened reactivity or psychological vulnerability. Therefore, although responses to AAT may vary depending on individual characteristics—particularly in children with neurodevelopmental disorders—the therapeutic potential of such interventions remains substantial [25].

Furthermore, the presence of an animal, along with the parent’s positive perception of it, may contribute to a sense of safety and predictability—elements particularly valuable for children with difficulties in emotional or behavioral regulation. From this perspective, a need emerges to design AAT protocols that consider not only the type of disorder but also the child’s temperament and personal preferences, as well as those of the parent. This personalized approach could significantly enhance the efficacy of interventions, fostering greater engagement and improving both physiological and psychological outcomes for the entire family.

The fourth theme emerging from this study concerns the impact of AAT on parental well-being. Many participants reported that seeing their child calmer and more relaxed, thanks to the presence of the animal, helped them better manage the anxiety, worry, and sense of helplessness typically associated with the hospital environment.

This study reveals the perceived role of the animal as a relational mediator, capable of strengthening the parent–child bond and creating moments of shared comfort and emotional closeness, thereby transforming a challenging experience into an opportunity for mutual support. Existing literature confirms these findings: parents who take part in AAT programs report reductions in anxiety and stress, with beneficial effects also observed in high-complexity settings such as pediatric oncology and intensive care units [26,27,28]

The fifth and final theme concerns preferences regarding animals and organizational aspects. The findings show a marked parental preference for dogs as the ideal animals for AAT. This aligns with the literature, which recognizes the dog’s strong empathic, communicative, and social abilities, particularly suited for therapeutic interaction with children [29]. In line with these studies, 70% of parents identified the dog as the ideal animal for pet therapy, emphasizing its unconditional affection and capacity to establish genuine relationships with children.

Similarly, several studies have demonstrated the effectiveness of dog-assisted interventions in pediatric settings. For instance, Tsai et al. [30] showed that interaction with a dog can significantly reduce fear and anxiety in hospitalized children, improving their emotional well-being and supporting the healing process. These results are consistent with the opinions collected in this study, where parents described dogs as reassuring presences that offer comfort and security.

Meanwhile, 25% of parents considered the horse to be the most suitable animal for AAT. According to the interviews, horses were valued for their relational and empathic qualities, consistent with the literature on the effectiveness of hippotherapy, especially for children with motor or neurological disabilities [31]. However, parents also acknowledged the practical limitations of using horses in hospital settings, viewing them as more appropriate for outdoor environments or specific rehabilitation programs.

An original insight that emerged was the cultural and symbolic value attributed to the horse, particularly in the Sardinian context. Some parents noted that the choice of horse was not solely based on therapeutic criteria, but also reflected a strong connection with local traditions and territory. This perspective aligns with Peterson [32], who emphasizes that human–animal relationships are profoundly shaped by sociocultural contexts.

From an organizational standpoint, parents expressed overall trust in the hygiene and safety protocols associated with pet therapy, consistent with international recommendations [33]. Moreover, the presence of a structured AAT program was a potential factor influencing the choice of healthcare facility, reinforcing perceptions of care quality.

These findings confirm and expand upon existing evidence regarding the perceived value of AAT in pediatric hospital settings, underlining the importance of such complementary interventions in promoting family well-being [34].

4.1. Nursing Implications and Family-Centered Care

AAT emerges not only as a tool to promote the child’s well-being but also as a relational and psychological resource for caregivers, contributing to an overall improvement in the hospitalization experience. This aligns with the principles of Family-Centered Care [9,11]. Within this framework, the involvement of nursing professionals is strategically integrated through the use of standardized nursing classifications such as the NIC. In addition to the specific intervention code 4320 (Pet Therapy), other complementary nursing activities play a crucial role in supporting the effectiveness of AAT and enhancing family engagement.

Among the nursing interventions that support AAT are emotional support—helping both the child and family manage their emotions and fostering a positive interaction with the animal—and promoting communication between the family and healthcare team, encouraging an open and collaborative dialogue. Nurses also contribute to reducing anxiety in both the child and caregivers by employing AAT as a complementary therapeutic resource.

The Family-Centered Care model encourages the active participation of the family in all stages of the care process, recognizing them as integral members of the healthcare team [10]. In this sense, AAT is an effective strategy for fostering a positive and collaborative relational climate.

A favorable perception of AAT among the families of hospitalized children awaiting surgery, when aligned with the principles of Family-Centered Care, could lead to greater family engagement and improved quality of pediatric care. This approach more effectively addresses the biopsychosocial needs of young patients and their caregivers.

Given their continuous presence and educational role, nurses are key figures in integrating AAT safely and coherently into the care plan. They are responsible not only for providing accurate information and ensuring clinical safety but also for monitoring the emotional, relational, and cultural dimensions that characterize each family unit.

5. Conclusions

This study highlights that parents perceive AAT as a valuable support during pediatric hospitalization, which helps reduce children’s anxiety and enhances their emotional well-being. Animals, especially dogs, serve as effective relational mediators, facilitating communication between children and healthcare staff while providing comfort and distraction. Parents view AAT not only as entertainment but as a meaningful, developmentally supportive intervention that fosters family engagement. Tailoring AAT to individual needs, particularly for children with neurodevelopmental disorders, and considering cultural preferences is essential. Integrating AAT within a Family-Centered Care framework positions nurses as crucial facilitators in delivering safe, holistic care. These findings support AAT as a complementary approach that improves the hospital experience for children and their families.