Table 3 Coding guideline
Category | Code | Subcode | Code definition | Anchor example | Coding rule |
|---|---|---|---|---|---|
AAT practice / environmental factors | Intervention site | Patientroom; bed / wheelchair / couch | All coding items describing the patient room; bed / wheelchair / couch as the site of the intervention | “Patient is in her room, lying in her bed” (P44) | |
Garden / outdoors; bed / wheelchair / walking | All coding items describing the garden / anywhere outdoors as the site of the intervention and / or the patient is sitting in a wheelchair or walks freely | “Leads her outside himself with the wheelchair” (P35) | |||
Multifunction room; wheelchair / Bed | All coding items describing the multifunction room as the site of the intervention; degree of mobility is mentioned: wheelchair or bed | “Patient is accompanied by physician and comes into the multifunction room to meet Lotti.” (P39) | |||
Integration of relatives / relatives | Active participation in AAT | Coding items related to relatives receiving AAT and participating actively | “Relative, i.e. husband is offered a session with therapy dog Lotti. Was pleased, suggested a walk on the hospital premises, talked about his situation when arriving at the hospital, on the ward. Declined offer to walk dog on the leash but was intensively aware of the dog’s repeatedly initiated physical contact and stroked and touched Lotti at regular and short intervals for a short time, later on continually and always accepted her prompts to touch and stroke her.” (P16) | ||
Active participation in AAT patient + relatives | All coding items mentioning the presence of relatives and their active participation in or integration into the AAT session | “Mother and daughter then try out a snack-game together. Both enjoy it and try various things” (P36) | |||
Passive participation in AAT patient + relatives | All coding items mentioning the presence of relatives, albeit in the background and without actively participating in the AAT session | “Sister barely participates in the interaction” (P42) “Wife keeps to the background, upon request handed dog to husband, became more active only when Lotti was sitting on a chair beside the husband’s bed.” (P49) | |||
Passive participation in AAT | Coding items related to relatives receiving AAT without the patient and staying passive | “Son stays in the background does not act, only watches.” (P30) | |||
Discontinuation of intervention | General | Coding items mentioning the discontinuation of the AAT session | “Discontinuation of AAT session.” (P12) | ||
Criterion | Coding items related to the reason for discontinuation of AAT session | “However, describes being too weak, too tired, it is too much for her. Discontinuation upon patient’s request” (P40) | Including problems during AAT session (“No further feeding or licking of patient’s left hand because of an inflammation of index finger, in order to protect patient and dog.”) | ||
Second contact | not desired | Coding items indicating no desire for another AAT session | “Patient refuses dog therapy. Reacts negatively, wishes to be left alone/ in peace.” | ||
(P41) | |||||
Desired but not performed due to hospital discharge / deterioration in health and functional status / death | Coding items mentioning patient’s desire for another AAT session which was, however, not performed. Therefore no documentation; Follow-up whether patient was discharged, lacking adequate health / functional status for an AAT session, had died. | “Patient sets a goal of going for a walk with Lotti, she would be pleased about a further visit.” (P50) | |||
Desired and performed | Coding items related to another AAT session being carried out | “Second contact with patient. Patients is pleased to see therapy dog again.” (P2) | |||
Content of AAT sessions | Performed AAT intervention | Exercises with therapy dog | All coding items related to exercises / activities during the AAT session | “Bottle trick” (P23) | Including feeding the dog |
Positioning of therapy dog | All coding items mentioning the positioning of the therapy dog | “Quedo is layed down by her side and initiates contact by licking” (P11) | |||
Patient-centred session | All coding items indicating that the AAT session is tailored to current patient needs | “Patient tells about her day so far and that the drugs have made her tired and that she therefore does not wish for “big action” with Lotti, but that she is pleased to see her. Lotti greets her at the bedside, initiates physical contact by laying her head onto the bed and nudging the patient. Patient is already talking about a photo session planned for next week. Then she shows her own photos and the video made during the last contact.” (P18) | E.g. changing from active to restful activities because patient / relative signals exhaustion. | ||
Photo | All coding items related to a picture / video being taken during the AAT session | “Right from the start it is very important for him to take a picture” (P25) | |||
Adressing death / dying | Coding items indicating death / dying as a conversation topic during the AAT session | “Only speaks once and shortly about the approaching end” (P33) | |||
Adressing disease and hospital stay | Coding items mentioning the patient’s disease and/or related hospital stays / therapeutic measures / limitations in everyday life | “Talks about her family, her staying here, also about her disease and the effects on her being” (P52) | Including comments on general state of health, independently of AAT session | ||
Stroking of dog | All coding items mentioning initiated / maintained tactile contact with the dog | “He strokes Quedo and grasps his fur” (P1) | |||
Effect of AAT | Effect of AAT | Closeness / intimacy and trust | Coding items mentioning closeness, intimacy, trust, bond | “She calls the dog to her, enjoys the closeness with her, strokes her only shortly” (P51) | |
Calmness / relaxation | All coding items related to relaxation / deceleration of life speed / calmness; either mentioned by the patient or perceived by the dog handler | “She seems relaxed and calm again” (P45) | |||
Self-efficacy | Coding items indicating actions of the patient and the ensuing effects; patient realization that his/her actions have effect on environment | “And realizes she can bring about things” (P44) | |||
Distraction | Coding items mentioning the patient’s distraction because of the AAT session | “Is happy ‘about the distraction from this disease’” (P52) | |||
Catalyst for communication | Coding items related to AAT facilitating and initiating communication, providing conversation topics, serving as ice-breaker | “He speaks about his experiences with dogs and animals, how beneficial these were for him, occasionally about the relationships one has with animals. This causes him to think about his children, he talks about them, his suicide attempt and his other thoughts.” (P32) | Patient - dog handler patient – dog patient – relatives relatives- dog relatives - dog handler | ||
Rejection / aversion | Coding items describing rejection of / aversion to AAT sessions or parts of the intervention | “She stroked her body, emphasised now that she did not like the dog licking her and lead Lotti together with me in a way which allowed her to reach her back and to stroke her there.” (P16) | |||
Activation | Coding items describing that the AAT session has an activating effect on the patient / relative | “He seems content, activated, a bit excited.” (P20) | |||
General effect of contact with animals | Coding items describing the effects of animals on human beings, what they evoke in human beings, what they can mean for human beings | “He speaks about his experiences with dogs and animals, how beneficial these were for him, occasionally about the relationships one has with animals.” (P32) | |||
Emotions / observer perception | All coding items related to the dog handler perceiving and identifying emotions of the patient or relative | “She is very pleased, almost seems to be touched” (P44) | Including tears interpreted as sadness / joy, interpreted by dog handler; facial expression unambiguous / clearly understandable | ||
Emotions / self-perception | All coding items related to the patient / relative identifying his/her emotions or speaking about emotions | “During that she talks in detail about her husband’s dogs, the associated feelings, e.g. pride, but also fear and grief” (P36) | Including relatives’ comments on behalf of the patient | ||
emotions / humour | Coding items related to patient currently being able so show humour by means of comment, laughing, joking | “Made some jokes, laughed several times a bit cautiously – but sincerely about her thoughts.” (P51) | |||
Emotions / understanding / reflexion | Coding items related to the patient perceiving sent emotions, reflecting on them, interpreting them and/ or reacting to them | “She watches and peers at Lotti intensively, verbally mirrors her behaviour and declares her being motivated, adopts this motivation for herself.” (P52) | |||
Patient’s behavioural activation through AAT | Behavioural activation | Yes; own ideas for exercises | All coding items identifying motivated behaviour during the interaction with the dog and patient’s own ideas for exercises are expressed and / or executed | “Patient asks for dog-snacks and bottle himself, he decides himself and becomes active.” (P38) | |
Yes; instruction / suggestions for exercises necessary | All coding items related to the patient being motivated but in need of ideas and suggestions on how to interact with the dog | “He needs a bit of prompting to initiate contact with Lotti” (P47) | |||
No motivation | All coding items related to the patient being listless or not motivated. Nevertheless, mention of patient having and expressing ideas for exercises is possible | “Patient does not respond to suggested activities” (P12) |