Scroll through a finished NUR 440 Module 3 annotated bibliography on animal-assisted activities for hospitalized children, with a short introduction, five annotated sources with levels of evidence, a synthesis paragraph and references. Searches like "nur 440 module 3 assignment", "nur440 module 3 annotated bibliography" and "nur 440 module 3 example" land here.
The NUR 440 Module 3 example, in full
Therapy Dogs on the Pediatric Unit: An Annotated Bibliography on Animal-Assisted Activities for Hospitalized Children
[Student Name]
Southern New Hampshire University
NUR 440: Research and Evidence-Based Practice
Module Three Annotated Bibliography
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Therapy Dogs on the Pediatric Unit: An Annotated Bibliography on Animal-Assisted Activities for Hospitalized Children
Introduction
A composite 22-bed pediatric unit has been approached by a volunteer organization offering weekly visits from certified therapy dog teams. Before the unit agrees, nurses want to know what the evidence says. The PICOT question is: in hospitalized children aged 4 to 17 (P), do visits from a therapy dog team (I), compared with usual care or other diversional activities (C), reduce pain, anxiety or physiological stress (O) during the hospital stay (T)?
Sources were located through CINAHL Complete and PubMed using combinations of animal-assisted therapy, animal-assisted activities, pet therapy, therapy dog, child, pediatric and hospitalized, and through the reference lists of retrieved articles. Five sources were selected for their relevance to the question and their range of designs. Levels of evidence follow a common seven-level hierarchy in which systematic reviews of randomized trials are highest and expert opinion lowest (Melnyk & Fineout-Overholt, 2023).
Branson et al. (2017)
Branson et al. (2017) conducted a randomized controlled study in which 48 hospitalized children were assigned either to a 10-minute animal-assisted activity with a therapy dog or to a control condition, 24 in each group. The researchers measured anxiety, positive and negative affect, and two salivary biomarkers of stress, cortisol and C-reactive protein, before and after the session. Positive affect rose and negative affect fell more in the animal-assisted group, but the differences between groups were not statistically significant, and there were no significant differences in cortisol or C-reactive protein.
As a randomized controlled trial, this study provides Level II evidence and is the strongest design among the sources found. Its strengths include random assignment and the use of biological markers alongside self-report, which reduces reliance on children's ratings alone. Its limitations include a small sample from one hospital, a single short session and the difficulty of detecting change in children whose baseline anxiety was already low. The source is highly relevant because it tests the intervention directly in the target population, and its nonsignificant results caution against claiming a measurable effect on stress from a single brief visit.
Kaminski et al. (2002)
Kaminski et al. (2002) compared hospitalized children who received a pet therapy visit with children who took part in a standard child-life play session. Outcomes included observed mood and behavior, parent and child reports, and physiological measures such as heart rate and blood pressure. Children in the pet therapy group showed more positive affect after the session, while physiological measures showed little difference between the groups.
This is a quasi-experimental comparison without randomization, which places it at Level III. Comparing pet therapy with an active alternative, child-life play, rather than with no activity is a strength, because it asks whether the dog adds something beyond general distraction. Limitations include the lack of random assignment, a single site and the age of the study. The source is relevant because it suggests that mood may improve more than physiology, which helps define realistic outcomes for the unit.
Sobo et al. (2006)
Sobo et al. (2006) conducted a descriptive pilot study with a convenience sample of 25 children aged 5 to 18 who had undergone surgery and were experiencing acute postoperative pain. Each child received a single canine visitation session and completed a survey before and after, followed by an interview. Perceived pain decreased significantly after the visit, and children's interviews suggested that the dog distracted them from pain and prompted comforting thoughts of home and companionship.
As a single-group pre-post pilot without a control group, this study provides Level VI evidence, and the reduction in pain could reflect time, medication or other factors rather than the visit itself. Its value lies in showing feasibility in a surgical population and in capturing children's own explanations of why the visit helped. It is relevant as supporting evidence for pain outcomes, but it cannot establish that therapy dogs caused the change.
Uglow (2019)
Uglow (2019) described and evaluated an established animal-assisted intervention service at a children's hospital in the United Kingdom, including how the service was organized, how visits were arranged and how patients, families and staff experienced it. Feedback from children, parents and staff was strongly positive, with respondents describing reduced stress and improved mood.
This service evaluation is closer to quality improvement than research and represents Level VI or VII evidence. Satisfaction surveys are prone to response bias, and the absence of a comparison group means effects cannot be measured. The source is nonetheless highly relevant to implementation, because it describes how a hospital actually runs such a program, including scheduling, handler training and staff support.
Murthy et al. (2015)
Murthy et al. (2015) present recommendations from a professional society in hospital epidemiology on animals in health care facilities, including animal-assisted activities. The guidance covers written policies, health and temperament screening of animals, handler training, hand hygiene before and after contact, and exclusion of patients for whom contact may be unsafe, such as some immunocompromised children.
As expert recommendations based largely on limited evidence and consensus, this source is Level VII. It does not address benefit, but it is essential to the question because any practice change must manage infection and safety risks. It will shape the implementation section of the final project.
Synthesis
Taken together, the sources suggest that therapy dog visits are well received and may improve children's mood and perceived pain or stress, but the only randomized trial found no statistically significant effect of a single brief visit on measured anxiety, affect or stress markers, and much of the supporting evidence comes from weaker designs. Safety guidance shows that visits can be managed with clear policies. The main gaps are a lack of larger randomized trials, limited data on repeated visits and little evidence on which children benefit most. The next milestone will appraise these studies in more detail and search for newer reviews before a recommendation is made.
For the unit, this means that a program could reasonably be offered as a comfort and diversional activity valued by families, with clear safety rules, but it should not be described to parents or managers as a proven treatment for pain or anxiety until stronger evidence is available.
References
Branson, S. M., Boss, L., Padhye, N. S., Trötscher, T., & Ward, A. (2017). Effects of animal-assisted activities on biobehavioral stress responses in hospitalized children: A randomized controlled study. Journal of Pediatric Nursing, 36, 84-91. https://doi.org/10.1016/j.pedn.2017.05.006
Kaminski, M., Pellino, T., & Wish, J. (2002). Play and pets: The physical and emotional impact of child-life and pet therapy on hospitalized children. Children's Health Care, 31(4), 321-335. https://doi.org/10.1207/S15326888CHC3104_5
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Murthy, R., Bearman, G., Brown, S., Bryant, K., Chinn, R., Hewlett, A., George, B. G., Goldstein, E. J. C., Holzmann-Pazgal, G., Rupp, M. E., Wiemken, T., Weese, J. S., & Weber, D. J. (2015). Animals in healthcare facilities: Recommendations to minimize potential risks. Infection Control & Hospital Epidemiology, 36(5), 495-516. https://doi.org/10.1017/ice.2015.15
Sobo, E. J., Eng, B., & Kassity-Krich, N. (2006). Canine visitation (pet) therapy: Pilot data on decreases in child pain perception. Journal of Holistic Nursing, 24(1), 51-57. https://doi.org/10.1177/0898010105280112
Uglow, L. S. (2019). The benefits of an animal-assisted intervention service to patients and staff at a children's hospital. British Journal of Nursing, 28(8), 509-515. https://doi.org/10.12968/bjon.2019.28.8.509
How this NUR 440 Module 3 example is structured
An annotated bibliography is judged on the quality of each annotation, so every entry follows the same four moves: what the study did, what it found, how strong the evidence is, and what it means for the question. A short introduction states the PICOT question and how sources were found. The five entries are ordered from the strongest design to the weakest, with the safety guidance last because it addresses risk rather than benefit. A brief synthesis at the end draws the entries together and names what the evidence does not yet answer, which prepares the appraisal and synthesis in later milestones.
Get NUR 440 Module 3 written to your instructions
Send the NUR 440 annotated bibliography instructions and rubric, your PICOT question and any sources you already have. The desk writes the annotations to that prompt within 24 to 48 hours; the first sample is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
NUR 440 Module 3 questions, answered
What does NUR 440 Module 3 usually ask for?
In sections that build the final project in stages, this point in the course often calls for an annotated bibliography: a set of sources on your PICOT question, each in APA format followed by an annotation that summarizes, evaluates and explains the relevance of the source. The required number of sources and annotation length come from your guidelines.
What should each annotation include?
Summarize the purpose, design, sample and main findings in a few sentences, then evaluate the source: its level of evidence, strengths and limitations. End with how the source relates to your question. Avoid copying the abstract, which is summary without appraisal.
Can I include a guideline or policy in an annotated bibliography?
Usually yes, if it is relevant to your question and your instructor allows it. Guidelines and professional statements are especially useful for safety, standards or implementation. Label them clearly as expert opinion or guidance rather than research.