Saturday, April 14, 2007

The truth about dogs (but not cats)

Based on the experience of several other hospitals (including our colleagues at Boston Children’s Hospital, Tufts-New England Medical Center and MGH), we recently started a pet therapy program in selected areas of the hospital. This is a collaborative program between the Departments of Volunteer Services, Social Work and Nursing. You may not believe this, but research studies suggest that interaction with healthy, well-behaved pets (specifically, dogs) can improve a patient’s mood, lower blood pressure and heart rate and stimulate other factors favorable to healing.

These have to be trained dogs. Ours come from a group called Caring Canines. A volunteer team (the owner and his or her dog) will spend 1-2 hours a week visiting hospitalized patients who give written consent to such visits. Family pets and other animals are not part of the visiting program. Obviously, there are very strict rules designed to protect against infection risks.

I can tell you are skeptical! But here is a story from the first week of the program from Terry Morgan in our Volunteer Services office:

This morning when I got to my office I was greeted by a doctor who I encounter on a regular basis. This morning instead of his cheery self and our talks about jazz, he was very serious and asked me if it was my idea to have the dogs come to visit. I told him it was a group effort and cited as many names of people as I could remember who drove this program forward. I told him it had been very well received. He still looked so serious, and I was afraid he was going to tell me he was not a fan.

The doctor told me that on Wednesday he had just told a patient that she had a serious life-threatening illness. He went back to see her after giving her this news and found her surrounded by three dogs, kissing her, loving her, cuddling with her -- a golden, a lab, and a pug. She told him about her dog at home that has diabetes and she said, "This visit made me so happy."

Then the doctor and I shared a hug and a few tears and then he said, "This program is a real mitzvah. I hope it continues and I wish you the very best with it."

I told the doctor that we hope to be upstairs every Wednesday. He said that was a very good day to come because he gets his patient lab results on Tuesday and usually gives his findings to patients on Wednesday.

Now, are you persuaded?

22 comments:

Anonymous said...

Congratulations and sincere thanks for starting a new pet therapy program at your hospital. The benefits that animals bring to humans have been proven many times over, not just between pets and their families in a typical home setting, but also between pets and patients/residents of nursing homes, psychiatric clinics, assisted living centers, physical therapy/rehab centers, and many other such facilities. Animals (particularly dogs) provide unconditional love, unconditional acceptance, and an unbridled enthusiasm for life.

The PetWork (http://www.petwork.com/petworkblog/?cat=19) has many listings for animal-assisted therapy, for anyone who still needs convincing or wants information about pet therapy services in their area.

Jennifer said...

It's great to hear you've gone to the dogs! I hope the program continues to go well.

Helen said...

i hardly needed persuading, but the story obviously reinforces my personal bias toward furry animals. as one friend keenly observed, a dog is one creature that will give you concrete, unfettered, and eager love - all for the simple price of humane treatment. as a healthcare provider who survives on a creed of giving and human feedback rather than financial reward, i'd say that 'man's best friend' and i have found our value system to be well-aligned. i can't help but identify with the caring canine. super props to them and their owners for their work.

for the skeptics out there, i attempted a pubmed, ovid search for the evidence-based literature to address the primary concern of pet therapy detractors. from a quick scan of a couple of nursing journal articles (that's where most of the studies are), Brodie et al summarized things rather nicely. "Zoonoses, allergies
and bites, the three issues surrounding pet therapy
causing greatest concern, have the potential to be
controlled in a supervised health care setting (Barba,
1995), thereby reducing risks to minimal levels for
patients and staff (Schantz, 1990). If simple guidelines
incorporating comprehensive veterinary care and improved
education are followed most areas can enjoy
problem-free animal interaction. An example of such a
guideline, drawn up on the basis of the literature
reviewed here, is given in Appendix 1. As identified by
the WHO (1981, p. 43):
Whilst irresponsible attitudes easily result in problems
of surplus and straying animals, environmental
pollution and an increased risk of zoonotic disease,
companion animals which are properly cared for
bring immense benefits to their owners and to society
and are a danger to no-one."

Pierre Thierry said...

What kind of measures are taken to avoid infections or parasites? Are the dogs specifically cleaned?

Val said...

Thanks for this post! I'm no skeptic - therapy dogs were regular visitors to my former acute rehabilitation center, and they brought great joy to our recovering patients. They even helped to chase after stray therapy balls in group exercises. Lots of fun! I can understand how cats might not be as effective in these sorts of endeavors, however.

Anonymous said...

Don't you have patients who are allergic to dogs? And don't these dogs--and their dander--come into areas of the hospital--hallways for certain, perhaps waiting rooms,etc.-- that will be used by your asthmatic patients also?
Considering how hospitals seem to continually and repeatedly ask patients if they are allergic to latex--no, I for one am not persuaded.
Of course, people who may go into anaphlactic shock are in a small minority; perhaps it isn't worth thinking about them if the dogs offer so much benefit to the majority.

Paul Levy said...

Perre,

Here's a summary of requirements for the dogs:

1. All dogs will be carefully screened behaviorally and medically twice a year by licensed veterinarians approved by Caring Canines
2. The behavioral screening will include successful completion of the Canine Good Citizen Test of the American Kennel Club or its equivalent.
3. The medical testing will include but not be limited to a throat culture (for Strepotococcus A) and fecal tests for giardia, cryptosporidium, salmonella, shigella, campylobacter, roundworm, hookworm, tapeworm and dermatophytosis infestation at least every six months.
4. The dog’s volunteer/owner will also supply proof from a licensed veterinarian that the dog has been vaccinated in the previous year against distemper, hepatitis, parainfluenza, parvovirus, leptosporosis.and current rabies documentation
5. All dogs must be on a flea and tick prevention program, but should not be wearing flea collars.
6. All dogs must also be on heartworm prophylaxis.
7. Female dogs will not be allowed to participate while they are in heat.
8. All dogs must be bathed and/or groomed the day before or the morning of the hospital visit. Toenails should be clipped and eyes and ears checked just before visit.
9. Dogs with skin or ear infections or gastro-intestinal upsets will not be allowed to visit until they have been cleared by a licensed veterinarian. Each dog’s evaluation will be kept on file in the volunteer office.
10. Each dog’s evaluation, including behavioral and medical screening, will be kept on file in the volunteer office.

Paul Levy said...

And here are the visit requirments:

1. A Beth Israel Deaconess volunteer office representative will meet the handler and dog at the designated entrance to review the visit protocol.
2. Patients and family members who receive a dog visit must wash their hands thoroughly after each visit.
3. Nursing and other hospital staff should not pet or handle the dog. If staff pet or handle the dog, they must wash their hands.
4. If the dog is to sit in the patient’s lap, a protective pad will be used to prevent direct contact with the patient’s clothing.
5. All dogs must be kept on a short leash at all times, in and immediately around, the hospital. Owners must remain with dogs at all times.
6. Dogs (and owners) must enter through the designated lobby and use only the visitor elevators. Owners should use judgment and ask permission of other people in the elevator before entering. The owner/dog teams must also leave directly via the lobby and should not stop in the cafeteria, café, gift shop, etc.
7. Before entering any patient room, the volunteer will check with the nursing station to make sure both the designated patient and his or her roommate have no medical conditions that will preclude such a visit. The volunteer will also be required to ask all people in the room (including visitors) whether an animal visit is acceptable to them at that time and whether they have animal allergies or asthma. If they are not amenable or have allergies or asthma, the visit will take place elsewhere or be cancelled for that room.
8. All dog visits will take place in rooms without carpets to minimize the chance that dog dander will linger in the environment.
9. Dogs may not be fed during a visit. Owners should feed and water dogs before entering the hospital.
10. Dogs with fur may be required to wear jackets to prevent excess shedding.
11. All dogs will be exercised before their hospital visit (to burn off excess energy) and should be curbed to minimize the chance of urinary or bowel accidents.
12. Any accidents in the hospital will be cleaned up immediately by the owner and reported to Environmental Services.
13. Any untoward events, such as scratching or biting, will be reported immediately to nursing; any dog involved in such an incident will be permanently banned from the program. The MD will be notified of any untoward event and the RN will complete an incident report.
14. If the nursing staff has concerns about the volunteer team’s behavior, the staff should call Volunteer Services immediately.
15. The dog handler/owner will call the volunteer’s office to report off at the end of each visit session.

Paul Levy said...

And here are the patient screening requirements:

This is a voluntary program. It is the role of the nurse to determine the appropriateness of pet therapy as an intervention for a patient. The nurse will obtain MD sign-off on the patient’s suitability for a pet visit.

1. Patients will be asked to sign a brief consent form before the dog visit.
2. If a pt is in a semi-private room, both patients in a shared room must agree to the visit.
3. Patients not permitted to receive a dog visit:
• Patients on isolation/precautions
• Patients with skin breakdown or uncovered wounds, or those with a roommate with skin breakdown or uncovered wounds
• Patients with immunosupressive illnesses which increase the risk of infection such as a transplant, leukemia
• Patients with neutropenia or who were recently treated with chemotherapy (anticipating imminent neutropenia)
• If the patient’s nurse or doctor objects to a pet visit the visit will not take place
• Patient’s with known fear of dogs
• Patient’s with animal allergies or those with a roommate with animal allergies
• Patients with: TB; Hepatitis; Salmonella; Staphylococcus Aureus; Shigella; FUO
4. The RN will place the signed consent in the patient’s record and will document the patients consent to participate and response to the visit in the progress notes.
5. Patients and/or staff can terminate a visit at any time.

Labor Nurse said...

You didn't need to convince me. There are more days than not where the only "people" I want to see are my cats and dog. They tend to be better conversationalists than most.

Nancy said...

sounds like the dogs are far less of a health risk for patients than the 30-60% of your employees who don't wash their hands!

Paul Levy said...

Trust me, the irony of putting these two posts next to each other was not lost on me!

Bwana said...

"You may not believe this, but research studies suggest that interaction with healthy, well-behaved pets (specifically, dogs) can improve a patient’s mood, lower blood pressure and heart rate and stimulate other factors favorable to healing."

Trust me, when I get near a dog, my mood gets ugly, my blood pressure goes up, my heart rate nears palpitation, and I feel as far away from healing as could be. When I got close to a dog about a year or two ago, the damned thing bit me because her master gave me a hug and she thought I was a threat to him.

Recently, when I was in a Store 24, someone brought an unleashed dog in - not a seeing-eye dog and, I believe not permissible in food stores.

Frankly, I think this is all poppycock -- it may be that research shows that people who are in a comfortable environment heal faster. The dog may make the environment more comfortable for a dog lover, but let's not confuse condition with cause.

This appears to me to be an unnecessary and misguided attempt - sort of political correctness vis-a-vis animals - to find holistic properties in meaningless phenomena and associations.

Next, we'll have pressure on health insurers to pay for pet food so that subscribers can enjoy a healthy cuddle with a stuffed mutt.

Sorry!

cheerz...Bwana Curmudgeon

Diane Geggis said...

Bwana,
I sadden to hear that you had such negative experiences around dogs. You are right that each person has there own value on interactions with animals. However,I have seen first hand the healing power of these theraputic dogs in the nursing home environment and I applaude the work of all involved.
I am gled to see that this type of therapy has moved to the hospital setting.

RJS said...

Trust me, when I get near a dog, my mood gets ugly, my blood pressure goes up, my heart rate nears palpitation, and I feel as far away from healing as could be. When I got close to a dog about a year or two ago, the damned thing bit me because her master gave me a hug and she thought I was a threat to him.

Recently, when I was in a Store 24, someone brought an unleashed dog in - not a seeing-eye dog and, I believe not permissible in food stores.

Frankly, I think this is all poppycock


Well you've just proved that it is NOT bunk. While you experience a sympathetic nervous response, many people experience the opposite. There IS an effect on you, it's just not the desired one. :p

So let's not throw the baby out with the bathwater... ;)

Anonymous said...

Every time I am in the hospital, I miss my dog. Same for a hotel room. Now, my beloved pet has left this earth, and I may need to go to the hosp just to get some good dog love!

Anonymous said...

I am writing because I was one of the Caring Canines volunteers who took part, with my dog, in the first therapy dog visit at BIDMC, and wanted to comment on the visit from our perspective.

First of all, we want to extend our appreciation to all at the hospital who made this arrangement possible, and to Paul Levy for his supportive blog remarks. We were delighted by the positive welcome we got from those we encountered as we moved through the hospital, and especially from the patients we spent time with.

Of course, our dogs are registered therapy dogs who have been obedience and temperament tested before being admitted to the program, and have proper health credentials. Most of all, they are gentle creatures who love people and love doing their visiting job--as do their humans. We have also been tested--for our handling and visiting skills. The dogs are always under our control, and we would never visit with anyone who is not comfortable with dogs for any reason or not able to be around dogs due to health considerations. A primary concern is for the people and facilities we visit, and we come with absolute respect for their needs and wishes and abide by the agreed-upon protocols.

All that having been said, in addition to considerable literature proving the beneficial effects of dog visits to patients, elders, special needs folks, at-risk kids, etc., we have seen firsthand, over and over, the positive--and sometimes even miraculous--results of dog visits. There are observable physical and emotional changes that make a huge difference for the "visitees."

It is a real privilege for me to be involved with Caring Canines and to be able to share the joy, comfort, and solace of canine contact with those we visit. I hope our involvement with BIDMC will continue to be a mutually beneficial arrangement.

--Miko's Mom

margalit said...

My son is currently in a hospital with a Caring Canines program. It has made a HUGE difference to his mood and his ability to heal. He partook of this program a couple of years ago when he was at Children's for 6 weeks and has never forgotten it. Ever since the program he has begged and begged for a dog. Unfortunately we can't have a dog (we have a cat who barely tolerates people and HATES dogs) but this introduction to dogs has turned my child from a fear of dogs to a severe love of dogs.

I'm sorry if people don't understand or appreciate this program, but as the mother of a child with a pretty severe illness, visiting dogs has made a huge difference for my son.

Anonymous said...

I just wanted to comment and say that I think this is a great idea and it is an up-and-coming sort of thing. I went to a Quinnipiac University in CT where our occupational therapy students actually have pet therapy as part of one of their required OT courses. There is evidence from research that this works for the right patient in the right situation and that's what we're all about right? Evidence-based practice and quality care...I'm all for it!

eeka said...

I'm a proponent of pet therapy (particularly for my clients with autism) even though I dislike most dogs myself.

When I was inpatient at another hospital in Boston last year, the pet therapist came around and asked people if they wanted to see a dog later in the afternoon. I stated that I didn't, and my roommate stated that she did. I wasn't asked about allergies or phobias or anything, or told that the dog was going to be brought into our room. I don't have allergies or phobias, but it did concern me that she didn't ask. The dog just showed up in the room later. The pet therapist kept trying to get me to come over and pet the dog, which I had no interest in. I thought this was pretty offensive -- what if I did have a phobia and didn't feel like discussing it with some intrusive stranger?

I think I'll suggest to the other hospital that they consider using more qualified handlers like it seems your hospital is.

Mary Lu said...

Paul,

The last couple years we've had Mother in and out of nursing homes for various reasons. At 81 yrs old Mother (actually my mother in law,) can be quite a handful for the staff with her bouts of depression from being institutionalized, or her occasional memory loss when she is seriously ill.

However-- we found out by accident we have a secret weapon in our arsenal of getting Mother well. The one thing that snaps her head around getting her mentally focused, and back on track are my daily visits with Andy our 5 yr old Miniature Schnauzer.

Andy started visiting her at 3 yrs old when she was institutionalized the first time, when she requested (more demanded,) that if the OT folks could have a dog in OT to visit patients-- she wanted to see "her Andy." So sheepishly I asked. After I answered the 20 questions about behavior, training, bathing and clean bill of health the RN's and OT/PT staff said to bring him in for a "trial" and see how it went.

So we took Andy in to see Grandma the next day. From the moment he hit the grounds he knew this was a special deal and going to see Grandma. Along the hallway he stopped to say hello's to all the patients and took their reactions as cues to either stay a moment or move along. You could hear the happy twitter as he left a wake in the hallway behind us. The nurses actually told us that his visit made some of the patients smile for the first time in weeks. So we knew we were doing something right.

When we finally hit Mother's room he made a bee-line for her and flew into her arms. There he stayed for the next hour sucking up every hug and pat as if it were his life mission. Mother's mood dramatically changed. Even her doctors dropped by to see the reaction to her change in her behavior and mood. One MD whispered to me... "Keep bringing him. She needs this stimulation and a reason to push herself." And so we started to use "Andy Therapy" as our secret Rx to getting her well enough to come home...

What we learned was her BP did drop at least 10 pts after Andy's daily visits, she remained and gained/retained mental focus as well. Andy became the reason we could get her to do her all of her PT and gain strength, because she needed to be able to navigate her walker and/or wheelchair to go outside to the patio to play ball with Andy. Remember any reason to give patients a will to live is a good thing... And so we played it out.

Frankly there were days when she was frustrated at being kept at the nursing home, I could have dropped Andy off at the front door and she'd have been happier to see him than us. (smile) But as long as we brought Andy along she was happier and more cooperative. Anything to keep the RN's happy!

All in all we've found 90% of the nursing homes here in Southern California welcome well behaved family dogs to visit their patients, as long as they meet the healthy, clean etc standards. Every place is a little different, but by far most welcome the idea as it removes the isolation elderly patients feel and establishes a "home type" routine.

Years ago I never thought in a million years we'd be allowing pet visits in our hospitals-- now, they're a secret Rx where unconditional love may be the key in turning people's psychological health around so the body can heal.

Go walk around and observe what happens next time the dogs hit the hospital floors-- Just listen. You really will be surprised just how much good they do.

Kim said...

Hey, Paul, love your blog! Very interesting discussion about dog therapy!

Check out my new blog: Top Dog Blog!

It's still pretty new, but I'll be adding new content and pictures daily.

Visit http://topdogblog1.blogspot.com

See you there!
Kim