Abstract
“The combination of an aging population and advances in
critical care medicine is resulting in a growing number of survivors of
critical illness.[1] Survivors' descriptions of their stay in an intensive care
unit (ICU) are frequently filled with traumatic events, and include experiences
of confusion, anxiety, sleeplessness, pain, and loneliness.[2,3] Sedative and
anxiolytic medications administered to manage patient symptoms are associated
with delirium and worse physical and mental health outcomes.[4] Therefore, there
is growing interest in the use of non-pharmacologic interventions and in
creating a more humanized environment in the ICU for patients and their
families.[5] Such efforts have included a focus on understanding the critically
ill patient as an individual and providing comprehensive medical,
psychological, and rehabilitation care.[6–8] This publication aims to: 1)
suggest a conceptual model for the use of non-pharmacologic interventions to
reduce suffering and promote recovery in a more humanized ICU environment; 2)
describe animal-assisted intervention (AAI) as an exemplar of a
non-pharmacologic intervention and provide a conceptual model for the utility
of this intervention; and 3) discuss the basic principles for introducing a
non-pharmacologic intervention program in the ICU.” (Hosey et al. 2018, p. 1)
Highlights of this study include:
“Some healthcare facilities have integrated AAI, in
populations ranging from pediatrics to geriatrics, in order to reduce suffering
and promote recovery behaviour”.
“Anecdotal evidence suggests that a dog sitting in a
patient's lap eases suffering and builds motivation in ways that medical
interventions may not”.
Directly quoted below, Hosey
et al. (2018, p. 5) have identified six critical success factors to build an
AAI Program in an ICU:
- designating a champion who is consistently present in the ICU with established credibility to create systematic change;
- having clear program goals with milestones and measurable outcomes, such as a. improving patient mood, b. improving engagement in medical care and rehabilitation therapies, and c. reducing perceived pain;
- including stakeholders who can help identify and surmount barriers to implementation, such as risk management and hospital epidemiology and infection control staff;
- identifying animal teams and partnering them with an organization that has credibility in training teams for the hospital environment, such as Pet Partners, Inc. (https://petpartners.org/) and Assistance Dogs International (https://assistancedogsinternational.org);
- creating a policy that a. establishes goals of the program, b. outlines roles/responsibilities for all involved in the program, c. outlines logistics of animal visits, d. specifies what do in the event of an accident, and e. establishes a plan for program evaluation; and
- launching the program with patients who have a high likelihood of success, such as patients without delirium, communicable disease, or the need for contact precautions due to colonization with a drug-resistant microorganism, to build confidence and create momentum for the program.
Finally they conclude that in terms of non-pharmacological
interventions, Animal Assisted Interventions has the potential to reduce
patient suffering and enables people to be able to take and “active role in
their recovery”.
Reference
Hosey, MM, Jaskulski, J, Wegener, ST, Chlan, LL & Needham, DM
2018, “Animal-assisted intervention in the ICU: a tool for humanization”, Critical Care, vol. 22, no. 22, pp. 1-5.
