Pets Impact on Quality of Life, a Case Study

Ellen “Tracy” Thatcher, MSN, ARNP-C, GNP, CHPN

Pets definitely improve QOL and numerous studies support this. Pets inspire smiles, storytelling
and relaxation. In a review of the literature collected on this subject, it was found that a study
was done, "A CE offering, Innovative Approaches, from the American Journal of Critical Care
Animal-Assisted Therapy in Patients Hospitalized With Heart Failure". The Research conclusions
indicated that the presence of and interaction with animals had measurable positive effects.1 It
decreases heart rate and blood pressure and improves anxiety. It also concluded that Animal-
assisted therapy reduced epinephrine and norepinephine levels, suggesting adventitious
changes in activation of the autonomic nervous system. It revealed that the volunteer-dog team
visit resulted in decreases in pulmonary artery and wedge pressures and stated anxiety levels.
And finally, but most importantly, it determined that dog ownership is a significant,
independent predictor of survival one year after a myocardial infarction. It was very powerful to
see that this had been researched in such a professional and significant way. It was impressive
to realize that this had been presented as a formal research study in a professional medical
institution and had very positive meaningful outcomes that were often surmised but never
proven in such a manner.1

Pets and Medicine

There are many stories of how animals can be integrated into nursing and medicine. On Ripley’s
Believe It or Not, there was a story about cancer smelling dog. This story was on television and
showed how a dog was able to detect cancerous melanoma on several occasions with a high
accuracy rate. One way that they tested the dog was by taking a small biopsy slice of known
melanoma and put it under one of twenty band aids applied in various places on a person and
let the dog find the one with the melanoma under it. The dog did find the one with the
melanoma under it each and every time it was presented with this scenario. Also was found in
the review of the literature, was a pet cat in a nursing home facility that was highly accurate at
predicting approaching death by getting on the patients bed and lying at the foot of their bed
until they passed away. The nurses believed that the cat had the ability to predict the patient's
death. So much so, that the nursing home staff would call family to the patient's bedside if the
cat started lying on the patient's bed. At first the attending physician, Dr. David Dosa dismissed
these claims but later had a change of mind and heart. As it turns out the cat was highly
accurate in her predictions and he took heed. This inspired him to such an extent, that he wrote
a book on the subject, Making Rounds With Oscar. It was wildly popular with high readership
and became a book on the top sellers list. 2 While yet, another article talked about how owners
are motivated to quit smoking if veterinarian suggests that the animal will be harmed and die
earlier if they are exposed to second hand smoke.3 The bond between animals and humans is
strong. Although most stories are anecdotal they are very powerful and valid. Numerous stories
similar to these supported the strong undeniable pet to human connection.

Institutional Policies and Procedures

I bring my dog with me to work often. This is not as simple as it may seem. Some people may
think this is an unofficial act or that animals are forbidden, but it is not the case. I have been
stopped by some staff and security asking me about this and telling me this is not allowed. This
is where the education comes in. There is a process for bringing animals into the work place
and this is explained to anyone who may have questions or reservations about this. Education is
a key to these programs working for facilities. There are policies that have been developed to
ensure safety in these settings. The animal has to be seen by a veterinarian, be deemed free
from communicable disease, up to date on its immunizations and have no aggressive
tendencies or history. This has to be documented annually and presented to the designated
person at the facility, in our facility it is the Recreational Therapy Department. Next, it is our
policy that the pet goes through pet volunteer program that assess the appropriateness of the
animal as a pet volunteer. The volunteer organization is called PUP, Pets Uplifting People. It is
surmised that if the pet passes these rigorous requirements that are required of a volunteer
animal, then the pet is fit for our program. The screening involves an obstacle course that
presents the animal with various scenarios that the animal may encounter when in the nursing
home or other institution. There are coughing, crying and yelling people, and housekeepers
with vacuums, brooms and mops, people in wheelchairs, walkers and canes and others with
service animals or other volunteer pets. The dog is presented with each scenario and the
response of the dog is closely monitored and documented on a grading sheet as a pass or fail. If
the dog does not pass this obstacle course then they will not be allowed to be in project PUP.
Then at the facility level, a pet care plan that is formulated. The animal is not allowed on the
acute care wards, in intensive care units, isolation rooms or anywhere where a patient many be
immunocompromised or otherwise at risk. Common sense should be used and if a patient is ill,
undressing, involved in rounds or otherwise occupied then consider visiting at another time.
The visits should be a pleasure, not a nuisance. This is a collaborative, shared governance
approach; many team members are involved in the process to include, but not limited to the
pet owner, infection control team, the recreational therapy team, supervisors and security.

Animal Assisted Therapy (AAT) vs. Animal Assisted Activities (AAA)

Many people call this pet therapy. However there are some distinctions one must consider
before calling pets at work or living in facilities "pet therapy". There are marked differences in
Animal Assisted Therapy vs. Animal Assisted Activities. AAT are ordered by the provider, goals
and limits are set with therapeutic advances expected i.e. increased ROM and mobility. AAA
are activities where a group would gather around an animal and enjoy the interaction, but
there are no formal orders or expected outcomes, only enjoyment and recreation. Both of
these modalities have great benefits and have well researched documented positive
outcomes.4,5

Culture Transformational Initiatives and Quality Measures

Pets are an integral part of culture transformation efforts that are under way. For those who do
not know about culture transformation, it is an effort to make long term care settings more like
home environments. There are different things that facilities can do to achieve this. Animals
definitely help to do this and our leaders recognize and appreciate this. There is a tool that
facilities are now using to measures the facilities accomplishments in meeting culture
transformation efforts. Quality measures and indicators are in place and are measured. Animals
have been identified as an important part of this tool that measures certain actions and
components in the CLC that contribute to culture transformation. Pets in the CLC's are now a
measureable event. On this culture transformation tool, there is a point system that gives
facilities points for different culture transformation efforts. The presence of residential pets and
visiting pets earns the CLC points. It is highly encouraged that CLC's have pets. It is realized and
proof exist supporting the positive effect this has on peoples QOL in all stages of life, to include
hospice modalities.6 Pets are not forbidden but rather embraced!

Cultural Considerations
Cultural differences are a special and important consideration when undertaking a pet
program. There are many different beliefs in other countries and cultures. With America being
the melting pot that it is, to neglect to consider and abide by others beliefs would be remiss
and could cause a failure in the programs that are intended to add to peoples QOL. Many
cultures do not hold the pet as near and dear as many of us do. Some of us feel the "pets are
people too". We kiss our dogs, dress our dogs and sleep with our animals. Some cultures find
this disgusting and unimaginable. After considering this and reviewing the literature it was
surprising on how diverse the beliefs about animals were. Some culture felt dogs were very
dirty and had no place in the home but believed cats were to be held in high esteem and were
allowed to live in the home with humans.7 Some cultures would eat a cat or a dog and this was
very acceptable.8 It was not usual to see these animals on the barbecue. If they have access to a
dog, they cook them for lunch, but it's not actually a formal family meal type thing, unless in
times of poverty and financial stress, then it makes its way onto the family's regular meal menu
and this is a fairly regular occurrence. In Niue; the police used to shoot stray dogs and give
them to people, mostly Tongans who eat dogs. Under New Zealand's Animal Welfare Act it is
legal to kill a dog if the animal is slaughtered swiftly and painlessly. In Korea both dogs and cats
are eaten. Cats are seen as vermin or as deliverers of bad fortune. In recent years, a small but
growing number of Koreans have begun keeping cats as pets. Cats can be found in Korea
because they were useful in controlling rats and as 'medicine' for sufferers of rheumatism.
Allegedly, cats may be put in a sack and pounced on the ground or hit with a hammer before
being put, sometimes still alive, into boiling water along with ginger, nuts and dates, to make a
'medicine' called goyang soju.9 In Islam A dog can be owned for purposes such as the following:
A trained dog for hunting, in Islam dogs are only allowed to hunt for food; there is no such
thing as hunting for fun, they are not allowed to kill or torture or drive them out of their
habitats for the fun of it. A trained dog as a guide is allowed and if a person is blind and he/she
has no choice but to keep a dog for essential services this can be acceptable and it is
permissible for him/her to keep a dog inside the house once it has been trained for service, but
it is still recommended that the dog have its own sleeping arrangement. They also allow a dog
trained for police duties, a guard dog to guard houses or property and a dog used by farmers to
shepherd cattle and sheep. Cats however, are held in high regard and are considered pure in
spirit, as is noted in the Quran. In one story a prophet was said to have a cat sit with him as he
gave his sermons. They can eat or drink from the same bowl as a cat and a woman was sent to
hell for not caring for her cat properly. In China animals are not treated with kindness, they are
treated inhumanely and abused. They eat their meat and use their fur. It must be realized and
appreciated before you judge the Chinese that they have not yet established a "pet culture". A
recent survey indicated 75% of Chinese polled wanted to end animal cruelty and human con-
sumption of dog meat. It's hard, but try to overlook the unkindness it is their belief system. 10
Owning pets is a relatively new phenomenon in Korea. Previously, animals had a very utilitarian
purpose in people’s lives, they were workers or food. As the society industrialized and became
wealthier, disposable income became the norm for a growing number of Koreans. And the pet
industry entered a boom period. Pet funerals are now legal in Korea. The current law classifies
dead pets as 'general disposal' and therefore animals can be disposed of with the household's
regular trash. With the legalization and licensing of pet funeral services, owners can choose
cremation or melting the bones into a solid mass, similar to a monument. 9 There were many
other finding s about cultural differences and there could be a whole separate article about
these differences, but these were some of the noteworthy findings I felt needed to be conveyed
and considered.

For the program to be successful and to avoid offending others the pet owner or handler must
first ask the person if they mind having a pet near them, on their bed or in their room. And, if
they do not want the animal around them then this needs to be abided by and respected to the
utmost without question or judgments.
Servant Leadership

Finally, servant leadership must be discussed.11 Without the awareness and blessings of our
leaders these program cannot exist and prevail. Before undertaking any pet project program it
must be discussed and evaluated by the leadership teams. There are many considerations and
planning that must take place before a program like this can be undertaken. I talked to people
at work about my new puppy and how happy she made me when I would go home after a long
day. They knew how special she was to me. My supervisor exhibited true servant leadership. I
did not ask my chief if I could bring my dog to work, but rather, I was asked by my chief if I
wanted to bring my dog to work. We went through the process with the different departments,
the vet and the Project PUP. I was honored that I was asked to do this and we embraced the
opportunity. We took the necessary steps to make this special thing happen. I exhibited servant
leadership and shared the process with others. I developed in-services and became an ANCC
CUE's provide on the topic. The facility developed formal policies. Later I was invited by our
nation's leaders to be a presenter at the National VA Leadership Conference in a breakout
session in Washington DC. It turns out servant leadership is contagious! Now there a several
dogs in our work area and service. Bringing the dog to work and incorporating her into my
practice has had a positive profound effect on everyone involved including the dog. It is hugely
rewarding. The smiles are infectious; the stories are endless and are very meaningful to the
human condition and experience. Pet therapy and activities provide unconditional acceptance
of a person. It allows people to think beyond themselves and to care for others. Pets allow all of
us to be better humans by focusing on the love of others and the QOL and palliation are greatly
improved for everyone involved.

References:

1. Cole, Kathie, RN, Gawlinski, RN, Steers, Neil, PhD, Kotlerman, Jenny, MS. (2007). Animal
Assisted Therapy in Patients Hospitalized With Heart Failure, American Journal of Critical
Care, 16(6).

2. Dosa, D. (2010), Making rounds with Oscar: The extraordinary gift of an ordinary cat,
Hyperion, New York, NY 10011

3. News & Notes, Pets: Motivation for smokers to Quit, April (2009) Clinicians Reviews, 19(4).

4. Crotts, Mark; Benefits of Pet Therapy, accessed at http://ezinearticles.com in April 2012.

5. Goldsborough, Bob; Special to the Tribune, Dogs lift patients’ spirits at Edward Hospital
chicagotribune.com on July 15, 2009
6. Tomeo, Jaime; Bide-a-weeis Pet Therapy Program Helps Hospice Patients Cope,
Farmingdale Observer, May 4, 2007.

httpt:/www.antonnews.com/farmingdaleobserver/2007/05/04/pethospice.html

7. Excerpted, with some modifications, from: www.muslims.ca accessed in June 2009

8. From Internet: ABC News, Dogs on Barbies 'Not Pets’ By News Online's Clayton Bloom,
Posted Tue Aug 18, 2009 12:24pm AEST

http:/www.medpagetoday.com/MeetingCoverage/ASAMeeting/mr/8455

9. Internet source: Korea4exparts.com Animals and Pets Culture in Korea accessed May 2009

10. Internet source: http://www.squidoo.com/dogsinchina "Dogs in China : A Horrific Story of Senseless

Cruelty in the Dog Meat Industry"

11. Marriner-Tomey, Ann, PhD, RN, FAAN (2008) Guide to nursing management and
leadership, Mosby 8th Edition, Evolve.elsevier.com