Pain and Anxiety Management in Hospice care patients through Pet Therapy
- Arlena Davis
Pet therapy is a form of treatment used in hospitals, nursing homes and educational institutions. It involves guided dealings between a trained animal, an individual and the animal trainer. Pet therapy offers patients the opportunity to improve their life through human-animal relations. The practice problem is to determine the effectiveness of using animals to aid humans cope better with health matters. For this proposal, the focus will be to determine the effectiveness of pet therapy in the treatment of hospice patients.
Background and Significance
The focus of this research proposal will be on Hospice care; planned care to provide medical services, spiritual and emotional support to individuals who are in the advanced stages of illness. It centers on comfort and abundance of life rather than cure. Hunters and gatherers first used the pet therapy and the initial report was done in late 18th century at the York Retreat in Britain headed by William Tuke. Domesticated pets, marine creatures and farm animals are the most used. Several benefits are associated with pet therapy, lower blood pressure and reduced depression. A major problem of pet therapy is although scientists present the relationship between humans and companion animals as favorable, there is need for investigational studies to determine its effectiveness.
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In using pet therapy, it is important that the rights of the people affected as those of their animal companions be respected. The patient can choose the pet of his choice to improve their health. The pets used are service animals and must be allowed to accompany a disabled person wherever they go. However, caution should be taken to avoid pets with a temperament as they tend to be a nuisance. Elderly people and people suffering from chronic illnesses are the most affected.
Pet therapy has its complications and can be costly. Failure of this therapy can result in a painful and intolerable death for a patient in a short period. Pet therapy gives hospice patients and their families some hope of a quality life. If this program fails, the family members of the patient might suffer from depression. It might also instill fear and uncertainty to patients undergoing pet therapy. Pet therapy can be costly because it entails hiring a certified and well-trained pet. In addition, hospice patients may need to be in a health facility.
Review of Literature
The research proposal discusses the different studies conducted concerning pet therapy by various authors. It includes both theoretical reviews of data previously recorded and empirical studies in different places with patients of different age groups. The different study designs applied by the authors include; systematic review of the evidence, Quasi-experimental investigations, review of qualitative studies, survey questionnaires, randomized control trial and pre-post quasi-experimental design.
According to Stem (2011), pet therapy treatment enables patients in a hospice get short time relief from pain, stress and anxiety. He however did not have an in-depth analysis due to lack of quality research data. The review was conducted on the comments 31of professionals who used Animal Assisted therapy (AAT) for mental health care. Animal Assisted Therapy was beneficial (O’Callaghan, 2008). The method provided qualitative, and the interpretation could have been biased. A convenience sample of 58 residents living in a facility was studied to determine the changes in the use of medication. A Decline in pain Medication use (Lust, Ryan-Haddad, Coover, & Snell, 2007). AAT helped in rehabilitating schizophrenic patients (Kovács, Kis, Rózsa, &Rózsa, 2004). The findings were made after surveying the independent living skills of seven schizophrenic patients at a hospice.
In a different approach, pre-post quasi-experimental design was used on hospitalized patients with the aim of finding out the effects on not only their mood but also the cost incurred. Pet therapy improved mood in hospitalized patients and was cost effective (Coakley & Mahoney, 2009). The patients in hospice care also include children. In this research proposal, a review of the effectiveness of pet therapy on them is also done. AAT has benefits for the children in pain. The group having AAT had a significant loss in pain level relative to the control group (Braun, Stangler, Narveson, & Pettingell, 2009).
Survey questionnaires also serve as an excellent source of conducting research. In one such instance used to investigate the effectiveness of pet therapy, Companion animals reduced anxiety (Peacock, Chur-Hansen, & Winefield, 2012). The conclusion was made after reviewing the responses of a sample of 70 hospitalized patients. Persons with neurological conditions also get assistance through pet therapy to help improve their functioning. In one of the prospective studies, the researchers focused on the improvement in walking distance covered and the speed of the patient as well. Walking with a dog improved patient ambulation and patients responded positively to the experience (Rita, Brienne &Joseph, 2007)
However, the positive findings of using pet therapy do not reflect the opinions of all the researchers. Anxiety inventory did not decrease significantly but was low after Animal Assisted Therapy (Ekeberg & Braastad, 2011). Also according to Bercovitz, Sengupta, Jones, & Harris-kojetin, (2011), there are no differences in demographics, health, functional status between patients discharged from hospice or those who got complementary and alternative therapies CAT. They made this conclusion by reviewing the outcomes of complementary and alternative therapies.
The different research methods applied by the researchers had their shortcomings. The most common being; lack of randomness in sample selection, biased interpretations due to use of either qualitative or quantitative information, the lack of evidence of the cause and effect and a limited sample size. The findings of some researcher proved quite unreliable, as they did not do follow-ups on their subjects. It is crucial to know how Animal Assisted Therapy works and which animals are best suited for this treatment.
Introducing a pet into the life of a patient has been proven to distract the patient from pain, anxiety and reduces hypertension. Furthermore, it helps patients regain control of their social and communication skills (unity point, n.d.). The caregivers use this option to provide palliative care; care aimed at reducing pain, suffering and discomfort in order to provide them with a better chance at living (1800hospice, n.d.).
Control of pain and anxiety is the main aim of hospice care. The option is considered when one is no longer aggressive in treating illness and is ready to accept death. A caregiver’s responsibility is to offer the best therapy possible. The patients find it easier to interact with the animals than with family members (Hospice of North Central Ohio, 2014).
Studies have indicated that the presence of a pet in the facility help relieve patients’ pain and gives the staff morale to continue providing care to the patients. The act of petting has an automatic and subconscious relaxing and calming effect (Methodist Health, 2014). Furthermore, the use of pets can help bridge the communication gap between the patient, the doctor and family (Matuszek, 2010).
Theoretical Framework and Conceptual Definitions
The theory of comfort asserts that comfort exists in three main forms; relief, ease and transcendence. When the comfort needs of the patient are met, he experiences comfort in the form of getting relief (March & McCormack,2009). Ease facilitates the comfort of a patient through contentment by arraying any fears and anxiety from the patient. Transcendence facilitates the patient achieve a level of comfort by rising above any challenges during or after treatment.
The theory posits that patient comfort occurs in four contexts; physical, psycho-spiritual, socio-cultural and environmental (Kolcaba & DiMarco, 2005). It emphasizes that patients are individuals, families, institutions and even communities that need healthcare services. The environment encompasses any aspects of the patient, family or institution that nurses may manipulate in order to provide comfort to patients.
The theory is a good fit for the study since it informs the need for nurses and patient’s relatives to pursue available methodologies to mitigate pain and patient discomforts. The theory fosters courage and spirit of enthusiasm and positivity and reminds nurses not to give up (Lasiuk & Ferguson, 2005). The independent variable is pet therapy to reduce pain while the dependent variable is end of life patient management.
The independent and dependent variables are linked to the concepts since the choice of appropriate therapies is ideal to effective patient management especially in the end of life processes. In order to attain desirable relief for the patient, the nursing personnel formulates proper nursing care plans and continuously evaluates comfort levels of the patient to determine the need for change (Melnyk & Overholt, 2010). The nurse may use objective or subjective measures to evaluate the levels of comfort for the patient. Objective assessments involve, making observations of the patient and the healing process. Subjective measures include seeking the patient’s comments.
Hospice care patients and their families will chose pet therapy as a feasible treatment option when end of life conversations are being debated at the time of diagnosis.
Design and Rationale
The research design will be in the form of a cross-sectional survey of pain and anxiety management in hospice care through pet therapy. It will be used to determine the success of this treatment and to predict its usefulness in future. The rationale of using the cross-sectional approach is because this proposal will focus on one variable; the effectiveness of pet therapy for hospice care using data collected in different institutions during the same period.
Population and Sample
The appropriate population for this proposal is the patients under hospice care. The sample will be chosen randomly which will include patients in hospitals, nursing homes and those in hospice care institution. Since the number of patients is large, the sample size for this study will be 60 patients involving people of different ages and suffering from different illnesses.
Human Subjects Protection
In conducting this study, the ethical practice of human subject protection will be adhered to. The research will be based on objectivity and the data collected from the patients will only be used for the research. The relevant authorities of such as family and institution directors will be consulted for permission.
The independent variable for this research proposal is the use of pet therapy to reduce pain and anxiety in hospice patients. Pet therapy is a program, which involves creating a relationship between a patient and animal to help improve their health condition. The dependent variable is the end of life patient management this is provided through hospice care to patients who are in the late years of their life.
In determining the success of use of pet therapy in managing pain and anxiety among hospice patients, both qualitative and quantitative measurements will be done. The key factors to be considered will be the amount of time spent with the pet, the blood pressure of individuals before and after pet therapy. The state of depression shall also be monitored as well as the amount of intake of pain relievers.
Pet therapy for hospice care patients has proven very helpful remedy during the end of life stage. The animals provide companionship and sense calmness in the patient’s life. In depth, research should be done to determine the animals that best suit the treatment and to establish how the treatment occurs. For this proposal, the focus will be to determine the effectiveness of pet therapy in the treatment of hospice patients.
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