Caroline J. Hewson, MVB, PhD, MRCVS
Animal welfare is the extent to which animals are 'Fit and feeling good' (Webster, 2005). Veterinary medicine has traditionally concerned itself with fitness, but, for most owners, their animals' feelings are also of great concern, not least when the animals are hospitalised. This presentation:
Reviews the effect that patients' feelings of fear and anxiety can have on the animals themselves and on the veterinary business.
Highlights ways to assess how your clinic may be contributing to negative and positive feelings in patients.
A further two presentations will outline the scientific evidence for some simple, cost-effective approaches to reduce fear and anxiety in patients, and will use video footage to describe some behavioural signs of stress.
Many patients suffer stress at the veterinary clinic because they are in unfamiliar surroundings and cannot predict or control what happens to them. That is, the animals undergo physiological changes such as increased heart rate and cortisol release that are associated with negative feelings such as anxiety or fear (Gregory, 2004). If persistent, stress can adversely affect healthy animals' immunity, general health, and behaviour (Connor, et al., 1998; Dobson et al., 2001; Knowles, 1999; Moberg, 2000). Examples in companion animal practice include feline idiopathic cystitis (Buffington 2007) and conflict-related aggression in dogs (Luescher, 2004). For some feline patients, anecdotal evidence indicates that the stress of having been hospitalised can continue for some hours or days after a cat's return home, with the cat hiding, not eating, and showing aggression (Riccomini, 2007). Moreover, stressed patients can be difficult to handle, increasing the risk of injury to personnel. Also, even if health is not affected by any stress suffered, it is important to make animals' experience of being at the clinic as positive as possible, for the sake of their mental wellbeing and because, from the patient's point of view, their memory of a stressful experience will make future visits more unpleasant.
Many owners perceive that their animals don't like being in the veterinary clinic. Owners are concerned about this and about how their animal will fare during hospitalisation. Some clients may worry in silence and, at worst, may redirect their worry into dissatisfaction about other matters, particularly the veterinary fee. In my experience, many other owners are not concerned about their animals' being stressed while hospitalised, because these owners assume that comparable care is taken with hospitalised animals' feelings, to that taken with human patients, with equivalent provision of quiet, privacy, and 'something to do'.
When veterinary patients are hospitalised, they are typically put in a stainless steel or hard plastic cage containing a litter tray, and food and water as appropriate. There is newspaper on the floor +/- soft bedding, but little scope for environmental control (e.g., no hiding place; no toys). There may also be quite a lot of traffic in the area, and noise (e.g., laughing or chatting hospital personnel; beeping machinery; talk-radio; and other animals' vocalisations.)
This common approach to veterinary hospital wards simplifies healthcare, but does little to reduce stress in susceptible patients. That is not to deny the high standard of healthcare that veterinary practices provide and are justifiably proud of. The point is rather that, with the ever-expanding scope of medicine and surgery, it is all too easy to overlook simple ways of enhancing patients' experience and minimising their stress. In particular, recent research from animal welfare science has confirmed that stress occurs in many animals when they are separated from their owners and caged (e.g., Dybdall, et al., 2007; Gourkow and Fraser, 2006; Kry and Casey, 2007; McCobb, et al., 2005; Välsänen, et al., 2005). The research indicates some ways that the hospital environment can minimise the stress using simple techniques that go beyond pheromone diffusers and TLC (see the next presentation).
For all these reasons, it is important to have an up-to-date practice policy on patient stress. The policy would take account of aspects of the clinic design and management that may cause fear and anxiety to patients. There are at least 100 points to consider, such as:
Whether cats are exposed to passing dogs, perhaps because the client has to place the cat carrier on the floor at reception, in order to pay the bill, or because cats in the hospital are kept in cages at ground level.
Whether you interrupt procedures in conscious animals (e.g., blood sampling) to chat to those present, even about the animal, or to talk to an owner on the phone, leaving the animal restrained for longer than is necessary.
Whether unnecessary or loud conversations are held in the hospital ward. For example, bursts of laughter or of exasperation may be alarming to patients, as well as interrupting their sleep.
The sort of auditory background (radio, silence, etc) that you provide in the ward area.
How do you go about evaluating whether your clinic's approach to patients' stress is complete? The relevant scientific information and collective experiences of best practice are somewhat dispersed. The Feline Advisory Bureau's Cat Friendly Practice booklets (Feline Advisory Bureau 2007) are an excellent starting point, and many of the principles there can be extrapolated to other species. For a systematic, practice-wide evaluation that includes dogs, cats and rabbits, I have developed an online assessment that generates a score and ranking relative to other practices, and has an accompanying manual that describes simple ways to improve areas of weakness (information available on request or from firstname.lastname@example.org).
However you go about it, evaluating and, if necessary, overhauling the practice policy on patient stress is a 'win win' approach. Upgrading your approach takes little or no capital investment and can benefit otherwise anxious patients, increase owners' peace of mind and satisfaction, and increase job satisfaction for staff. None of these benefits necessitates having a luxury hospital. They only involve application of the collective experience of the veterinary community and of the growing body of research on animal welfare. The next presentation will examine some applications of this research in more detail.
1. Buffington CAT. 2007. Interstitial cystitis and the feline. Proceedings American Board of Veterinary Practitioners 12th Annual Practitioners' Symposium, Long Beach, California. Available from: https://www.vin.com/Members/Proceedings/Proceedings.plx?CID=abvp2007&PID=pr16503&O=VIN. Last accessed 30 March 2008.
2. Connor TJ, Leonard BE. 1998. Depression, stress and immunological activation: The role of cytokines in depressive disorders. Life Sciences 62: 583-606.
3. Dobson H, Tebble JE, Smith RF, Ward WR. 2001. Is stress really all that important? Theriogenology 55: 65-73.
4. Dybdall K, Strasser R, Katz T. 2007. Behavioral differences between owner surrender and stray domestic cats after entering an animal shelter. Applied Animal Behaviour Science 104: 85-94.
5. Feline Advisory Bureau. 2007. Cat Friendly Practice. Available at: http://www.fabcats.org/catfriendlypractice/vets.html. Last accessed March 30 2008. Tisbury, UK: Feline Advisory Bureau.
6. Gourkow N, Fraser D. 2006. The effect of housing and handling practices on the welfare, behaviour and selection of domestic cats (Felis sylvestris catus) by adopters in an animal shelter. Animal Welfare 15: 371-377
7. Gregory NG. 2004. Physiology and Behaviour of Animal Suffering pp 12-21. Oxford: Blackwell.
8. Knowles TG. 1999. A review of the road transport of cattle. Veterinary Record 144: 197-201.
9. Kry K, Casey R. 2007. The effect of hiding enrichment on stress levels and behaviour of domestic cats (Felis sylvestris catus) in a shelter setting and the implications for adoption potential. Animal Welfare 16: 375-383.
10. Luescher UAL. 2004. Dominance and conflict-related aggression in dogs. Proceedings Western Veterinary Conference 2004, Las Vegas, Nevada, US. Available from: https://www.vin.com/Members/Proceedings/Proceedings.plx?CID=wvc2004&PID=pr05273&O=VIN. Last accessed March 30 2008.
11. McCobb E, Patronek G, Marder A, Dinnage JD, Stone MS. 2005. Assessment of stress levels among cats in four animal shelters. Journal of the American Veterinary Medical Association 226: 548-555.
12. Moberg G. 2000. Biological response to stress: implications for animal welfare. In: The Biology of Animal Stress: Basic Principles and Implications for Welfare pp 1-21. Wallingford: CABI Publishing.
13. Riccomini F. 2007. How to recognise feline stress in veterinary practice. VN Times 7 (8): 10-11.
14. Välsänen AM, Valros AE, Hakaoja E, Raekallio MR, Vainio OM. 2005. Preoperative stress in dogs--a preliminary investigation of behavior and heart rate variability in healthy hospitalised patients. Veterinary Anaesthesia and Analgesia 32: 158-167.
15. Webster J. 2005. Animal Welfare. Limping toward Eden pp 1-23.Oxford: Blackwell.