A Few Minutes With a Therapy Dog Might Help Lower ED Clinicians’ Stress

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Emergency department doctors and nurses might get some stress relief from a few minutes with a therapy dog, a new study suggests.

Researchers had 122 ED clinicians at a safety-net hospital spend five minutes either coloring, interacting with a therapy dog or doing nothing. Lowered self-reported stress levels occurred only after sessions with a dog, they report in Academic Emergency Medicine.

“This study provides evidence that therapy dogs can reduce stress in emergency care providers,” said lead author Dr. Jeffrey Kline, the Eskenazi Foundation Professor of Emergency Medicine at the Indiana University School of Medicine in Indianapolis.

“One of the most important findings is one that is difficult to put in a quantitative paper,” Klein said. “And that’s how happy they were to interact with the dog.”

Participants recruited later in the study, when word of what it entailed leaked out, were disappointed if they ended up being randomized to the coloring arm, Klein said.

An earlier study showed that patients’ stress decreased significantly if they spent time with dogs, Klein said.

To see if the same effect would occur in clinicians, Klein and his colleagues randomly assigned 83 ER doctors and nurses to spend five minutes with a certified therapy dog and its handler or five minutes coloring. A convenience sample of 39 ED clinicians was enrolled in a control group that spent five minutes doing nothing.

The researchers didn’t do a three-way randomization in order to avoid a possible nocebo effect that might occur if participants were expecting something good and got nothing, Klein said.

Clinicians were asked to report on their stress at the start of their shift, 40 minutes after the intervention and at the end of their shift. Stress measurements were captured with three different instruments – a visual analog scale (VAS), a 10-item modified Perceived Stress Scale, and a FACES scale – along with a saliva cortisol measurement.

Intriguingly, VAS measurements of stress rose in those who colored and went down in those who spent time with a dog, while stress in the control group stayed the same. The mPSS scores similarly rose in the coloring group but declined in the dog group. The control group saw an increased score on the mPSS.

The saliva cortisol measurements showed a completely different pattern. The measurements were highest at the beginning of the shift for all three groups and declined at about the same rate in all three. It’s possible, Klein said, that people feel the greatest stress, due to anticipation, at the beginning of the shift and the stress declines throughout the day.

The results didn’t surprise Robert Miller, who coordinates the creative and expressive arts therapy program at the UPMC Western Psychiatric Hospital.

Often the staff have bigger reactions to therapy dogs than the patients and they will talk about how time spent with the dogs made their day, Miller said. “They have loved staff-only pet therapy events we were hosting,” he said.

“In higher stress areas, a short intervention such as pet therapy could give a bright spot to a potentially intense shift,” Miller said.

There’s a clear need to find ways to help ER staff de-stress, said Stewart Shankman, chief of psychology at the Northwestern Feinberg School of Medicine. “It’s essential that they do something to relax, whether it’s coloring or meditation or deep breathing,” he said. “What I liked about this study is they tried to do a brief intervention for these healthcare workers.”

Shankman points to another area that could use some attention: sleep problems in frontline healthcare workers.

“That’s really important,” Shankman said. “What we are seeing here is a lot of insomnia. It’s a huge problem for ER doctors and health care workers.