SAEM Wellness Consensus Conference
Background: Cognitive stress during shiftwork contributes to burnout in emergency care providers. We hypothesize that if emergency care physicians and nurses interact with a therapy dog, their stress levels will decrease.
Methods: Subjects (emergency physicians and nurses) were randomized to either interact with a therapy dog or perform a mindfulness exercise via art therapy (Mandela coloring) for five minutes. Dog interactions occurred outside the clinical work area in a research room; coloring could happen at work station. Self-perceived anxiety [visual analog scale (VAS), 0-10 cm] and stress [Emergency Care Worker Stress Scale (ECWSS), 0- 40] were obtained at start of shift (T1), 30 minutes later (T2) and near the end of shift (T3). Dog handlers graded the quality of the interaction between the provider and the dog, and we assessed providers’ post-experience opinions. The sample size of 40 per group was predicated on a 25% relative decrease in mean ECWSS with dogs vs. coloring.
Results: From 6/1-12/27/18, 66 providers were randomized (n=33 per group). At the end of their shift, 50% of providers who colored reported an increase in their ECWSS score, compared with 39% of providers who interacted with a therapy dog (p=0.33, Fisher’s). The mean (SD) difference in ECWSS from T3-T1 was +4 (21) with coloring versus -1 (20) with dog (13% greater decrease with dog; P=0.33, unpaired t-test). For the VAS, T3-T1 change (cm) was +1 (7) for coloring versus -1 (7) for dog (P=0.30). Handlers rated 32/33 provider- interactions with dogs as “Highly engaged” or “Engaged.” Most (n=32) dog participants indicated positive or neutral experiences; only one dog participant commented negatively. Dog participants indicated that the unscheduled need to leave their work station to see the dog counteracted the benefit of the dog. Many in the coloring group expressed disappointment being assigned to coloring.
Conclusion: The present design found no statistically significant reduction in provider stress/anxiety reduction with exposure to a therapy dog compared with art therapy. The requirement for the provider to leave the work environment to see the dog may have increased provider stress. A design that allows a therapy dog “on demand” at the convenience of providers may show a larger effect on reduction in emergency care provider stress.