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Tuesday, March 22, 2011 - Gypsy’s Story - From racetrack failure to Heart-patient champion

Vineland, NJ — As a racing greyhound, Gypsy chased a mechanical rabbit—at full throttle.  From all accounts, she was an utter failure--never winning a race.

As a registered therapy dog, Gypsy leads heart failure patients—slowly and steadily. From all accounts, she is a consummate champion, measurably improving the health and well-being of these patients. In fact, Gypsy is now the star of a nursing research study recently published in the Journal of Cardiovascular Nursing, a respected peer-reviewed nursing journal.

The idea that animals can provide benefit to hospitalized patients is not a new one. Dogs and other animals have visited patients in a variety of health care settings for decades. Scholarly papers have been written on the subject. However, Gypsy’s interaction with patients goes beyond anything ever documented in a clinical study. And the results were so dramatic they may open up a whole new area of animal-assisted therapy. In fact, nurses from other hospitals have already contacted the study’s lead author, Sami Abate, R.N., B.S., C.C.R.N., Gypsy’s owner and the assistant nurse manager of the Cardiac ICU and Cardiac step-down units at the South Jersey Healthcare Regional Medical Center.

Decked out in her red therapy-dog vest and standard issue hospital ID badge, Gypsy cautiously walks across the shiny tile floor of the hospital lobby and into the elevator. Truth be told, she doesn’t like the shiny tile floor.

“The first few times we walked through the lobby, she was very skittish,” said Abate. “The tile floor is beautiful, but not particularly dog friendly.”

Together, Abate and Gypsy ride to the fourth floor, with its carpeted hallways, and staff that are always happy to see them. On the Cardiac Care Center, Gypsy’s responsibilities are two-fold. First she has to ignore all of the sights, sounds and smells of a busy inpatient unit. And then there’s the real reason for her twice-a-week visits. Clinically known as Canine-Assisted Ambulation, Gypsy’s “job” is to encourage heart failure patients to walk more frequently and to take more steps. Through the sheer sweetness of her personality and the heart-melting gaze of her large caring eyes, she carries out her responsibilities with great success. For the patients, Gypsy’s companionship is a pleasant diversion with real clinical benefits.

“There’s no doubt that getting our patients up and walking helps them function better and feel better,” said Gladwyn Baptist, M.D., a cardiologist who strongly supported the proposal to introduce canine-assisted therapy at the Regional Medical Center. “In our hospital, we use specially trained staff known as ambulators and our friend Gypsy to motivate patients to walk more often and for longer distances. This can actually help patients get back home sooner.”

Although the benefits Gypsy brings to patients may often be shared through anecdotes, the nursing research study and recently published journal article provide hard data that demonstrates just how significant Gypsy’s impact can be. The article presents in detail how a mild mannered former racing dog improved the lives of heart failure patients at the SJH Regional Medical Center.

According to the study results, patients who were given the opportunity to walk with Gypsy were nearly four times less likely to refuse ambulation. This significantly lower refusal rate illustrates the impact that canine-assisted ambulation had on patients’ decisions to follow a prescribed walking regimen. In terms of steps taken, those patients who walked with Gypsy took an average of more than twice as many steps than those who walked without her.

Additionally, heart failure patients who walked with Gypsy were, on average, able to go home one day sooner than patients who did not walk with her. This decrease from an average of seven days in the hospital down to six can bring significant benefits to both the patient (clinically and from a patient satisfaction standpoint) and the hospital. Canine-assisted therapy is also cost effective because the services of a therapy dog and its owner are usually provided on a volunteer basis.

“We strongly encourage our nurses to perform research studies in an effort to continuously improve patient care,” said Bruce Boxer, director of Nursing Quality and Magnet Coordinator, and a co-author of the study. “The results of this novel therapy are likely to have a positive impact on heart failure patients across the country. When staff at other hospitals read about the proven benefit of canine-assisted ambulation many will implement similar programs. This is a great example of how thinking outside the box can produce great ideas that translate into better patient care.”

“This is a tremendous example of the value nursing research can have on patient care,” said Michele Zucconi, clinical director of the Cardiac Care Center and a co-author of the research study. “We are fortunate that the senior leadership of the health system and our Chief Nurse Executive Betty Sheridan in particular, have created an environment that supports innovation and research. We are also blessed to have nurses like Sami, who are so deeply committed to providing the best possible care for our patients.”

“And we can’t forget our sweetie, Gypsy. She can strengthen your heart and steal it at the same time,” Zucconi added. 

SJH is a nonprofit, integrated health care system, providing access to a continuum of health services. SJH provides hospital services, numerous community health clinics, home health services, and specialty services, which serve the medical and health care needs of Southern New Jersey residents.

Canine-assisted Therapy is just one component of SJH’s robust heart failure program

Without question, she is cutest and most famous member of the South Jersey Healthcare Heart Failure Team. Her big dark eyes, slender body and pointy snout bring instant smiles to patients and staff whenever she visits the Cardiac Care Center of the SJH Regional Medical Center. Her presence draws so much attention you might be excused for not realizing that there are other innovative components of the hospital’s heart failure program. Yet in fact, she’s not even the only member of the team that is dedicated to getting patients up and walking.

It has been almost three years since SJH added patient ambulators to its heart failure program. These nurse aides with specialized training are charged with encouraging patients to get up and walk several times a day. As a group, heart failure patients who walk on a regular basis get better more quickly and enjoy a higher quality of life.

“Our ambulators have been a great addition to the team,” said Michele Zucconi, clinical director of the Cardiac Care Center.  “They get to know our patients, learn what motivates and scares them, and take a strong interest in their recovery. We receive a great deal of positive feedback about our ambulation program.”

SJH also provides comprehensive heart failure-management education to all heart failure patients and their families. Heart failure is a chronic condition, which with proper instruction and careful monitoring can be controlled reasonably well in a home setting. Providing patients with a good understanding of heart failure, including its warning signs and simple interventions, can reduce hospital re-admissions and enhance quality of life.

Since heart failure is a chronic condition that should be monitored and managed on a daily basis, SJH offers a free home monitoring service to all of its heart failure patients. Simply by using a standard telephone or PC with Internet Access, patients answer a few simple questions each day about how they are feeling. The answers are recorded and then reviewed by an SJH advance practice nurse who can contact the patient or the patient’s doctor directly if any intervention is required. This system has been shown to help people with heart failure maintain a better quality of life by keeping them at home and out of the hospital. This program also encourages participants to take a more active role in the management and monitoring of their chronic disease.

Assigning a highly skilled clinician to oversee heart failure and other chronic disease care has also brought benefits to patients. Advance Practice Nurse Patricia E. Heslop, R.N., M.S.N., C.C.R.N., is responsible for monitoring patient outcomes and implementing new initiatives. She also serves as a bridge to the community by interacting with patients while they are in the hospital and after discharge. Patients who participate in the free home monitoring system receive calls from Heslop if their condition deteriorates or if they don’t call in for a couple of days.

“Several years ago we set a goal to improve the care of heart failure patients,” said Heslop. “It began with a grant from the Robert Wood Johnson Foundation to reduce the racial and ethnic outcome disparities that were being observed across the country for heart failure patients. Yet from the start, we were determined to improve care for all heart failure patients.”

“I’m thrilled to say we have made great strides and remain committed to providing the best possible care for our patients, including the transition of care from the hospital to a home setting.”

When heart failure patients are discharged, they are reminded to pay close attention to any changes in their condition, such as weight gain or shortness of breath. SJH provides additional home care tools to assist with this transition. Patients are also urged to walk on a regular basis and, if they don’t already have a dog, to consider getting their own “Gypsy” as a walking partner.