Stress and anxiety implications on long-term patients — nursing considerations

In recent years the fields of both human and veterinary medical treatment have started to assess the welfare implications of hospitalisation. Hospitalisation can result in decreased sleep quantity and quality, physical and social stress, circadian rhythm disruption, and altered feeding patterns; these often compound patient anxiety and ultimately patient recovery (Lefman and Prittie, 2019). Although no complete studies have been completed in veterinary medicine, comparisons can be drawn from analysis of the adverse effects on mental health of long-term hospitalisation in human medicine (Chahraoui et al, 2015), and from records of stress and anxiety in animal shelters. Some relatively simple improvements to veterinary nursing practices have the potential to significantly mitigate these concerns.

Anxiety and stress both result in activation of mechanisms meant to preserve the organism and restore homeostasis. These are known as the ‘stress response’ and are regulated via the sympatho-adreno-medullary (SAM) and the hypothalamic-pituitary-adrenal (HPA) axes. The response of the SAM and HPA have been linked to patient morbidity and mortality (Lefman et al, 2019). Immunosuppression causing upper respiratory infections and the reactivation of infectious agents such as feline herpes virus has been linked to stress response in shelter cats (Tanaka et al, 2012). Although the hospital environment is slightly different it may still cause immunosuppression and result in similar infections. Cutaneous disease and delayed wound healing are also dramatically affected by the stress response, due to the impairment of the skin barrier permeability increasing the risk of local infections, such as Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis. These not only infect the individual but can infect the hospital environment too (Holmes et al, 2015). Gastrointestinal disease is also thought to be influenced by stress, due to alteration of intestinal microflora causing inflammation, and transport of intestinal bacteria along the mucosal surfaces causing infection. These can all lead to vomiting, diarrhoea, weight loss and inappetence, potentially resulting in serious nutritional issues for the long-term patient (Lefman et al, 2019). It is therefore important to create a stress-free ward environment that provides optimal patient outcomes in the long-term patient.