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Patient Care Vignette

JK was a 65-year-old man initially admitted to the hospital with acute cholecystitis for which he would need a cholecystectomy. His course was complicated by delirium, sepsis, and the inability to breathe well on his own, requiring a long-term breathing tube. After 2 weeks of hospitalization, JK remained in the intensive care unit. He had undergone tracheostomy placement to support ventilator weaning and feeding tube placement for nutritional support. JK’s mental clarity slowly improved but he became increasingly depressed, communicated feelings of hopelessness, had limited eye contact with his family or healthcare team, and did not want to participate in physical therapy. Psychiatry was consulted and JK’s family was present at the bedside every day trying their best to support him.

On day 21 of JK’s hospitalization, the nurses lifted him out of bed to a bedside lounge chair. His wife and daughter were sitting next to him. They were surprised to see JK opening his eyes to look outside of his ICU room. There stood a hospital therapy dog, a brown Labrador retriever named Tugger. JK lifted his arm to wave at Tugger. Glenn, Tugger’s handler, asked the bedside nurse if it was okay to visit JK and his family. The clinical team and JK’s family were encouraged by JK’s engagement since little else had captured his attention. Tugger and Glenn entered the room. Glenn placed a towel on a chair for Tugger to jump up and sit face-to-face next to JK. Within seconds, the first smile anyone had seen on JK’s face since his admission appeared; his wife and daughter began to cry. Tugger and Glenn spent an hour with JK. Two days later, Tugger and Glenn came by for a second visit. During this second visit, the physical therapist was doing routine patient care rounds and session scheduling. Previously, JK would not engage in sessions beyond getting out of bed to the chair. Today was different. With Tugger at his side, JK wrote to the physical therapist, “Can I try to stand and take a few steps with Tugger?” That moment was a turning point in JK’s care. He found the strength and the drive to participate in his recovery. JK later described his experience by saying, “Tugger ignited in me a good feeling for the simple joys of life that I truly missed and want to experience once again.”

Hospital environments are complex, fast-paced, and at times, chaotic that are very different from other spaces. Moreover, much of a patient’s time in an acute care facility is spent in their room, and often in bed or in a bedside chair. For most, it is a very different environment than what they were used to before becoming ill. The intensive care unit (ICU) environment may be even more overwhelming, given its continuous flow of personnel, the loss of privacy, frequent alarms, and bright lighting at all hours of the day and night. ...

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