Table 1.

Considerations of the P.A.C.E. Model^™ Specific to the ICU

Practitioner (Animal Handler)	Animal	Client (Mechanically Ventilated Patient)	Environment
Should have specific ICU training related to: Technological equipment Mechanical ventilators Monitors Feeding tubes, intravenous lines, mobile lift devices; Severity of illness Clinical signs of patient physical decompensation Modifications that can be made for immobility; Psychological stressors Tailoring sessions appropriately based on levels of fatigue, pain, etc.; Handling difficult situations of the ICU Decompensating patient Distressed family member Combative patient Medical emergencies in adjoining ICU rooms; Commonly used terminology and abbreviations IV ET Tube Vent The roles of other personnel and healthcare team members in the ICU: Nurses Physicians Physical and Occupational therapists Respiratory therapists Social workers Case managers	Consider the size of the animal Smaller animals may be better option for ventilated patients because they are more mobile in the tight constraints of patient equipment Consider hypoallergenic breeds Ventilated patients have significant respiratory compromise, thus exposure to allergens should be minimal Verify the animal is: Registered with a national AAI group At least one year of age Receiving veterinary care with all appropriate vaccinations and medical approvals (i.e., negative fecal, no open sores or wounds, no digestive issues) Properly bathed/groomed before each session Behaviorally neutral to hospital smells, sounds, surfaces,	The following patient factors should be evaluated with input from healthcare staff and/or family caregivers prior to each AAI session: Psychological disposition Awake Alert Calm Interactive and cooperative Desire for animal interaction Do they like animals? Do they have a pet at home? Have they had a previous negative experience with an animal? Options for physical engagement in AAI session based on: Range of motion Eyesight Hearing Presence of lines or tubes	To ensure safety, it is imperative that healthcare staff participate with animal handler in preparing and maintaining a safe environment. The following is necessary for each AAI session: Adjust lines/tubes to prevent dislodgement Cover any open areas on skin Wash hands before and after (patient, healthcare staff, and handler) Provide adequate lighting Apply glasses or hearing aids if applicable Place the head of the bed in an upright position Adjust room temperature appropriately The handler should also locate the nearest exit to ensure the animal can be quickly and easily removed in a crisis situation.