RSS – YES! It has a name!

What is RSS? (1)

Relocation Stress Syndrome also known as Transfer Trauma is defined as the physiological and psychosocial disturbances that result from transfer from one environment to another.

Transfer anxiety is a specific form of separation anxiety that occurs when patients are required to relocate from an environment that is known and secure to an unfamiliar environment. This anxiety particularly arises when the move happens quickly or without warning. As well, the effect of transfer anxiety is intensified when the patient is frail or very sick.

A form of transfer anxiety, expectant anxiety, arises when patients are aware of the future relocation and perceive the move as a negative situation causing them internal anxiety.

The North American Nursing Diagnostic Association (NANDA) approved relocation stress as a new nursing diagnosis to describe the syndrome that had been observed and documented over the previous 40 years. There were several shifts in the research of RSS with mixed and controversial results starting in the 1960’s up until the official diagnosis in 1992.

For the record, a nursing diagnosis is a clinical diagnosis made by a registered nurse which, unlike a MD's diagnosis, does not cover the patient's medical condition, but the patient's response to the medical condition.

Five characteristics that define the nursing diagnosis of RSS are:

· Dependency

· Confusion

· Anxiety

· depression and;

· withdrawal

Broken down, the major characteristics of RSS include:

· loneliness

· depression

· anger

· apprehension and;

· anxiety.

The minor characteristics of RSS are:

· changes in former eating and sleeping habits

· dependency

· insecurity

· lack of trust and;

· a need for excessive reassurance

Even the U.S government's Administration on Aging, believes Transfer Trauma to be associated with:

· depression

· increased irritability

· serious illness and

· elevated mortality risk for the frail elderly.

Some researchers have theorized about the reasons behind the decline in health status of patients who have been relocated. Their theories can be divided into three main areas: Patient, Transfer and Facility effects.

Patient Effects:

Lack of personal control, change in environment can cause an individual to experience high levels of stress before and after the move. Those who perceive improvement in their care at the new location are less likely to decline in health status post-relocation.

Transfer Effects

Transfer anxiety is a specific form of separation anxiety that occurs when patients are required to relocate from an environment that is known and secure to an unfamiliar environment. This anxiety particularly arises when the move happens quickly or without warning. As well, the effect of transfer anxiety is intensified when the patient is frail or very sick. A form of transfer anxiety, expectant anxiety, arises when patients are cognizant of the future relocation and perceive the move as a negative situation causing them internal anxiety.

Facility Effects

The new facility must be able to handle the medical requirements of the transfer patients, especially if it is possible that their health status could decline upon transfer. If the new facility is unable to handle potential adverse events, a patient may face another transfer to a facility that is able to treat more complex care situations. As well, if the two facilities are relatively different, some of the transfer patients may find it difficult to cope with the change in environment.

Another theory called the Transition Hypothesis, focuses on the varying level of care and support received by patients throughout the transfer. This hypothesis assumes that all patient transfers are not identical. It assumes that there are varying levels of care at facilities and some are better than others at individualizing care and providing a continuum of care to each patient.

The stress associated with relocation is so extreme that experts evaluate it as similar to the stress of divorce or the death of a family member. The after-effects of a move can last for several months, a year or even longer.

Contributing factors:

· degree of change experienced

· perceived reduction in patient care

· perceived lack of predictability in their environment or routine.

It’s not just adapting to transition and change that causes such stress and anxiety. They are coping with loss on a significant scale: loss of lifestyle, friends, family, familiar routines and structure of life. Relocation stress is experienced until the person regains a sense of control over his/her life.

RSS and Mortality Rates

While the degree of change has an impact on their mortality, RSS has been observed since the mid-1960’s and evidence from some studies suggest that as many as 25% of patients die within 24 hours. This percentage seems to fluctuate from year to year.

Coping Methods

How well RSS is managed depends on variables such as age and stage of life, personality, how well they are prepared for the move and the type of support received during the move. There are personal factors involved too, such as coping strategies, coping barriers and coping resources.

Apparently, there have been enough studies and symptoms of RSS suffered by enough people that guidelines have been put in place for the transfer of a patient, state bills have been enacted, and other organizations are recognizing the importance of protecting elderly transfers.

It would be accurate to conclude then, that change, and the threat of change, is disrupting to people who are near the end of their lives

FERRETS AND RSS(2)

So why, you ask, is Little Dudes Ferret Camp reporting on RSS? While indeed, RSS is researched, studied and reported on humans and certainly adversely affected in the elderly population, ferrets can and most often are, traumatized by a move to a new environment, especially an older ferret. Symptoms are not only the same as experienced by humans, but they can and DO experience physical deterioration as well.

Symptoms of RSS in ferrets may cause them to:

· get depressed

· develop loose stools

· stop eating

· lose weight and;

· lose the will to live

In ferret shelters, caretakers aggressively battle RSS with subcutaneous fluids, forced feedings, and medications. Sometimes their effort is successful and sometimes it’s not. When we are able to help a ferret through RSS and he survives, often you are left with a ferret that goes through the motions – he will eat, sleep, and also suffer underlying health problems which surface due to stress, BUT has virtually no life, no enthusiasm, no interest. A ferret devoid of character; rejected, and forlorn. Even if they are lucky enough to be adopted into a loving home, they may not bond with their new family because they no longer trust the stability of their life. This is often the fate of a ferret that has been transferred to a shelter, or even a new home.

A temporary boarding facility will also encounter RSS to a lesser degree. The severity will often depend on the length of time their owners are away. In addition, the level of bond with their family and perceived abandonment may contribute and also determine how well the ferret copes. If the boarding facility is an experienced ferret caregiver (i.e. Ferret Camp), early signs of RSS will be recognized and appropriately treated. This is one of the very important reasons why weight is so carefully monitored at Little Dudes Ferret Camp – and most ferret shelters.

Ferrets are born trusting, loving, innocent and loyal. Until they experience separation, they tend to take their families for granted. Ferret owners don’t often realize how truly intelligent, loyal and loving these ferrets really are or the deep bond they form with their family. When a ferret owner surrenders or rehomes their ferret, they may never experience this aspect of their personality. The ferret owner who boards their ferret for the first time may be pleasantly surprised at the change in behavior of their ferret when they return. This is an observation I have personally experienced countless times when families and ferrets are reunited. An experience I enjoy and never get tired of.

On the downside, permanently transferring an older ferret to a shelter or new home, and less often a younger ferret, can be devastating because of perceived abandonment. Regardless of the reason for giving up a ferret, good, bad or indifferent, ferrets don’t understand intentions because they can’t reason. They will consider the transfer to a new location as abandonment.

So go back and read about RSS again with the understanding of how this syndrome might affect your ferret. If you need to rehome/surrender your ferret, help him prepare for the change. If you need to board your ferret temporarily, be sure he has some of his belongings with him such as toys and bedding (don’t wash them no matter how tempted you are). Help your caregiver by providing as much detail about his home routine as possible. If you have the luxury of extra time (most people don’t), bring him for a visit before you go.

Anything you can do to help your ferret prepare for a change in his environment will help him adapt and reduce the impact of RSS. It may even save his life.

Terri Cunningham

Little Dudes Ferret Camp

August 5, 2010

(1) Disclaimer – Information has been obtained and edited from a variety of sources and condensed into a shorter, less technical and detailed version. There is certainly much more information about RSS and Transfer Trauma if anyone chooses to research for themselves. I only report on subjects that can be validated from a reliable source so that I don’t add to the inaccuracies found all over the web. This short article may not seem like much but it is one I started almost 3 years ago and spent time and money to assure complete accuracy since the subject I am writing about is continually being researched and studied.

(2) There is no way to “prove” that RSS exists in ferrets. There are no formal studies. The association I made between RSS and ferrets is based on personal experience as a ferret shelter operator, other shelter and rescue stories, conversations with shelter moms, shelter volunteers and other testaments. Therefore, this is opinion, not fact. However, regardless of the name you attach to it, the symptoms exist and it continues to be a valid concern for shelters everywhere. Back to top

For shelters – there is a special version of RSS created especially for your target audience for you to edit, post or otherwise distribute as you see fit. Call or email if you would like that version.