Plus-Hex CLINICAL
Introduction
Animals, by nature, are motivated to meet their own basic needs. Preventing them performing behaviours related to these needs can elicit stress responses [ 1, 2 ]. Nearly three-quarters of the UK ' s cat population shows some form of stress-indicative behaviours [ 3 ], which can negatively impact on health [ 4 ].
Within UK households, cats are provided with a range of lifestyle opportunities in relation to the amount of outdoor access they have. Decisions around the access of cats to the outdoors in the UK are made by owners, who weigh the benefits of the opportunities for the cats to express normal behaviours against the risks of road traffic accidents, predation and disease [ 5, 6 ].
The American Association of Feline Practitioners( AAFP) and the International Cat Care Veterinary Society( iCatCare), previously known as the International Society of Feline Medicine( ISFM), define the main needs of cats as [ 7 ]:
• A safe space
• Multiple separate key resources
• Predatory and play behaviour
• Positive and consistent human – cat interactions
• An environment respecting the importance of a cat ' s sense of smell.
There is limited literature investigating the behavioural differences between indoor and outdoor cats; however, evidence indicates that indoor-only cats are more interested in artificial play [ 8 ] and are more likely to display abnormal repetitive behaviours associated with laser light pointers [ 9 ]. Evidence investigating the incidence of behavioural problems among these populations is conflicting [ 10, 11 ], further illustrating the need for a deeper understanding of the effect of outdoor access on feline behaviours in different settings.
It is suggested that outdoor cats can meet their own needs through self-play / predation [ 12 ]. When outdoor access is restricted, the need should be supplemented to prevent stress [ 1 ], but this is not always possible in a veterinary setting. The ISFM / AAFP Cat Friendly Veterinary Environment Guidelines [ 13 ] also suggest that changes in, or restriction to, outdoor access is a stressor for cats visiting veterinary clinics. Although this claim is not supported with evidence, recognition of this stress adds rationale to the current study.
The AAFP and ISFM have suggested that‘ maintaining consistent schedules’ has calming effects on patients [ 7 ]. A schedule that needs consideration is the amount of outdoor access available to cats in their home environment. Morrison ' s [ 14 ] view on holistic nursing builds on this idea by demonstrating the positive effects of maintaining the patient ' s routine after admission. It is appreciated that although hospitalised cats cannot access outdoor facilities, other considerations could be given, such as providing more enriching kennel spaces.
The authors have not found any literature that evidences how the level of outdoor access in the home environment may affect the stress behaviours of a cat during hospitalisation. It is the obligation of veterinary nurses to provide patients with environments of minimal stress [ 15 ], which should also include exploring new methods to reduce stress through holistic nursing.
The current study aimed to establish a baseline knowledge of the relationship between behaviours displayed by cats during veterinary hospitalisation and the level of outdoor access in the cat ' s home environment. As behavioural differences have been found between the two populations, the current study hypothesised that a difference in cat behaviour would be seen in hospitalised patients based on the level of outdoor access in their home environment.
Methods
Confirmation of consent
Permission from the owners of each participant was gained before any observations were carried out. Permission from the veterinary practice for the use of the facilities was also gained.
Ethical approval
Ethical approval was granted by the University of Bristol Health Science Student Research Ethics Committee( HSSREC)( 12548) and by the Animal Welfare and Ethical Review Board( AWERB)( VIN / 22 / 051). Data protection guidelines were adhered to throughout [ 16 ].
Participant criteria
Feline patients, undergoing an elective procedure on their first day of hospitalisation, were recruited from one veterinary hospital. If at any point during the study they presented for uncontrolled pain, uncompensated systemic disease or worsening clinical signs, they were disqualified as a participant.
A non-probability, convenience sampling method was used and all potential participants presenting to the hospital during the data collection period were targeted. Owing to time constraints, the sample size was small; however, a small sample size can be justified if a study has an exploratory objective, if resources are limited or if the research is based on non-probability sampling [ 17 ]. A desired minimum sample size of 27 was set for the project, in line with other similar studies [ 18, 19 ].
Volume 40( 5) • October 2025
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