How to do more with your chronic disease patients
Caring for patients with chronic diseases is an enormous area of potential for the veterinary nurse. These patients require so much care and support from us – right from the first signs of illness, during diagnostic procedures and throughout inpatient care. However, one of the biggest areas we can make a difference is after they are discharged.
By providing regular, consistent nurse support for the rest of the pet’s life, we can improve client compliance with treatments, and build a bond with both the patient and client. This is incredibly rewarding for the veterinary nurse, increases our veterinary nursing skills, provides job satisfaction and allows us to pick up on subtle changes to the patient at an earlier stage because we know them well.
By implementing the six things we’re discussing in this post, you can set up a chronic disease nursing service in your clinic - improving patient and client care, freeing up the vet’s time to focus on role-specific tasks and allowing nurses to build their skills and develop their role in practice.
#1: Start early
We want to establish ourselves as key individuals in the patient’s long-term care, so starting nurse support early is vital. Ideally, the nurse should either perform the patient discharge or have the opportunity to speak to the client alongside the veterinary surgeon at the discharge appointment. This shows the client that we are an important part of their pet’s care and lays the foundations of the nurse/client relationship. It can also be helpful to have a nurse present at discharge to answer any questions, explain treatments and diseases in a way which suits the individual client, and help prevent them from feeling overwhelmed as they adjust to having a pet with a chronic disease.
#2: Preparation is key
Anything we can do to improve the patient’s wellbeing during the clinic will encourage the client to bring them back, and make consultations a positive experience for the patient. This starts at home – reach out to the client before the appointment to provide information on how to transport the pet to the clinic calmly (e.g. getting the cat carrier out before the appointment, using pheromone sprays and covering the carrier), and ask them to gather any required items which will be required for the consultation (e.g. their pet health journal and a urine sample if necessary).
First impressions count, so make a good one by taking the client into a clean and tidy consultation room, away from the noise and distractions of the reception area. Ensure that your consulting space is well-stocked with the required equipment for the appointment, to avoid you having to leave and re-enter the room multiple times, which may impact client communication and potentially startle a nervous patient. A supply of comfortable bedding for the patient and some disease-friendly treats should also be available, to make the appointment as positive as possible!
#3: Consider your communication
By using effective communication skills, we can increase the volume of information we receive from our clients, which in turn helps the team monitor disease progression, and guides further decisions on diagnostic testing and medication dosage. Clients will also get much more from their consultations, improving treatment compliance and patient care.
You can ensure you’re communicating effectively by:
Asking open questions to maximise the amount of information provided
Seeking clarification if any points are unclear
Avoiding distractions such as taking the client into a consultation room, avoiding questioning in a busy reception area
Using pauses and silences to encourage the client to continue talking
Restating and summarising key information to ensure it is correct
Have written information on-hand to provide to the client if required (e.g. leaflets about medications, diets or diseases). Providing the client with a physical item to take away with them can help increase their sense of value, as well as giving them information to refer back to at a later stage. YouTube and website links are also really useful here too.
#4: Begin your consultation
Begin your consultation by collecting an updated clinical history, whilst allowing the patient to explore the consultation space (tip: get clients to remove the door from their cat carrier and let the cat come out in their own time whilst you collect the history).
This will allow time for the patient to acclimatise to their new surroundings, and make parameters such as their heart rate, respiratory rate and blood pressure more accurate when it comes to examining them. During history collection, the nurse can review the pet health journal, and discuss any specific concerns the client may have.
A clinical examination should then follow, including a bodyweight assessment, as well as body and muscle condition scoring. This will help identify trends in weight loss or gain and muscle wastage, which may be part of the patient’s disease process, or indicate a concurrent disease such as osteoarthritis - common in our older patients, who are most likely to come in for chronic disease consultations.
Measuring blood pressure is also recommended at this point, particularly in cats, as many chronic diseases can cause systemic hypertension.
#5: Collect your diagnostics
Chronic disease consultations are a great way to collect repeat samples under the direction of the veterinary surgeon. The veterinary nurse can collect blood samples and perform any required follow-up testing (such as biochemistry, total T4 levels, ACTH stimulation tests, haematology, manual platelet counts, and urine analysis, depending on the patient) under the direction of the veterinary surgeon. This avoids the client having to pay for a veterinary consultation, frees the vet up to see other patients, and fully uses the veterinary nurse’s skills! Also, as we typically have longer consultation slots, we can use these to apply topical local anaesthetics and allow for acclimatisation time, making the sampling process a nicer experience for both the patient and client.
#6: Close your consultation
After the required samples have been collected, the nurse should discuss any repeat medications which have been dispensed, review medication administration technique, and provide any other advice or training as necessary, depending on the individual patient and their disease.
Before ending the consultation, review the history and points discussed with the client. Are there any concerns or ‘red flags’ which require the veterinary surgeon’s attention? If so, ensure these have been dealt with before the client leaves the clinic.
To close the consultation, summarise the discussion and any recommendations which have been made, provide written reference material to back up any recommendations, ensure the client has no further questions, and arrange a follow-up consultation at an appropriate time - ideally before they leave the clinic, to ensure one is made.
If possible, set a reminder to follow up with the client in a few days either via email or phone call, just to see how they are getting on at home after the appointment, and if they have any questions at all. Little touches like this don’t take much time at all, but make a huge difference to the client/nurse relationship, in turn improving patient care.
So there you have it! If you want to do more with your chronic disease patients, begin by establishing nursing support early. See patients regularly through chronic disease nursing consultations, which you can use to gather updated clinical histories, collect diagnostic samples, and provide advice. The most important thing is to establish trust and build a relationship with your clients - and a simple way to do this is to make the patient and client’s experience as positive as possible. Now you have the tools to go ahead and develop these clinics in practice, and I can’t wait to hear how much of a difference it makes to your patients!
