How to make a difference to your medical patients
Have you ever stepped back and thought about just how much of a difference we veterinary nurses make to our patients each day?
If you haven’t, picture this instead: every nurse has called in sick, and the vet team have to run the clinic for the day instead. I bet you’re thinking about how vital our role is now!
The veterinary nurse plays a huge role in the patient’s journey through the hospital, from consultations to diagnostics, and procedures to inpatient care. This role is especially important in patients with significant or long-term disease - these patients have often complex conditions and care requirements, needing even more nursing input during their hospital stay.
There are three key areas where veterinary nurses can make an enormous difference to their medical patients. Together, we’re going to go through each one, providing you with the tools to provide better patient care, whilst using more of your veterinary nursing skills.
PS. If you want to learn even more about caring for medical patients and using your nursing skills, make sure you sign up for my free webinar here.
#1: Making the most of the nurse/client relationship
Our relationship with clients is very different from the vet/client relationship. We often find ourselves in the fortunate position of having more time with clients, which allows us to build rapport with them and learn more about our patients.
This relationship is vital when caring for medical patients - these patients have complicated, often chronic diseases and collecting a thorough clinical history is an important diagnostic step.
The veterinary nurse is ideally suited to collect this history, asking questions about the nature and duration of any clinical signs, the patient’s normal lifestyle (including dietary history, normal daily routine, exercise, relationship with any other animals in the home, and travel history) the presence of any pre-existing disease, preventative healthcare status, and information about any current or previous medications.
#2: Providing tailored inpatient care
Caring for hospitalised patients is the main area where we can make a huge difference as nurses - there’s nothing quite like getting that cat who’s refused food for a week to finally eat, or seeing an anxious patient finally turn around and trust you!
In order to provide the best possible care, we need to consider the patient’s normal routine, their clinical signs and suspected disease process, and their behaviour. These factors can then be used to create a problem list, and plan nursing care tailored to the individual patient.
If your practice doesn’t collect information about your patients’ normal routine, likes and dislikes on admission, then now’s the time to start! This is another way for nurses to build rapport with clients and ease their worries about their pet being admitted to the hospital.
When planning nursing care there are a number of things to consider, including:
Nutrition
Has the patient been eating normally? If not, how long have they been anorexic for? How will this impact the patient’s calorific requirements? Will we need to place a feeding tube, and if so, which tube type is best for our patient? What could be causing the anorexia, and can this be treated, e.g. though administration of analgesics or antiemetics (if pain and nausea are suspected)? Is the patient receiving a special diet, and if so, should this continue in hospital? How will we make this work alongside tube feeding (if applicable)?
Hydration
Are there signs of dehydration or hypovolaemia? If so, is emergency fluid administration required? Which fluid are we going to use, and why? What rates will we use? How often are we going to re-assess fluid requirements, and how will we do this? Is the patient at an increased risk of fluid overload, and if so, what signs will we monitor? Does the patient usually drink normal amounts, or is there a history of excessive, or inadequate water intake? Where do they normally drink, and what kind of water (e.g. tap, puddle or running water)? Is the patient polydipsic? If so, we’ll need to check their water bowl and top it up more frequently.
Exercise
How active is the patient usually? How will we provide mental and physical stimulation to an active patient? Are they well enough to play? Do they have a disease where we need to keep exercise levels consistent day-to-day, or where they require strict rest? Are they ambulatory? Do they have any weakness? If so, how will we take these patients outside in a supported manner?
Behaviour
What is the patient normally like? Are they typically anxious at the vets? If so, knowing about this in advance can be helpful when assessing pain (as fear may be mistaken for signs of pain), and to ensure we provide an appropriate environment for for the patient. Do they get on with other animals, or do we need to house them out of view of other dogs, for example? Do they have any specific fears or dislikes (e.g. men) that we need to know about, so we can adjust their care team accordingly? It’s also useful to find out about any specific seasonal fears - such as fireworks - if they are hospitalised around this period.
Toileting
What are the patient’s normal toileting habits? With dogs, do they prefer to toilet on grass, concrete or another surface? Do they have any toileting commands?
With cats, do they toilet inside or outside? If inside, do they use a tray - and if so, what type? What litter substrate do they prefer?
Is the patient polyuric? If so, we’ll need to schedule frequent walks or litter tray checks.
General Nursing Care
Is there a possibility of a contagious or zoonotic disease? If so, where will we house the patient, and what level of barrier nursing will we perform?
Does the patient have any indwelling lines, such as intravenous or urinary catheters, or chest drains? If so, how will these be maintained and how often will we routinely check them?
What are the patient’s clinical signs and examination findings? Based on these, how often will we need to check their vital signs?
Are there signs of pain? If so, how often will we monitor these and how will we assess them? Which pain scoring system will we use and why?
What kind of kennel environment will we provide for the patient? Do they have any pre-existing diseases such as arthritis which might require a specific bedding type? Is the patient recumbent? Are they sociable, or do they prefer to hide behind a kennel covering, or under a cat hide for feline patients?
Can they groom themselves currently? If not, how will we provide skin/coat care? Are they at risk of urine or faecal scalding, and if so, how will we prevent this?
TLC
How are we going to provide mental stimulation and care to our patients during hospitalisation? Can they spend time outside of their kennel each day, and how will we plan this? Do the clients have the ability to visit their pet in the hospital, or will this make the patient more anxious? When are the patients going to sleep during hospitalisation, and how can we make sure this happens - can we adjust our treatment times to provide set ‘breaks’, and can we schedule ‘lights out’ time to promote sleep?
#3: Providing long-term client support
The veterinary nurse also plays a key role in supporting clients (and patients) at the time a disease is diagnosed and when treatment begins. This can be a scary time for clients, as they adjust to administering medications, changing their pet’s food and exercise regime, confining their pets indoors in some cases, monitoring their pet for deterioration, adjusting their lifestyle and routine to fit with treating and monitoring their pet and returning to the clinic regularly for appointments (which also comes at an increased cost).
These fears have the potential to affect treatment compliance and patient outcomes - so using our relationship to support clients through this process is vital. By providing tailored advice throughout a patient’s illness, the veterinary team can ensure the client feels supported throughout treatment, in turn improving treatment and patient care.
So there are three examples of just how much we can do with our medical patients. If you want to use your skills and get the most out of caring for your patients, consider the role you’ll play in their admissions process (by building that client relationship and collecting an up-to-date clinical history), plan tailored nursing care (considering factors such as nutrition, hydration, exercise, toileting, behaviour and much more) which continues after the patient leaves the clinic, by providing long-term client support.
