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“Care”, “Aggressive”, “Angry”, “Land-shark”… these are just some of the words used in the veterinary industry to describe our patients, often in bold capital letters, written in red ink and followed by exclamation marks. Communicating patients’ individual needs is important to keep both them and us safe, but the language we use to do this can have an immeasurable impact on the quality of care they subsequently receive. 

Imagine seeing a stranger having an emotional outburst, with the narrative of them being “dangerous, aggressive, angry”. Notice your own emotional response, the fear that may elicit in you, the reluctance to approach and the lens through which you witness this scene

Now: imagine seeing a stranger having an emotional outburst, with the narrative of them being “grief-striken, sad, scared”. Notice how you feel more compelled to help, less afraid to approach them and how differently you feel about your own role in that scene. Replace that person for a patient having an emotional reaction to their confusion, fear and pain.

Considering the feeling behind the behaviour will help you to find your compassion, which in turn shapes our patient care approach. Ultimately, the language that you use to create a story of a patient will directly affect the way people interact with them. Every patient deserves to be treated with patience, kindness and love, even when they cannot show us those qualities in return.

Understanding the ways animals communicate can help us choose the most appropriate language to describe their needs. For canine friends, the ladder of communication is a good place to start to help us recognise non-verbal cues.
When we recognise and respond appropriately to early signals that a patient is stressed, afraid or uneasy, it prevents them from needing to escalate their communication to more overt signals. For example, if we can respect that the patient bowing away from us and licking their lips is asking for more space, they are less likely going to need to snap or bite to relay that same message. Respecting and responding to the body language of our patients helps to build a bond of trust because they feel heard and less threatened. Patients who do not have their early signals listened to may eventually learn that these are pointless steps, and may go straight to the signal that achieves the desired reaction, which is often when we see a patient ‘bite with no warning’.

Contextualising the specific likes and dislikes of our patients can further build trust and understanding when handling them. Signs on the front of their kennels will alert other staff members to their individual requirements so that they do not need to be wholly described as an ‘aggressive’ animal, but instead ‘displays aggressive behaviour WHEN…’. They are NOT aggressive at their core, but they show aggression when they are experiencing something specific. For example, ‘please do not touch my feet’, or ‘does not like men’ are easy ways to guide interactions to avoid undesirable behaviour whilst maintaining kindness towards the patient’s individual experience. Pre-appointment ‘getting to know your pet’ questionnaires can help to gather this important information, and also helps to reassure the pet carers that their pets’ personal needs will be catered for. 

Managing and constantly considering the anxiety and fear of our patients not only benefits their well-being but also helps us provide better care. This should be done through environmental management and use of anxiolytic medications when clinically appropriate. Pre-emptive anxiolytics for patients returning to the practice are the most effective way at managing anxiety in the hospital setting because it is harder to reduce stress once the patient is already heightened than it is to prevent the initial response. 

Building a bond with a patient can take time, so how do we compassionately nurse a patient we cannot touch? Below are a few tips. It is always easier to de-escalate these measures than it is to implement them later. Considering each patient’s individual needs upon admission and when recovering from sedation/anaesthetic, sets us up appropriately for their specific nursing care requirements.

Practical tips for nursing a ‘less is more’ patient; 

• Use extension lines with a needle free bung on the end to attach to the catheter port; this allows you to give medications and flush the catheter without entering the patient’s personal space. Intravenous fluid therapy (IVFT) or constant rate infusions (CRIs) can also be connected to a long line so that they can be disconnected from a distance. This applies for dogs and cats. 
• Leaving an appropriately fitted harness on canine patients whilst they are in their kennel, with a lead long enough to hang outside of the kennel door means that you can safely open the door and stand aside, letting the patient choose to come out to you in their own time rather than leaning over them to place a slip lead. 
• Place a suitably sized buster collar, secured with k-band if necessary, for patients who do not tolerate use of a muzzle well. The buster collar can remain on for the duration of their stay. This provides a physical barrier to help you feel safe in your interactions without needing to rely on restraint. Physical restraint may trigger reactive behaviour if the patient feels threatened by it. 
• Plan for and utilise intramuscular (IM) pre-medication when placing an intravenous catheter (IV) is causing too much stress for a patient. Compromising a patient’s wellbeing to avoid delays in procedure times is not aligned with compassionate care. Factoring in the potential need for an IM pre-med can avoid unexpected delays and subsequent frustration amongst the team.
• Ideally, every patient should receive topical numbing cream one hour before venepuncture to reduce pain and discomfort, and subsequently manage negative associations. Waiting for a patient to become less co-operative before applying numbing cream is counter productive as the fear has already started to build for them for the next attempt. Use of numbing cream should be adopted for all patients, but especially not overlooked for patients displaying anxious behaviour.  
• Tailor your treatment plans to reflect the individual. Frequent decompression walks for canine patients who find a kennel environment stressful can be very beneficial, whereas a kennel curtain and some calming music may be more appropriate environmental management for a patient overwhelmed by noise and busyness.
• Provide TLC with environmental changes rather than through touch. Ensure feline friends have a castle to hide in, give patients a toy with a pheromone spray on it, use food as enrichment with kongs and slow feeders, play calming music through the laptop or put a nature video on outside of the kennel for them to watch. Simple things, such as reducing foot traffic past a worried patients’ kennel can have a huge impact.
  
• If tolerated, sitting with the patient without touching them can build trust and prevent them from associating every interaction to be stressful and hands-on.  Remember to check on their body language during this process to ensure they are not being pushed past where they are comfortable. Give more space when it is asked for. 
• These patients may benefit from frequent breaks during nursing care. Tailor that into your schedule for the day and plan ahead to incorporate that need. 
• Consider escalating the anxiolytic medication used if it is not reaching the desired effects; for example, a CRI may be more appropriate than periodic medication. Communicating with the veterinary surgeon is essential to adapt the treatment plan when needed. This can be for anything, from medication changes, to discharge times. 

In summary, the degree of compassionate care received by a patient can be affected before they even enter the building, simply by the language that we use to describe their characters. 

Practice being mindful of this in yourself and others around you, noticing the difference that it makes to the patient’s experience when you change your choice of words. Implementing changes in mindset and practice can be challenging, and heavily relies on us advocating for our patients; being their voice. The change starts with you.

Thank you for taking the time to read Ria’s article from our Spring newsletter! Head back to the Our Community page on our website to take a read of the rest of this edition of The Ralpher.

Bye for now!

Team Ralph 🐾