AVNJ December 2023

The Official Journal of the Veterinary Nurses Council of Australia Inc. Reg. No. A0031255G ABN 45 288948433

VOL . 29 • NO. 4 • DECEMBER 2023

THE AUSTRALIAN VETERINARY NURSES JOURNAL

VNCA Conference

CELEBRATING GROWTH INSPIRING EXCELLENCE

Creating a gold standard preschool for your pup-ils

Understanding palliative care

Workflow efficiency and the role of veterinary nurses

CONTENTS

Contents TH E AU STR A L IA N V E TE R I NA RY N U RS ES J O U R NAL

VOLUME 29 • NO. 4 • DECEMBER 2023

NEWS & UPDATES

01

President’s report

03 AVNAT – Progress and accountability: Advancing mandatory registration for veterinary nurses and technicians

04 Creating a gold standard preschool for your pup-ils

BOARD OF DIRECTORS President Gary Fitzgerald

04

Vice President Trish Farry Michelle Foxcroft, Anita Parkin, Rebecca Coventry, Asha Yeoman, Samara Blake

VNCA MEDIA CHAIR Janet Murray Email media@vnca.asn.au

30

24 Workflow efficiency and the role of veterinary nurses

30

PO Box 7345, Beaumaris VIC 3193 Phone 03 9586 6022 Fax 03 9586 6099 Web www.vnca.asn.au

ADVERTISING Phone 03 9586 6022 Email vnca@vnca.asn.au

Fear-free in the clinic

34 Case Report – Surgical excision

Lauri Steel Cert IV VN, DipVN (ECC & GP), DipVET, DipTDD, AVN, TAE, DipBus, Dip.Couns, DipBA, DipMgt, Cert IV CAS

VNCA NATIONAL OFFICE

Understanding palliative care

19 30th VNCA Conference

REVIEW PANEL

Jo Hatcher Dip VN, Cert IV VN, Cert IV TAE, RVN, AVN Shauna James Cert IV VN, GradCertCaptVertMgt (CSturt), RVN

10 And that’s a wrap for the 2023 12

Janet Murray Lauri Steel Elise MacPherson Shauna James

Elise MacPherson Dip VN (GP) & SURG, Dip Lab Technology (Pathology Testing), Cert IV VN, RVN, AVN

Nurse/Technician of the Year award winners …

Veterinary Nurse & Technician Awareness Week – The future is in your hands …

EDITORIAL COMMITTEE

Janet Murray BSc Veterinary Nursing, AssocDegAdult&VocEd, Cert IV TAE, RVN, AVN

09 Celebrating our Veterinary

of dentigerous cyst

OUR VISION & OUR MISSION VISION STATEMENT The VNCA aspires to strengthen the position of Veterinary Nurses as part of the veterinary healthcare profession.

MISSION The VNCA:

Serves and represents all Veterinary Nurses

36 Client fact sheet – Multiple cat households

38 VNCA HR Advisory Service – Unpaid work – Is it ever OK?

40 Member Vitals – Annette Scott and Chloe Johnson

41 Congratulations to our AVNs and new members

Protects the professionalism of Veterinary Nurses

Promotes the value of Veterinary Nurses as vital in delivery of quality veterinary care Advocates for the increased recognition of Veterinary Nurses across Australia

Supports Veterinary Nurses through the provision of continuing education and networking opportunities

Strengthens the position of Veterinary Nurses across the veterinary industry Engages all Veterinary Nurses across the veterinary industry.

Cover image ©shutterstock/GagliardiPhotography

FROM THE PRESIDENT

President’s report Greetings AVNJ community As we swiftly approach the year’s end, I trust that spring has treated you well.

The VNCA has been keeping busy in recent months, and I am delighted to share some notable highlights and future prospects.

NSW PARLIAMENTARY INQUIRY INTO VETERINARY WORKFORCE SHORTAGES In late August, I had the opportunity to represent our submission in a parliamentary hearing. The submission was positively received, reflecting a shared understanding of the significance of registration and regulation for veterinary nurses and technicians. Following the hearing, the VNCA was invited to a targeted stakeholder consultation with the NSW DPI. Board Director Rebecca Coventry attended this crucial meeting, emphasising our commitment to shaping the future of our profession.

VETERINARY NURSE AND TECHNICIAN AWARENESS WEEK From 9–13 October, we immersed ourselves in the spirit of celebration during Veterinary Nurse and Technician Awareness Week.

With daily themes of Accountability, SelfManagement, Education and Utilisation, and Advocacy, we hosted insightful webinars that resonate deeply with our profession. I extend heartfelt thanks to our presenters for sharing their expertise and

insights, contributing to the success of this celebration. The week was a resounding success, concluding with Vet Nurse and Technician Appreciation Day. For those considering their personal development in 2024, the VNCA’s Professional Development and Helen Power Future Leader scholarships are now open, with applications closing on December 1.

ROYAL CANIN VNCA WORKFORCE SURVEY AND NURSEKIND CAMPAIGN Earlier this year, we partnered with Royal Canin for a comprehensive survey of the veterinary nurse and technician workforce.

The insights gained are invaluable, and we are thrilled to announce an ongoing collaboration with Royal Canin and the Lincoln Institute through their ‘Nursekind’ Campaign. Stay tuned for more details in early 2024, as we continue to advocate for the welfare and recognition of our profession.

AVBC PATHWAY TO VETERINARY NURSE/VETERINARY TECHNICIAN REGULATION – EARLY DECEMBER As key stakeholders, we have been invited to a workshop in Melbourne in early December to chart the course towards national registration and regulation of veterinary nurses and technicians. This event presents a crucial opportunity to shape the future of our profession, and

Gary Fitzgerald

VNCA President

This event presents a crucial opportunity to shape the future of our profession, and we are eager to contribute our insights and perspectives.

we are eager to contribute our insights and perspectives.

I will endeavour to continue to keep you informed of our continued progress into the New Year. As we step into the holiday season, I extend warm wishes for a safe and joyful period. Let us take a moment to acknowledge the dedicated vets, nurses and technicians who will be working to provide care to the pets in our communities throughout the holiday period. Your commitment does not go unnoticed. Thank you! I hope each of you can find meaningful moments with friends and family. I look forward to the exciting developments that lie ahead in the coming year.

Wishing you all a safe and joyful holiday season.

Warm regards Gary Fitzgerald VNCA President

VNCA SUPPORTERS 2023 VET NURSE/TECHNICIAN OF THE YEAR SUPPORTER

PROFESSIONAL DEVELOPMENT SUPPORTER

December 2023

1

NEWS

NOMINATIONS NOW OPEN

Your opportunity to lead and influence our future – nominate for the VNCA Board Don’t miss this chance to be part of the proactive and influential team shaping the future of our profession.

The VNCA Board holds a pivotal position within your profession. It’s responsible for providing visionary leadership, setting the course for our strategic direction, and overseeing the association’s activities. The Board is answerable to our members, ensuring the organisation’s performance aligns with your expectations.

We warmly welcome all Full and Life Members of the VNCA to consider taking a role on the VNCA Board. These

voluntary positions are essential in contributing to the growth and success of our organisation and the broader profession. There’s no better time to engage and actively influence the path forward.

Nominations are open until 5:00 pm AEDT on Wednesday 21 February 2024.

For additional information on the Board’s responsibilities and the VNCA’s governance framework, please refer to our website, including the Board Charter

at: https://www.vnca.asn.au/the-vnca/ governance/. You can also get in touch with the VNCA’s President via president@vnca.asn.au should you wish to discuss this opportunity further.

Your leadership journey starts here!

2023 Veterinary Nursing Industry Survey The 2023 Veterinary Nursing Industry Survey is now officially launched and we want to hear from you!

Participate in the 2023 Veterinary

Nursing Industry Survey and influence the future of your profession! This

unique opportunity allows veterinary nurses and technicians to share

insights into various aspects, such as the working environment, practice

types, qualifications, job roles, hours,

DIVISION CONTACTS NSW

Melissa Shoard E nsw@vnca.asn.au 2

December 2023

Submissions closing on 13 Dec 2023; don't miss out!

salaries, and skill sets. Your input is crucial in providing a comprehensive understanding of the current state of veterinary nursing.

advocate for the profession and condensed results will be featured in the Australian Veterinary Nurses Journal.

The survey, managed by Association Professionals on behalf of VNCA, ensures the confidentiality of your details. Your contribution helps

Take the 10–15-minute survey now – your voice matters!

SCAN ME

If you would like to attend a divisional committee meeting, it is important that you RSVP. QLD

Jade Davies E qld@vnca.asn.au

SA

Sonia Van De Kamp E sadiv@vnca.asn.au

VIC

Danielle Gaynor E vic@vnca.asn.au

WA

Tracey Woods E wadiv@vnca.asn.au

NEWS

Quality practice through standards and learning

Progress and accountability: Advancing mandatory registration for veterinary nurses and technicians WORKING TOWARDS FORMAL REGISTRATION OF VETERINARY NURSES AND TECHNICIANS

the scheme and you may be curious as to

Much work is continuing on the goal

compliance with the criteria required for

to achieve mandatory registration of

veterinary nurses and technicians as we

approach the end of the year. There have

been many meetings and discussions with

key parties on the next steps in the process.

The VNCA and AVNAT representatives

have been asked to provide input into

these discussions, with VNCA President Gary Fitzgerald attending the NSW

parliamentary inquiry into the veterinary shortage and speaking on the impact

of underutilisation and lack of regulation for veterinary nurses and technicians.

Our AVNAT chair, Jo, also attended Royal Canin’s Veterinary Wellbeing Seminar to

speak on the utilisation of veterinary nurses and technicians and what legislation allows. Both sessions received very

positive responses from the parliament

and veterinarians and highlighted only a

small part of the work going on behind the scenes towards national regulation.

why this is required and what it involves.

An audit is undertaken to check for

were selected you may have been

the future, an audit is a standard procedure

nervous about what was required

move towards mandatory registration in to demonstrate a thorough, robust

and transparent registration scheme standards.

The audit is conducted by randomly selecting several registered nurses

and technicians from each state and

registration class to make up to 10% of

the total number of individuals registered under the scheme. Those selected

as a VNCA member and they are keeping

clear and up-to-date records. It was noted that some CPD evidence submitted was

not eligible due to the CPD event not being AVNAT, RACE or NZVNA points; however,

most of those audited did have enough

eligible points through other CPD events

undertaken, which may have included

minimum of 20 eligible points for each CPD

their attendance at CPD events. The ARC

contact us at avnat@vnca.asn.au

all relevant evidence of CPD activities

attended. Always check that you have a

copies of certificates or letters of proof of

cycle. For any questions on this, please

then reviewed these documents to ensure that the activities undertaken met the

minimum level of AVNAT-prescribed CPD

activities as set out in the AVNAT CPD Policy.

have been nervous about what was

than 10% of all individuals registered under

was already recorded in the My CPD tracker

needed to ensure that they had provided

The AVNAT Regulatory Council (ARC) has,

required to undertake an audit of no less

and the outcome.

that meets national and international

The process itself was relatively simple;

annual audit of the scheme. The ARC is

relatively simple; however, if you

the scheme by individuals. As our goal is to

WHAT IS THE AVNAT CPD AUDIT AND WHY IS IT REQUIRED? over the last few months, undertaken an

The process itself was

however, if you were selected you may

The audit will take place each year, so if

you are selected at the end of the cycle

next year, and have kept your records up to date, you can relax knowing it is a formality

and a simple process that does not require much from you.

required and the outcome. We are pleased to report that the majority of individuals needed to submit very few additional

documents as all of their CPD evidence

Are you interested in becoming registered?

December 2023

3

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©getty images/primeimages

Creating a gold standard preschool for your pup-ils

by Narelle Braunack

BVT (Hons 1 Animal Behaviour), BSc Ecology and Conservation Biology, Cert IV VN, AFHEA, Elite FFCP (Veterinary), RVN

INTRODUCTION Puppy preschool is the most common type of formal dog training occurring within

veterinary hospitals across Australia. It is an incredibly valuable asset to have in

any clinic; however, depending on how it is run, it can have lifelong negative or

positive impacts on puppies, owners and

the overall client-to-clinic relationship. With continuously updated literature describing dog behaviour and how dogs learn, it is

important that staff running these classes are educated in understanding the hows and whys of their lesson plans.

PUPPY DEVELOPMENT There is an abundance of literature

explaining how critical it is that various animal species have a positive early

developmental stage in their lives. When focusing on puppies, and even kittens,

early development and life experiences

can directly impact their future resilience, coping strategies and overall behaviour.

‘Early development’ incorporates the

physical, emotional and psychological

health of the pregnant and nursing bitch/

queen and the maternal care she provides.

It also includes the interactions the puppy

has with conspecifics, allospecifics and the 4

December 2023

environment that the individual is exposed to during this time.

When looking at the start of a puppy’s life, the first 2 weeks are defined as the neonatal stage in which its focus is nursing, sleeping and staying close to its mother.

Puppies then enter a transitional period (2–3 weeks old) when their eyes and ears begin to open, and their vision and hearing begin to improve. After this, they enter their socialisation period. Most breeds of dogs have their key socialisation period occurring between 3–12/16 weeks, which is when they are significantly influenced by their surroundings and experiences, both positive and negative. The puppies’ senses are fully developed during this time and they begin to learn how to interact with the world. The individual will absorb information about what is considered frightening/ negative in life and what is a positive and rewarding experience, and this will heavily influence how they interpret the same and

similar stimuli throughout the rest of their lives.

Their socialisation period is also a time when they gain bite inhibition and learn how to play with other puppies, which can be hindered if they are removed from their littermates too early. This socialisation window only lasts approximately 9–11 weeks

and is not a period of time that can be

re-simulated later in the individual’s life,

which is why it is such a critical component of their early development. Around the 6–8 week mark, there is also a shorter

‘fear period’ window, where the individual can feel more easily frightened of new

situations, have reduced resilience and

recovery skills, and behaviour regression can occur with manifested anxiety.

The puppy then enters the juvenile period

(4 months – ~6 months old or until the dog is sexually mature). After sexual maturity, they are in their adolescent period until

they reach social maturity, which ranges between 12 months – 24 months old.

VACCINATION VS SOCIALISATION With puppies going to their new homes at ~8 weeks old (in the middle of their

socialisation period), the age-old dilemma arises – I can’t ‘socialise’ my dog outside because it’s not 16 weeks and fully

vaccinated. Unfortunately, with 16 weeks generally being the end of a puppy’s

socialisation window, if owners only take their dogs outside after this time their

critical socialisation window will be closed

and an enormously imperative opportunity has been missed.

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Vaccinations are essential for puppies, and in no way is this content designed to underappreciate the importance of vaccinations and prophylactics. These notes are, however, intended to examine the importance of socialisation and how to complete it in a safe manner when a puppy is not ‘fully’ vaccinated with its initial 3 puppy vaccinations.

Most dogs that are relinquished and euthanised at animal shelters are primarily due to behavioural issues. On the RSPCA annual statistics report for 2021–2022, when assessing reasons for canine shelter euthanasia, 68% of dogs fell under the ‘behavioural’ category, 28% were ‘medical’ and 3.7% were due to ‘legal’ reasons. It is likely that some categories cross over and behavioural issues could be included in both the medical and legal categories; however, one can only presume such information. Additionally, there are numerous studies demonstrating that reduced or inappropriate socialisation during a puppy’s socialisation period can significantly contribute to whether the individual develops a behavioural problem. With various amounts of literature emphasising the importance of understanding, supporting and treating challenging behaviour problem cases at a young age, the significance of appropriate socialisation at a puppy preschool cannot be underestimated.

WHAT IS SOCIALISATION? Frequently, when the question arises of ‘What is socialisation regarding puppy preschool classes?’, a common response is ‘dog to dog play/interaction’. This is, in fact, socialisation (if done correctly); however, it only forms a very small component when looking at the bigger picture of socialising puppies.

feeling frightened and unable to cope with this stress.

There are copious amounts of literature examining the benefits of appropriately socialising puppies, yet there are still many veterinary practices, clinicians, support staff and breeders giving puppy owners a blanket rule of ‘Don’t take your puppy outside until it is fully vaccinated’, without elaborating on this further. Of course, we should not be encouraging unvaccinated puppies to walk in high-risk infectious areas (i.e. dog parks and risky, inappropriate areas); however, we should still be emphasising the importance of noncontact socialisation for these puppies.

Noncontact socialisation is an easy way to help introduce puppies to the world in a safe and controlled manner. Examples of this can be gradual introductions to car rides at the puppy’s pace. To begin with, sitting with the puppy in the car, then turning on the engine, the radio at a low volume and if the puppy is still comfortable, going for a short car ride even with the windows down. If this was a positive experience for the puppy, then they have been exposed to different sounds, movements, vibrations, smells and sights without setting foot on the ground.

This event is also beneficial as mental stimulation for the puppy, which within itself is also critical for puppies and dogs of all ages. Puppies can also be carried on short walks to be exposed to the outdoors, which may include the sounds and smells of cars, scooters, children, wind, etc. As long as the puppy is comfortable, this is socialisation to the elements it is being exposed to.

Household items that are mobile and generate sound can frequently cause some form of stress in dogs (i.e. the vacuum cleaner). To help avoid this fear, socialisation with foreign objects within the household should occur during this critical window when the puppy is brought home.

The same principles apply to any form of socialisation, and that is to start at a very minor level and gradually increase the intensity at the pace at which the puppy remains comfortable. For the example of a vacuum cleaner, initially, owners should bring it out of the cupboard quietly and frequently and let the puppy investigate it while it is not plugged into a powerpoint.

If the puppy is comfortable, owners can continue on to moving the vacuum (again with it remaining turned off). Gradually increase the intensity of the item until they are vacuuming with the machine turned on. It is important to allow the puppy the opportunity to approach the vacuum and feel as if it can walk away from it if they are feeling overwhelmed (in which case the owner should turn the machine off and take the training back a step).

As long as the puppy play is mutually positive, safe, engaging and beneficial for the dogs, then this is socialisation.

©getty images/101cats

Socialisation, in its simplest form, is positive exposure. As long as the puppy play is mutually positive, safe, engaging and beneficial for the dogs, then this is socialisation. As is the puppy learning to walk on a slippery surface and feeling comfortable that it can complete the same task again. Or seeing and hearing loud children playing down the road and not

Continued next page

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Creating a gold standard preschool for your pup-ils Continued from previous page

Noncontact audio socialisation can be utilised within the household too.

Background sounds of traffic, children, fireworks, etc., while the puppy is occupied (i.e. chewing on a dehydrated chew) can be played at a low volume, positively exposing the pup to these unfamiliar sounds in a controlled and safe manner.

RISK ASSESSMENT When determining when and where to take unvaccinated puppies out, the risks vs benefits need to be realistically considered.

Assess the geographical location the puppy is in or is planning to be taken to.

Be aware of the infectious disease risk and avoid any high-risk areas at all times.

©getty images/Svitlana Hulko

Puppies should have at least 1x vaccination prior to external exposure ‘events’. However, this isn’t to say you can’t recommend clients go for a car ride, have some visitors over to their house and start playing a variety of audio sounds in those first few weeks (again, at all times ensuring the puppy is comfortable). Play dates can also occur within a safe contained yard/ house with friendly, well-matched, healthy, vaccinated puppies and dogs.

GOALS OF A GOLD STANDARD PUPPY PRESCHOOL There are numerous ways and formats that puppy preschools can be run and there is no one-size-fits-all. Depending on the individuals in the class, there may be scenarios where some puppies are asked to come to classes earlier to release some energy or have a play with another well-matched pup, or classes may run on rotating enrolments compared to structured enrolment weeks, or classes may teach ‘laying down’ on the first, second or third week, or not at all.

Despite the flexibility in specifically how each session is completed, there should always be some baseline guidelines to every class to ensure the class is completed to its greatest potential and highest standard.

trainer who uses and educates using

only positive reinforcement and rewardbased training. Alternatively, it can be a

around socialisation and helping

a further quality study in the field of animal

educate clients about puppy

reinforcement training). These teachers

body language and how dogs

acquired additional training or completed behaviour (again while utilising positive

are more than just puppy trainers; they are

learn, which leads to basic

owners on the subtle body language

training.

responsible for interpreting and educating signals of the puppies and ensuring no

pups are psychologically damaged and

potentially ‘broken’ in these classes. They

are responsible for intervening proactively

prior to puppies feeling fearful, are the ones keeping records of any ‘behavioural red

flags’ occurring, and also have a duty of

care to feel comfortable in recommending

Ensuring there is an appropriately qualified instructor/s running the preschool is critical. This can include an accredited

There should generally always be two

December 2023

preschool classes should be

nurse, technician or support staff that has

CLASS INSTRUCTORS

6

The main focus of puppy

veterinary intervention.

instructors in these classes for a number of

reasons. The main goal is to allow one to be able to assist with puppies continuously while the other is focusing on teaching the class. Another benefit of having two teachers run these classes can be to help manage the human attendees more effectively, as well as offering the ability for new instructors to gain experience in a safe and controlled manner.

CLINICAL

INSTRUCTOR GOALS The main focus of puppy preschool classes should be around socialisation and helping educate clients about puppy body language and how dogs learn, which leads to basic training. The instructors should ensure every puppy is comfortable and is being positively exposed to a variety of substrates, textures, sounds, stimuli, handling, objects, people, puppies, etc., in a safe, controlled and calm manner.

This does not equate to ‘flooding’ the puppy with copious amounts of overwhelming stimuli. ‘Flooding’ a puppy by trying to socialise them to large amounts of new stimuli at a pace that is too fast for the individual will make the puppy feel uncomfortable and stressed and will likely cause consequential panicking. This is not socialisation and should be avoided at all costs as it can in fact damage the puppy’s resilience and association with the stimuli.

Puppy play can be an excellent opportunity for the individual to socialise with other puppies, however, it can also be an easy way to ‘flood’ a puppy. Instructors should be mindful to only allow off-lead play for 2–3 puppies at any one time, with consistent monitoring occurring during this session. Adult dogs naturally play in dyads or triads, so it is important to help simulate what would be considered normal for the pup when it grows up.

The puppies that are selected by the instructor to play together should be matched by their similar play styles, temperaments and, sometimes, physical size. Puppy play can be a fantastic opportunity to educate owners on body language, signals and reciprocation of behaviours, while also reinforcing the significance of actively intervening in the play. It is, however, important to remember that not all puppies may be feeling ready to play with others in the class and to help support them by not forcing them into situations where they have to interact if they do not want to.

If there is a puppy that is uncomfortable, scared, overwhelmed, or stressed, there needs to be the ability for the instructor to immediately help that individual by removing them from the stressor or removing the stressor from them.

Flowing on from the focus of educating clients on how puppies learn and their body language, instructors should also be utilising the opportunity to demonstrate the benefits of positive reinforcement training.

As classes can be mentally exhausting for both owners and puppies, it is important not to discuss learning theory at great depth, but more to touch on this content briefly and regularly while giving alternative methods of training advice to those who may be trying to use punishment-based approaches. For example, if a puppy is walking towards another puppy (very normal behaviour in context), and the owner doesn’t want this to occur so pulls on the puppy’s lead and says ‘ah ah’ or ‘no’, the instructor should instantly encourage them to use a treat as a lure in front of the pup’s nose and call them back onto their mat or to the owner. This should be demonstrated without judgement or making the owner feel belittled. There are numerous studies that explain the negative toll that punishment can have on puppies, so it is important that the instructor does the best they can to pass this information along and actively show owners how easy it can be to use positive reinforcementbased training. As such, the instructor should also be actively using this form of training consistently during all classes.

Avoiding verbal and physical punishment, reprimanding, time-outs, and outdated training methods are essential to provide current, scientifically proven and ethical preschool classes. Any form of ‘dominance’, ‘alpha theory’ or ‘pack leader’ training is obsolete, scientifically disproven and should have no place within animal training – especially puppy preschool classes.

BEHAVIOUR ‘RED FLAGS’ FOR PUPPIES One of the most important tasks a preschool instructor has is to be able to identify any behavioural ‘red flags’ puppies may have and discuss these with the owner, with or without the veterinarian’s input. Behavioural ‘red flags’ for puppies are the early signs that the individual may be neurodivergent, have a behaviour problem or require further veterinary intervention for displaying ‘abnormal’ puppy behaviour.

When looking at animal behaviour holistically, context is always extremely relevant, which is where a well-educated instructor is worth their weight in gold.

‘Abnormal’ behaviour to some can actually be very appropriate within the context of someone with further knowledge and understanding in the field. An example can include a puppy who is barking and has snapped at other puppies during off-lead play. This can be appropriate; however, it depends on the situation and context. Are there 6 other puppies jumping on this one individual, and despite the puppy giving every other signal that it’s uncomfortable, has had no one intervene in this overwhelming play? Is this barking and snapping only when the other puppies come near its high-value food, accidentally left on the mat? Does this pup recover and bounce back after the barking and snapping incident and proceed to calm down? Has the pup recently been spayed and is still feeling raw at the surgical site when another pup landed on her?

There are an endless number of variables that form the context of behavioural responses, which is why it is critical to have well-educated and focused staff leading these classes. Instructors should always be considering what is appropriate for the species, how quickly the individual recovers from the stressful event/stimulus and the frequency and intensity of the behaviour in question.

If the puppy’s behaviour is considered concerning, then the instructor should discuss this with the client privately to avoid any potential embarrassment, or alternatively and additionally, a veterinarian, and recommend a consultation.

CLASS LOCATION Safety should always come first when considering an optimal location for puppy classes. The classroom should be an area that can be completely and thoroughly cleaned, one that is fully contained/fenced, one with minimal external distractions and one with enough space between puppies and owners (ideally, at least 2 metres). The classroom should also have the ability to allow puppies to be separated if they are Continued next page

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Creating a gold standard preschool for your pup-ils Continued from previous page

feeling overwhelmed. For example, this

separation can simply be a table with a

sheet covering it, being utilised as a visual barrier for the puppy and owner, who are

now sitting behind it. This visual barrier can help the puppy feel safe and in control

when it wants to voluntarily approach the remainder of the classroom.

CLASS ATTENDEES Puppies between the ages of 8–16 weeks should be attending puppy preschool.

Ideally, pups should be enrolled to start

at 8–10 weeks of age, so by the time they have finished the 4–5 week program, they will have spent the majority of

their socialisation period in their new

home being guided by a well-educated instructor, helping them be positively

exposed to the various elements of the

world that they may encounter at a later

age. Puppies of all sizes and breeds should be allowed in these classes to simulate

an accurate portrayal of life outside the classroom.

CLASS SIZE Puppy preschool classes should not have more than 6 puppies as a rule of thumb.

Larger classes can be more challenging

for the trainer/s to assess and manage all

puppies (and people), are generally much

louder, can be overstimulating for the pups and can be a safety issue depending on the size of the classroom itself. There

should be 1–2 owners per puppy, with restrictions on having young children

(< 7 years) attending due to the length of time expected for them to sit quietly and

focused. Exceptions can be made; however, this may be up to the instructor’s discretion.

By keeping the classes small, ~3–6 puppies

per class with 1–2 owners per puppy, will set puppies, owners and staff up to succeed.

CLASS MATERIALS AND WHAT OWNERS SHOULD BRING Puppy preschool classes can be mentally stimulating and sometimes draining for owners, challenging them to remember what was taught in the previous class(es).

For this reason, and to reinforce the content being taught, it is usually a good idea to give clients hard copies or electronic learning materials at the end of each session. Ensure these are current, referenced and consistent with the goals of the sessions.

Owners should also be encouraged to bring their own treat pouch (or even utilise this opportunity to advertise the type you sell through your clinic). Treat pouches will be useful for the remainder of their dog’s life and are a valuable tool to have during preschool classes.

High-value treats are a necessity to be brought to classes every week as well, along with a soft mat for their puppy.

Having the same mat being brought to every class can assist the puppy in visualising a familiar item and associating it with where they can settle. The mat should never be used as a negative location for punishment; rather, it should be used as a rewarding positive item where treats ‘magically’ appear and calm behaviours are formed.

Since preschool classes can be very stimulating, owners will need to bring a variety of enticing snacks for their pup (roast chicken, cheese, training treats, etc.).

Owners should not expect puppies to be focused on them if they are bringing the standard ‘boring’ treats that the puppy would normally be interested in during a boring day at home. Understanding that puppies will enthusiastically learn and engage in training, however, if the

Investigating and thoroughly understanding what/who/ where you are recommending clients go to for puppy preschool is of understated importance. If your clinic is unable to run a puppy preschool, then ensure you are recommending the best one you can.

8

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environment is exceptionally exciting, then the owner/trainer will be required to use higher value items that the puppy deems more rewarding than what it would feel if engaging in the distracting environment.

SETTING BOTH CLIENTS AND PUPPIES UP TO SUCCEED Most general practitioner veterinary clinics around Australia have some form of puppy preschool or are able to recommend one close by. However, what is actually occurring in these classes and who is running the session? Investigating and thoroughly understanding what/who/ where you are recommending clients go to for puppy preschool is of understated importance. If your clinic is unable to run a puppy preschool, then ensure you are recommending the best one you can.

With behaviour problems being the greatest threat to the animal-owner bond, as well as being the number one cause of relinquishment and euthanasia at shelters, it is clear the importance of educating and supporting puppies, breeders and owners during the puppy’s early developmental period to ensure behavioural problems don’t arise.

References Blackwell EJ, Bradshaw JWS, Casey RA. Fear responses to noises in domestic dogs: prevalence, risk factors and co-occurrence with other fear related behaviour. Appl Anim Behav Sci. 2013;145:15–25.

Hewison L, Mills DS. Learning principles and behaviour modification. CAB International, Oxford, 2020.

Howell TJ, King T, Bennett PC. Puppy parties and beyond: the role of early age socialization practices on adult dog behavior. Vet Med (Auckl).

2015;6:143–153.

Landsberg G, Hunthausen W, Ackerman L. Behavior problems of the dog and cat E-Book.

Elsevier Health Sciences, 2011.

Overall KL. Understanding how dogs learn: Importance in training and behavior modification.

WSAVA Congress, 2006.

Serpell J, Jagoe JA. Early experience and the development of behaviour. In: Serpell J (ed.).

The Domestic Dog: Its Evolution, Behaviour, and Interactions with People. Cambridge, UK: Cambridge University Press; 1995.

Stolzlechner L, Bonorand A, Riemer S. Optimising puppy socialisation; short- and long-term effects of a training programme during the early socialisation period. Animals. 2022;12:3067.

Ziv G. The effects of using aversive training methods in dogs—A review. Journal of Veterinary Behavior. 2017;19:50–60.

NEWS

Celebrating our Veterinary Nurse/ Technician of the Year award winners …

CONGRATULATIONS

Clinical Excellence: Implementing improvements like regional nerve blocks and invasive blood pressure monitoring, Rhonda enhances patient care and safety.

Rhonda Ponder

2023 Veterinary Nurse/Technician of the Year We’re thrilled to announce Rhonda Ponder as the 2023 Veterinary Nurse/Technician of the Year! With nearly two decades of experience, Rhonda’s journey from Aberfoyle Hub Veterinary Clinic to her current role as Surgery Team Leader at Greencross Referral and Emergency Centre has been exceptional. Her outstanding contributions include:

Education Advocate: Rhonda champions veterinary nurse accreditation, proudly wearing badges symbolising her dedication.

Leadership and Teamwork: As Surgery Team Leader, Rhonda unites teams, fostering collaboration and elevating care standards.

Veterinary Expertise: Rising from Head Veterinary Nurse to Surgery Team Leader, Rhonda’s clinical skills and leadership stand out.

Industry Involvement: Rhonda’s dedication is evident in her six-year commitment to the VNCA SA Division General Committee and past work with the VNCA Membership Committee.

Commitment to Education: As a Senior Nurse Educator at Vetprac and Greencross, Rhonda shapes the future of veterinary nursing by advancing skills and knowledge.

Community Outreach: Passionate about responsible pet ownership, Rhonda educates children in schools and kindergartens, fostering a love for animals.

CONGRATULATIONS

Commitment to Education: As a lifelong learner, Emma embodies the joy of learning, has joined the VNCA, and is eager to inspire colleagues with a journal club for continued education.

Emma Reilly

2023 Student Veterinary Nurse & Technician of the Year Announcing Emma Reilly as the Student Veterinary Nurse/Technician of the Year.

Her rapid rise, dedication to patient care, and commitment to learning set her apart.

Emma’s meticulous approach to surgery, empathy, and support for colleagues make her a standout in the profession. Emma’s remarkable journey includes: Clinical Excellence: Emma’s meticulous approach to anaesthesia and surgical prep has increased the success of complex surgeries, especially in oromaxillofacial cases.

Team Player: Beyond being an exceptional clinician, Emma prioritises inclusivity and wellbeing, brightening the workplace and organising thoughtful gestures like birthday celebrations.

Leadership Qualities: Emma excels in emergencies, motivates colleagues, and communicates effectively with clients. Her leadership shines through in every aspect.

Rhonda’s influence extends beyond her workplace through speaking engagements and workshops. Her relentless pursuit of excellence and advocacy makes her the embodiment of the Veterinary Nurse/ Technician of the Year. Join us in celebrating Rhonda’s exceptional achievements and the positive impact she has made on the veterinary field. Her dedication and passion inspire us all, and we’re proud to have her as our Veterinary Nurse/Technician of the Year!

Emma, your passion, compassion, and commitment make you a shining star in veterinary nursing. Congratulations on being named the 2023 Student Veterinary Nurse/Technician of the Year!

Client Relations: Adored by clients for her consistency and dedication, Emma’s clear and compassionate communication, especially in stressful situations, is invaluable. She goes the extra mile, even assisting elderly clients in a rural town.

Clinical Impact: Emma has significantly impacted her practice, alerting critical changes during high-risk anaesthesia, assisting in successful CPR efforts, and demonstrating expertise in monitoring and caring for cleft palate patients.

The VNCA extends our sincere gratitude to Hill’s Pet Nutrition and Boehringer Ingelheim for their sponsorship of the Veterinary Nurse/Technician of the Year Award and the Student Veterinary Nurse & Technician of the Year Award. Their support is pivotal in enabling us to celebrate excellence in our profession. We look forward to them handing out these awards at the upcoming 30th VNCA Conference in Adelaide.

PROUD SPONSORS

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And that’s a wrap for the 2023 Veterinary Nurse & Technician Awareness Week – The future is in your hands …

The 2023 Veterinary Nurse & Technician Awareness Week was an outstanding success, thanks to the incredible support from our sponsors, dedicated speakers, and the enthusiastic participation of our community.

T

he week was a true celebration of the vital role veterinary nurses and technicians play in the care of animals. We are immensely grateful for the valuable contributions of all involved and together we shone a spotlight on your essential work in our industry. Thank you for making this week a resounding achievement!

A standout feature of the week was the enlightening VNTAW ‘The Future is in Your Hands’ webinar series. The microlearning sessions proved to be exceptionally popular, and our sincere appreciation goes to our

distinguished speakers—Patricia Clarke, Suzie McLean, Erica Honey, and the international keynote conference speaker for 2024, Amy Newfield. Their insightful presentations covered a spectrum of crucial topics, including accountability, self-management, advocacy, education, and utilisation. For those who missed the live sessions, the recorded videos are still accessible for viewing.

Vet Nurse & Technician Appreciation Day on Friday commenced with impactful videos from the Board of

Directors. These videos not only highlighted the VNCA’s achievements over the past year but also underscored the day’s theme— the significance of celebrating successes. The announcement of award winners added an exciting element, and the showcase of how various clinics celebrated their staff through competition entries was truly heartening. We extend our gratitude to the clinics that dedicated considerable time and effort to commemorate VNTAD. Selecting the three winners – Cherry Court Veterinary Clinic, AREC Vet, and My Pet Hub Townsville – proved to be a challenging task due to the overwhelming participation. It’s evident that, in the end, everyone emerged victorious by rallying behind the incredible veterinary nurses and technicians, expressing profound appreciation for their unwavering dedication and hard work. A heartfelt thank you to all who contributed, ensuring that this year’s appreciation day became an unforgettable celebration.

We extend our heartfelt gratitude to all our sponsors whose generous support played a pivotal role in ensuring the resounding success of Veterinary Nurse & Technician Awareness Week. Their invaluable contributions empowered us to offer a diverse array of content and resources, enriching the experience for all participants involved. As we wrap up the festivities for this year and set our sights on the preparations for next year’s celebration, we eagerly invite you to share your thoughts and ideas on how we can elevate the celebration of this significant

The future is in your hands

VET NURSE & TECHNICIAN AWARENESS WEEK 9-13 October 2023

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December 2023

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event. Your input is crucial in shaping the future of Veterinary Nurse and Technician Awareness Week. What innovative ideas do you have that can assist the VNCA in effectively promoting awareness about the indispensable role of vet nurses and technicians in the workplace? We encourage you to contribute to this collaborative effort, as together, we hold the key to shaping the future.

Remember, ‘The future is in your hands’.

PLATINUM SPONSORS

SILVER SPONSORS

December 2023

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Understanding palliative care Dr Jackie Campbell BVSc (Hons), Dip CMT, CHPV Sunset Vets | Palliative & End-of-Life Care drjackie@sunsetvets.com.au

P

alliative care within veterinary medicine is rapidly evolving and requires a mindset shift from routine clinical and preventive practice. As we look to support both patients and their owners/ families, it is helpful to reconcile with the concept that ‘neither sickness nor death is a failure of our medicine, but simply the natural progression of biology’.1

sometimes be well aligned, but at other times they are complicatedly opposed.

As practitioners, it gives us an incredible opportunity to change the goalposts of care and focus on what we can do to mitigate pain, suffering and distress in our patients, and help walk owners through the experience of end-of-life compassionately.

WHY SHOULD WE CARE ABOUT HAVING A STRUCTURED APPROACH TO PALLIATIVE CARE?

WHAT IS IT? Defined as ‘the active and total care of patients whose disease is not responsive to curative treatment’, much of what we practise stems from the human palliative models of ‘patient-centred’ care. In veterinary medicine, we have an adjusted care model that involves balancing both client and patient needs in what has now more appropriately been termed ‘bondcentred’ care.2 This recognition that the bond our clients have with their pets is the driving force behind their decision-making means anything we can do to support that bond ultimately influences the healthcare outcomes for that particular patient.

©getty images/Carmelka

In essence, palliative medicine is based on the ideals of comfort when a cure is not possible or practical or where the burden of treatment is no longer in the patient’s best interests. These three influencers can

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Being prepared for these challenges and having a rational, repeatable approach to your recommendations is important to ensure you are ethically balancing all interests and achieving the best outcomes for all involved.

We know the saying ‘Clients don’t care how much you know until they know how much you care …’. Palliative medicine requires us to extend this beyond just showing that we care for our patients, but that we care for our clients and their immediate challenges as well – recognising that what we do and say to clients in their decision-making moments greatly influences the choices they will make for their pet.

A confronting reality is that some clients who have long been great pet-owning clients, will at some point experience a communication block with a veterinary practice. It often comes through us not adequately appreciating the challenges of home nursing, not understanding the psychosocial factors of household dynamics, or delivering care options that are not in sync with our client’s value set.

Mitigating this risk starts with thinking objectively about your practice’s approach to palliative care. How open are you to

these discussions with your clients? Do you have answers to the questions they may throw at you?

BENEFITS FOR THE PATIENT Palliative care for the patient just makes sense and is probably what many of us aim to practise already from a medical and nursing perspective. If we appreciate that there has been a significant shift in how pets are perceived within our society, more and more of our clients will be asking for and demanding increased services in this area. This ties closely to an increase as our population ages in the number of humans having personal experiences with palliative care teams through the care of family members or loved ones.

Evidence within the veterinary literature measuring outcomes of formal palliative care programs is limited, but human data suggests that patients receiving structured palliative care tend to have better quality of life at the end and report increased survival times.3 Anecdotally, veterinary palliative care practitioners report similar results in their patients.2

BENEFITS FOR THE CLIENT Clients who are prepared for the experience of pet loss suffer less anticipatory grief, and on average, recover back to pet ownership again much faster.

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Again, if we look at the human literature, many studies support this. A 2010 study of 122 human caretakers demonstrated that a lack of preparedness when a person is dying, resulted in a prolonged grief period and a greater risk of depression. There was a reported 9x increase in the incidence of severe depression in this group when compared with caretakers who had exposure to even a brief component of palliative support prior to their loved one’s death.4

FOR THE PRACTICE If we are endeavouring to convince the owners of our hospitals and practices to invest in this area of medicine (i.e. upskilling both vets and nurses, extending consultation times, developing resources), communicating to them that fostering a palliative care program within also makes good financial sense.

Looking at a typical clinic population spread: more than 30% of patients are likely to be classified as ‘senior’ (i.e. > 7 years) and 16–18% could readily be considered geriatric (> 10 years). As a percentage of patients by age, one would expect that this is going to continue to be an upward trend.

A retrospective US study of patient records of over 2.5 million pets in 2012, revealed that dogs were living at least 4% longer and cats 10% longer than they were a decade previously.5 This presents a significant market for practices and often this can be driven by motivated veterinary nursing teams.

It’s also important to recognise that if we, within our own practices, are not capturing this market, these clients are going elsewhere. They’re seeking advice from friends and family, allied health, breeders, community forums, etc. In these situations, clinics are losing control of the information they are given and people with less understanding of the issues are weighing in on high-stakes, quality-of-life concerns. This imbalance in the delivery of care can sometimes lead to the prolonging of suffering for the patient and certainly contributes to emotional distress for clients.

RETHINKING THE CARE MODEL In human medicine, there is a distinct difference between the word ‘senior’ and the word ‘geriatric’. Senior is a classification by age (> 65 years), whereas geriatric is applied to patients exhibiting symptoms of a defined physiologic state. You may be 80 and still not considered geriatric unless you are displaying sarcopaenia, weight loss, cognitive and behavioural changes, weakness, balance issues, social withdrawal, etc.6 This concept may be readily applied to the veterinary space and forces us to look more intently at the patients coming through our doors. I think many practices now have robust senior wellness programs already in place but how many of us have a palliative program for them to transition into? This needs to begin to encompass not just the individualised medical needs of the patient but the education and emotional support of the client/caregiver and is an area of service for clinics to focus on.

UNDERSTANDING THE LANGUAGE Palliative care as a field of human medicine didn’t really find its feet as a dedicated specialty until the 1980s and wasn’t recognised by the American boards until as late as 2006. The World Health Organisation has recently identified palliative care as an area of increased focus, holding the world’s first global resolution on palliative care in 2014. This identified a need for improved access to services in this area and recognition of the practice as an essential component of comprehensive health services.7 With respect to veterinary palliative care, while a handful of veterinarians have been working in this field since the early ’90s, an international body representing the efforts of these practitioners wasn’t formed until 2009 and it has only been in the last 4–5 years that there has been a significant shift to accept palliative care across the US/UK. It is likely that many clients seeking palliation for their pets will have had experience with the delivery of palliative care services in the human space. As such, it is useful to be aware of the broader public understanding of the language used.

PALLIATIVE VS HOSPICE Palliative care – ‘the relief of suffering and the alleviation of symptoms, patients do not necessarily need to be terminal’ As a vet who aims to help families access care in the home environment, I sit firmly in the space of palliation. I aim to help my clients understand the limitations of our capacity to deliver true ‘hospice care’ Continued next page

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Understanding palliative care Continued from previous page

without hospitalisation. We endeavour to provide active symptom control while balancing the client’s needs during the caregiving period. I am an advocate for compassionate euthanasia when suffering cannot reasonably be controlled.

Hospice – ‘a philosophy of care, often associated with a physical place where this care is delivered, typically correlates with a high intensity of support e.g. 24 hr nursing, patients are always terminal’ The term ‘hospice’ is more practically applied to the human healthcare system; however, it is being used in the veterinary field internationally. I personally have some concerns with this, as while clients are likely to be familiar with the term, its true meaning implies an intensity of care that is rarely opted for with our companion animals. For most clients, when care of this intensity is required to control symptoms, euthanasia becomes an option they

The term ‘hospice’ is more practically applied to the human healthcare system; however, it is being used in the veterinary field internationally.

PAIN MANAGEMENT – THE MAINSTAY OF PALLIATION While a detailed examination of pain management in the palliative patient is beyond the scope of this lecture, there are a few key concepts that are helpful to remember when approaching cases. The first is that there are significant differences between the management of acute/ adaptive and chronic/maladaptive pain.

I think many of us are pretty good at analgesia and the management of pain while patients are under our watch in a hospital setting. But what of the more insidious types of pain? The osteoarthritis patient who has been physiologically adapting to their pain for many years? Or the congestive heart failure patient who is decompensating? Humans suffering from dyspnoea report this sensation being not only painful but the anxiety of

not being able to get breath has more of a negative effect on quality of life than a 10/10 experience of pain. How do we objectively overlay the very real emotional component of this experience in our animal patients? What about visceral pain due to an abdominal mass? Is it just nociception we should be worried about, or do we need to appreciate and rationalise that our pets likely experience the humanreported sensations of malaise and oppression with abdominal pathology?

Or what of the long-held assumption that degenerative myelopathy is a nonpainful condition? What evidence do we have for this assumption? Humans with seemingly comparable disease states report a wide variation in the experience of pain due to their physical dysfunction.

In human palliative care, practitioners working with noncommunicative patients apply a presumed pain present (PPP) approach. This recognises the inherent difficulty in the identification of pain in patients who are not able to describe their experience.

To date, there are no consistent, reliable physiological indicators (i.e. heart rate, respiratory rate, etc.) that have been found to be useful for the measurement of chronic pain. As such, the litmus test for the presence of pain is to treat what we assume to be there and assess the response.

When approaching maladaptive pain, it’s important to have a basic understanding of some of the pathophysiology of pain and the pharmacokinetics of the drugs we are selecting. Multimodal drug therapy is essential in many cases to achieve good control, as is an appreciation of the impact of nonpharmacological interventions – these are useful even with very endstage patients. The best approach centres on the layering of complementary or synergistic medications and dose adjusting to account for patient tolerances e.g. an advanced osteoarthritis patient may begin on a regime of an NSAID and neutraceuticals but will step up through the tiers of +/- gabapentin +/- amantadine +/amitriptyline, as indicated over time.

©getty images/NATALIA ANDREEVA

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are required to consider for the relief of suffering. For clients who are morally opposed to euthanasia, you may need to begin to talk about the provision of hospice; however, in almost all cases, hospitalisation and appropriate medical supervision will be required to successfully manage pain and very few clients want their pets to be hospitalised for extended periods if there is no prospect of discharge before the end.

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MY TOP TIPS FOR PALLIATIVE PAIN MANAGEMENT: 1. Recognise that for true palliative care cases, we are likely to have a short

opportunity to achieve improvement in a patient. Often if we cannot show

owners rapid improvement and give them a functional management

plan, pain becomes a life-or-death

situation. If we are in this scenario, we may need to start aggressively with a pain management plan (with an

understanding of potential side effects and extensive owner education), then scale back if able.

2. Reassess – Using the word ‘palliative’

gives us all an opportunity to reassess whatever has gone before medically and evaluate where the patient is currently at with respect to their

symptom control. Clients should be

encouraged to be assessing pain at

least daily and reporting back to the

clinic as appropriate. Nurses facilitating pain check-ins can be a great

communication link between the client and the case veterinarian.

3. Reprioritise – It’s not uncommon with

chronic or complicated medical cases that we can be so distracted by the

various diagnoses, we fail to see the patient. Nurses are often our lifeline here and are often really attuned

to patients. Empowering nurses to step up and become part of the

‘interdisciplinary palliative care team’ is

critically important for improving patient outcomes, particularly in busy clinics.

4. Labelled doses are our start point, not the end of the game. Remember that

most labelling is generated for drug use in isolation. You will often be working

with systemically compromised patients and multimodal regimes. There is never going to be a perfect rule book for this,

but we need to spend time working out our patient’s needs on an individual

level and have treatment plans that

prescribe to this. The minimum effective dose is sometimes significantly below the labelled dose in these patients.

5. Think about compliance. If the process of medicating is damaging the pet-

owner relationship we need to come

up with a better plan. Caregiver burden is a significant consideration for palliative care plans. Consider fear-free medication techniques (in food, games, compounded medications to different routes e.g. transdermal, transmucosal).

There may also be some situations where deprescribing is very appropriate.

This happens ALL THE TIME in human palliative medicine. When considering this as a care team, the timing in which we do it is important but if our patients are in the very end stages, a reassessment of whether medications that were prescribed to extend life (i.e. disease modifying drugs) are still useful and still in the patient’s best interest, is important. Remember, in palliative care, we are aiming to treat the patient’s symptoms rather than the diagnosis or disease.

SETTING YOURSELF UP FOR PALLIATIVE PRACTICE Palliative care is often simply a modified approach to our standard therapy, and the more this field grows, the more definition we’re getting around what ‘best practice’ palliative care is. Here are a few things you should be thinking about if you are looking at implementing a palliative care program within your practice. What does your practice have already? Are there things you can suggest to your vets as tools and resources they might want to consider exploring?

PALLIATIVE CONSENT FORMS These should be separate from standard hospital admission forms and are designed to clearly outline to clients that there is about to be a change in goals for patient care. They may include phrases such as: I understand that palliative care is focused on preserving quality of life for as long as possible and is NOT focused on curing medical conditions or providing routine medical care. The attending veterinarian has informed me if additional diagnostics, procedures and/or more aggressive care is recommended for my pet at this time, and I have: a) declined additional diagnostics, procedures and/or more aggressive care, or b) accepted the recommendation(s), and the attending veterinarian has assisted with the necessary referrals.

OFF-LABEL USE FORMS So much of what we do in palliative medicine involves the use of off-label medication. Gaining client consent to prescribe these medications is not only best practice but is part of building trust and building some credits in the bank that you may need to draw on later when the patient is either not responding or their condition is deteriorating. I use a lot of multimodal therapy, particularly for pain management cases, and have all my clients understand the risks associated with attempting to achieve the best possible symptom control.

I understand that there are often no suitable products that are specifically registered for use in a particular species of animal or for a particular medical condition in that species of animal. I understand that, in order for my veterinarian to be in a position to treat my animal, he/she may have to resort to using or advising the use of products registered for use only in other species, including human beings, and/or products registered for another purpose.

I understand that treatment with the products described below will mean that my veterinarian will be using or advising the use of such products on my animals outside of the recommendations or even in contradiction with the recommendations contained in the package insert relating to the registration of that product (i.e. ‘offlabel’).

PAIN SCALES Pain scales are useful tools for communication between team members within a clinic but can also be incredibly useful for clients in the home setting.

There are a number of robust scales for assessment of acute pain; however, chronic pain has proven much harder to reliably score.

In our practice, we use a 1–10 client scale that encompasses both pain and demeanour. This is what’s known as a Health-Related Pain Scale, which is essentially a merger of the pain and QOL scale concepts. The rationale behind the 1–10 system is that this is the common measure used in both adult and paediatric human medicine. Clients are more familiar Continued next page

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Understanding palliative care Continued from previous page

with this approach than say a 1–4 or

1–6 scale and are likely to give us more instinctive answers when asked. When

working with clients, it is useful for them to understand that the scale is really a

trend-monitoring tool. Having established

an agreed start point, the most important information comes from the direction

of the trend as opposed to the actual number.

QUALITY OF LIFE ASSESSMENT CHARTS QOL assessment charts allow owners to objectively measure parameters such

as demeanour, pain, appetite, hydration,

mobility, hygiene, and capacity for restful

sleep. These tools are often a good starting point for introducing a family to a palliative

care discussion. A word of warning – clients with highly analytical personality traits can find these tools more difficult to use and I typically avoid this approach in these clients.

GRIEF RESOURCES With good pre-euthanasia support, a large number of our clients are able to manage grief in a healthy way. For those requiring additional help, professional intervention needs to be delivered quickly. Clinics

should have a list of contacts for mental health support, including counsellors,

psychologists and mental health-focused GPs. Be aware that not all professionals

will have experience with pet loss, which can be challenging for clients if this is

their primary issue. For clinics without any

established written resources for grief, the

Argus Institute at Colorado State provides a number of good documents for use.9

EFFECTIVELY APPROACHING THE EUTHANASIA DECISION As a clinic, there are numerous things we

can do to improve the euthanasia experience for our clients and the better we do at this

critical point of care, the more likely we are to retain these clients into the future.

Studies show that while a high number of clients will report ‘satisfaction’ with their

experience of pet euthanasia, there is still a significant attrition rate of clients from

clinics following the loss of a pet.8 It follows 16

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that clients are reluctant to voice specific complaints around this subject; however, their choice to re-engage with clinics after a euthanasia experience is heavily influenced by the ‘feeling’ they were left with following their interactions there.

My top 10 tips for the euthanasia appointment: 1. People experience a huge amount of guilt when voicing the word ‘euthanasia’.

As care teams, we should always be the ones to give permission for the owners to explore euthanasia. Offering this option early in the disease process is important as it allows clients to come back to it when they need it. Saying the word ‘euthanasia’ is NOT going to influence the client to prematurely euthanise.

2. Stop yourself from ever telling clients that ‘they’ll know when it’s time’.

They don’t. Clients are paying for our professional support and for the consulting vet’s medical opinion. As care teams (both vets and nurses), we have more capacity to assess the impact of illness on quality of life than clients.

Advocate for your patient in terms of what you know about how they are feeling at that moment and what the prospect for ongoing life quality is.

3. Work as a team. In palliative care, we recognise and celebrate the importance of the interdisciplinary team. Be conscious that the whole of your wider clinic team is likely to have touchpoints with a client at some stage during the euthanasia process.

Receptionists often experience the brunt of client communication and should be trained in what to ask and how. Nurses can do so much of both the client and patient care during a euthanasia visit and should be encouraged to upskill in palliative communication and euthanasia support practices. This is absolutely an area where all team members should be involved and think about how you can collectively make this client’s experience of euthanasia the best it can be.

4. This may be controversial in some practices, but I recommend having a

single fee for euthanasia. Emotional clients want less information to think about at the point of booking, not more.

This is not an area where you need to begin itemising things on the bill, and I believe all charges should be captured in a single figure (e.g. Don’t add extra for sedation/catheter, etc.). While larger pets do require more drugs and therefore are often ‘charged out higher’ this is RARELY the client’s understanding or rationalisation of this issue. What they hear when being quoted for this service is more about how your clinic interprets ‘value’. At such a critical moment as end-of-life, to the client, an overly complicated pricing structure begs questions such as: ‘Why is my cat’s life seemingly worth less than a dog’s life’ with respect to this procedure?

5. Think about your communication style when talking about anything related to palliative care and end-of-life – consider when to use open-ended questions (e.g. history taking, exploring thoughts and emotions) and when to use closed (e.g. exceptionally grieving clients, highly stressful situations, decision-making moments).

6. Words matter. Be aware of your word selection and elect for a positive inflection on any statements you deliver.

7. Try to do the euthanasia outside the consult room if possible. Aim for the best possible location you have access to – a quiet part of the clinic, in the garden, if the pet enjoys travel ... in the car? Clients may need to be back in your regular consulting rooms with their other pets at any point and we know for some clients this association with space can be detrimental – avoiding routine consulting spaces for euthanasia appointments is preferable, if at all possible, within your clinic set-up.

8. Ask clients if they have been through euthanasia before and adjust your spiel according to their experience base.

Remember that even clients who have said goodbye to a pet many times before will need signposting of the steps.

9. Explain what is needed for the visit, but no more. Knowledge of the process

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Your words are powerful.

They have the capacity to influence outcomes for the patient, to reduce anguish for clients and ©getty images/Photoboyko

to create an experience that will be remembered for all the right reasons.

reduces fear and minimises client stress points but be succinct. Emotional brains have less ability to process language and are easily overwhelmed by information.

10. Aim to predict your client’s needs and immediately accommodate them.

People will struggle to articulate their

needs at this time. If they are obviously crying, don’t ask if they need a tissue

… just give it to them. If you sense they need time or space, don’t ask them if they need some time, assertively

manage this with ‘I can see you need

some time. I’m going to step out for a

moment.’ If this is not what they need, they will correct you. The reverse of

asking you for what they need will be harder.

COMMUNICATION TAKE-HOMES Euthanasia day can be the worst day of a client’s life, but it doesn’t have to be, and small gestures can go a long way.

Your words are powerful. They have the capacity to influence outcomes for the patient, to reduce anguish for clients

and to create an experience that will be remembered for all the right reasons.

Once the client has made the decision to euthanise, support them. At this point, all

clients need to hear that we are with them.

Don’t cloud the waters with other options

or treatment plans to appease a need for

Work as a team and if, within your practice, there are people for whom end-of-life communication is not their thing, support those in the practice who can do the majority of it. Nurses and support staff are often naturally good at this kind of communication and many vets should be supporting these team members to shine.

The euthanasia experience is something that people WILL talk about. Be exceptional and they will talk about you … do it poorly and they will talk about you too!

FURTHER READING A. Shanan, K. August, K. Cooney, L. Hendrix, B. Mader, J. Pierce. 2016. Animal Hospice and Palliative Care Guidelines. International Association of Animal Hospice and Palliative Care.

VH. Adams, A. Akashi, JA. Araujo, et al.

2011. Veterinary Clinics of North America: Palliative Medicine and Hospice Care.

Elsevier Inc. Volume 41, Number 3.

M. Epstein, I. Rodan, G. Griffenhagen, J. Kadrlik, M. Petty, S. Robertson, W. Simpson.

2015. AAHA/AAFP Pain Management Guidelines for Dogs and Cats. American Animal Hospital Association.

G. Bishop, K. Cooney, S. Cox, R. Downing, K. Mitchener, A. Shanan, N. Soares, B. Stevens, T. Wynn. 2016. AAHA/IAAHPC End-of-Life Care Guidelines. Journal of the American Animal Hospital Association. [Online].

Volume 52. Pages 341–356. Available at:

https://www.aaha.org/graphics/original/ professional/resources/ guidelines/2016_ aaha_iaahpc_eolc_guidelines.pdf.

References 1

McVety D. Lap Of Love Veterinary Hospice. 2017 [ONLINE] Available at: https://www.lapoflove. com/About-Us/Founders/.

2

A. Shanan, K. August, K. Cooney, L. Hendrix, B. Mader, J. Pierce. Animal hospice and palliative care guidelines. International Association of Animal Hospice and Palliative Care. 2016:37.

Available at: http://www.iaahpc.org/images/ IAAHPCGUIDELINES

3

Temel J, Greer JC, Muzikansky, A, et al. Early palliative care for patients with metastatic non-small cell lung cancer. New England Journal of Medicine. 2010;363:733–74.

4

Herbert R, Prigerson H, Schultz R, et al. Preparing caregivers for the death of a loved one: a theoretical framework and suggestions for future research. Journal of Palliative Medicine.

2006(9):1164–9.

5

BARK. State of Pet Health 2013 Report. [ONLINE] Available at: https://www.banfield.com/ Banfield/media/PDF/Downloads/soph/ Banfield-State-of-Pet-Health-Report_2013.pdf.

6 Gardner M. 2016. DVM360. [ONLINE] Available at: http://veterinarymedicine.dvm360.com/ senior-vs-geriatric-semantics-or-significant.

7

De Bode, C. 2017. World Health Organisation: Palliative Care. [ONLINE] Available at: http:// www.who.int/ncds/management/palliativecare/en.

8 Fernandez-Mehler, P. Gloor, P. Sager, E. et al., 2013. Veterinarians role for pet owners facing pet loss. Veterinary Record. [ONLINE] 172:21, 555.

Available at: http://veterinaryrecord.bmj.com/ content/172/21/555.

9 L. Barrett, C. Borchert. L. Lagoni and the Argus Institute Staff. Making decisions when your companion animal is sick. 2009. Colorado State University Veterinary Teaching Hospital, USA.

being medically ‘right’. Medically ‘right’ is not the only kind of right.

December 2023

17

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VNCA Conference

CELEBRATING GROWTH INSPIRING EXCELLENCE 17-19 April 2024

Adelaide Convention Centre Register now for this unique chance to come together to commemorate 30 years of VNCA conferences with colleagues from around the country and beyond.

WHO SHOULD ATTEND? We are excited to welcome a varied audience to participate in the conference, including experienced veterinary nurses/technicians seeking to broaden their knowledge, students embarking on their professional journey, those who look to strengthen their clinical skills, and emerging leaders in our profession prepared to advance to the next stage of their careers.

The conference promises a rich exchange of knowledge, hands-on learning options, networking opportunities, and industry updates from our generous sponsors and exhibitors – all highlighted by presentations from our two esteemed international keynote speakers – Amy Newfield and Leslie Wereszczak.

Amy Newfield

Wednesday 6 March 2024 Early Bird registration closes

Register on or before the Early Bird closing date and save (exclusive to VNCA Members) Leslie Wereszczak

Not a problem – join online to access the best value registration price and access the full range of exclusive member benefits.

PRINCIPAL PARTNERS

WWW.VNCA.ASN.AU

2024 CONFERENCE KEY DATES Now available Education Program

BEST VALUE – ACT NOW! NOT A MEMBER?

REGISTER NOW – EARLY BIRD CLOSES 6 MARCH 2024

Tuesday 16 April 2024 Pre-conference Masterclasses and President’s Welcome Drinks 17–19 April 2024 30th VNCA Conference

SCAN THE QR CODE TO VIEW THE EDUCATION PROGRAM AND REGISTER FOR THE 30TH VNCA CONFERENCE NOW

VN CA C o n f e r e n c E P ro g r a m DAY 1 – WEDNESDAY 17 APRIL 2024 STREAM TWO – ROOM E2

STREAM ONE – HALL D 6:30 AM–7:30 AM

STREAM THREE – ROOM E3

WORKSHOPS/COMMERCIAL SESSIONS – ROOM E1

VetPrac Breakfast Session – Presented by VetPrac

7:30 AM–8:00 AM

EXHIBITION OPEN – ARRIVAL TEA & COFFEE – DAY ONE

8:00 AM–8:45 AM

Conference Opening Ceremony and Welcome to Country

8:45 AM–9:45 AM

How to make the veterinary profession a sustainable career – Amy Newfield

9:45 AM–10:30 AM

MORNING TEA – DAY ONE

10:30 AM–11:30 AM

Special delivery: medication But I offered food! Kim Healy Avian orthopaedics – administration in the ICU from triage to discharge Leslie Wereszczak Iffy Glendinning

11:30 AM - 12:30 PM

Nursing management of the urinary obstructed cat Harold Davis

Veterinary nurse-trition: the power of nurse nutrition explored through real life cases Victoria Koks

12:30 PM–1:30 PM

Medically managing gastrointestinal obstruction in rabbits Amanda Clews

Workshop One: Face your (anaesthesia) fears: a case studies workshop Navin Prakash and Trish Farry

LUNCH - DAY ONE

1:30 PM–2:30 PM

Emergency anaesthesia Marcia Fletcher

What’s in those fangs?

Breaking down snake venom Asha Yeoman

Identifying and preventing common toxicities of exotic pets Emmajane NewtonDinning

2:30 PM–3:30 PM

Top ten challenges in the ICU Leslie Wereszczak

Approach to the collapsed patient Asha Yeoman

Progressing your veterinary nursing career Janet Murray

3:30 PM–4:00 PM

Workshop Two: Practice makes progress – techniques for reducing stress for dogs visiting vets Dr Petra Edwards

AFTERNOON TEA - DAY ONE

4:00 PM–5:00 PM

Five keys to developing workplace standards that build growth and excellence in your team Sue Crampton

5:00 PM–5:30 PM

VNCA Annual General Meeting

Preparing clients for loss – conversations and resources every practice should have Rosie Overfield

VTyeS: the ins and outs of Veterinary Technician Specialties Brittney Prakash

Sponsored Commercial Session Presented by VetPay

HAPPY HOUR WITH THE EXHIBITORS

5:30 PM–6:30 PM

OUR SUPPORTERS Thank you to the following sponsors for their support of the 30th VNCA Conference. This event would not be possible without their contribution.

PLATINUM PARTNER

GOLD SPONSORS

SILVER SPONSORS

The above sponsor and exhibitor list correct as of 24 November 2023.

*Program subject to change without notification.

DAY 2 – THURSDAY 18 APRIL 2024 STREAM ONE – HALL D 7:30 AM–8:30 AM

STREAM TWO – ROOM E2

STREAM THREE – ROOM E3

Hill’s Pet Nutrition Breakfast Session – Presented by Hill’s Pet Nutrition

8:00 AM–9:00 AM

Workshop Three: The anaesthesia Olympic challenge Anita Parkin and Trish Farry

8:30 AM–9:00 AM 9:00 AM–10:00 AM

EXHIBITION OPEN – ARRIVAL TEA & COFFEE – DAY TWO Initial assessment of the emergency patient Harold Davis

Planning for surgical success: Nursing the equine colic peri-operative X-rays patient Gemma Murphy Brittney Prakash

Workshop Three: The anaesthesia Olympic challenge (continued)

MORNING TEA – DAY TWO

10:00 AM–10:30 AM 10:30 AM–11:30 AM

When the beat drops: ECGs and arrhythmias Marcia Fletcher

Radiology of the avian and exotic patient Rebecca de Gier

The equine nurses’ role in equine lameness exams Gemma Murphy

11:30 AM–12:30 PM

When I was your age….

Cat Walker

Advanced medical math Sabrina Lepiane

Production animal field anesthesia Tenneal Prebble

12:30 PM–1:30 PM

Workshop Four: Theatre preparation – Getting clean and staying clean Jo Hatcher

LUNCH – DAY TWO

1:30 PM–2:30 PM

Understanding the blue patient Amy Newfield

Monitoring blood pressure under anaesthesia Laura Jane Butcher

Camelids – they’re not so scary! Tenneal Prebble

2:30 PM–3:30 PM

Nursing care of the mechanically ventilated patient Leslie Wereszczak

Take a deep breath, now exhale: understanding capnography Tori Brown

Everything brachycephalic: pre, peri and post operative care Kimberley Litster

3:30 PM–4:00 PM 4:00 PM–5:00 PM

WORKSHOPS/CASE STUDY – ROOM E1

Case study presentations These afternoon sessions will feature unique and interesting case management scenarios.

Each presentation will run for 15 minutes, and will follow on after each other over the afternoon sessions.

AFTERNOON TEA – DAY TWO Taking your team from toxic to terrific Amy Newfield

7:00 PM–12.00 AM

Balance of care – a You want me to do what Case study presentations manage­ment tool to in front of an owner?! (continued) determine appropriate Caesar’s story Hayley Strain staff to patient ratio in an emergency and critical care facility Michelle Rouffignac CONFERENCE DINNER – ‘DIAMONDS AND PEARLS’

COMMERCIAL BREAKFAST SESSION

COMMERCIAL SESSION

EXHIBITORS

The above sponsor and exhibitor list correct as of 24 November 2023.

DELEGATE BAG

CONFERENCE DINNER & PHOTO BOOTH

VN CA C o n f e r e n c E P ro g r a m DAY 3 – FRIDAY 19 APRIL 3023 STREAM ONE – HALL D 6:30 AM–7:30 AM

STREAM TWO – ROOM E2

STREAM THREE – ROOM E3

WORKSHOPS – ROOM E1

Royal Canin Breakfast Session – Presented by Royal Canin

7:30 AM–8:00 AM

EXHIBITION OPEN – ARRIVAL TEA & COFFEE – DAY THREE

8:00 AM–9:00 AM

Monitoring the IV fluid patient Amy Newfield

9:00 AM–10:00 AM

Catheter crisis: hitting the hard to hit Leslie Wereszczak

Don’t be scared – it's just an endoscope!

Jasmine Pengelly

Workshop Five: Avian and exotic case studies – exceptional encounters in specialised veterinary care I’m sterile... now what? The Conflict is a dish best served Rebecca de Gier role of the scrubbed surgical cold Cat Walker assistant Rhonda Ponder

10:00 AM–10:30 AM

How to juggle all the balls: The true reality of returning to the workforce as a mum!

Sarah Wandel

MORNING TEA – DAY THREE

10:30 AM–11:30 AM

RECOVER CPR: team ready!

Leslie Wereszczak

Effective action to beat The veterinary industry – climate change – emissions can we fix it? Yes we can reduction in practice Erica Honey Terry George

11:30 AM–12:30 PM

Blood transfusion 101 Amy Newfield

Relief at last: pain management for the small animal veterinary patient Tori Brown

12:30 PM–1:30 PM

Workshop Six: Hands free X-ray – radiography positioning workshop Brittney Prakash

Creating a culture of respect Janine Irwin

LUNCH – DAY THREE

1:30 PM–2:30 PM

Shining a new light on an old disease – periodontal disease takes the stage Maggie Burley

2:30 PM–3:30 PM

‘The Cat Walker Hour’ – Cat Walker

Anaesthesia mortality in exotic species – are they dying, or are we killing them?

Rebecca de Gier

3:30 PM–4:00 PM

CONFERENCE CLOSE AND AWARDS

PRE-CONFERENCE MASTERCLASSES Pre-Conference Masterclasses will take place on Tuesday 16 April 2024, 8.30 am–5.00 pm. These sessions will allow attendees to extend their knowledge in hands-on, practical workshops with highly qualified educators (additional fees apply).

Masterclass One RECOVER CPR: Rescuer Certification Workshop How do we best treat animals in cardiopulmonary arrest?

Evidence-based veterinary CPR guidelines published by the RECOVER Initiative in 2012 aimed at maximising patient survival after cardiopulmonary arrest led to the official veterinary CPR certification process approved by the American College of Veterinary Emergency and Critical Care. This course will teach the concepts and techniques of RECOVER Basic Life Support (BLS) and Advanced Life Support (ALS).

Masterclass Two Anaesthesia Masterclass This session will provide veterinary nurses techs with the essential knowledge and skills to contribute to safe and effective anaesthesia in veterinary practice. Topics include breathing systems and machine setup, anaesthesia monitoring simulation, and drug calculations and constant rate infusions, and will conclude by bringing it all together with anaesthesia bingo.

Masterclass Three Mental Health First Aid In this informative and practical course, you will learn about the signs and symptoms of common and disabling mental health

Client behaviour has changed – have you?

Janet Murray

problems in adults, how to provide initial help, where and how to get professional help, what sort of help has been shown by research to be effective, and how to provide mental health first aid in a crisis situation using a practical, evidence-based action plan.

SOCIAL FUNCTIONS What better way to celebrate than to come together – amongst all the amazing education – and have some well-earned fun! These functions are included with your full registration, with additional tickets available to purchase.

President’s Welcome Drinks Tuesday 16 April, 5.30 pm–7.00 pm – Foyer E Happy Hour with the Exhibitors Wednesday 17 April, 5.30 pm–6.30 pm – Exhibition Area Conference Dinner – ‘Diamonds and Pearls’ Thursday 18 April, 7.00 pm–12.00 am – Panorama Ballroom Sponsored by VetPay Marking a 30th anniversary is a significant achievement, and the VNCA deserves the perfect anniversary present fitting the theme of ‘Diamonds and Pearls’ for this year’s Conference Dinner. This special event is a celebration of shared knowledge, collaboration and innovation that have defined our conference over the years.

The Conference Dinner will feature a three-course meal, drinks, and entertainment.

Tar�nga Veterinary Pr�fessional Training � Wil�life Treatment � Care This course presented by Taronga will support veterinary professionals and veterinary nurses to develop knowledge and skills in native wildlife triage, including first aid, initial treatment and emergency care.

• Supported by the NSW Government Department of Planning and Environment

APPLY N�W!

Email: tarongprofvet@zoo.nsw.gov.au Visit: https://taronga.org.au/vet-professional-training

• AVA and VNCA certified • Online Course (20 CPD points) • Hands-on Workshop (12 CPD Points) – available in NSW, QLD and Vic (see website for details) • Subsidised positions available to eligible applicants nationally

Workshops available at:

G O L D

C O A S T

•

A U S T R A L I A

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Workflow efficiency and the role Graham Swinney

Regional Medical Affairs and Outreach IDEXX Australia and New Zealand

Kellie Lorschy

Professional Services Veterinarian Manager IDEXX Australia

Veterinary nurses, like veterinarians, have always been a precious commodity in veterinary practices/clinics. Veterinary nurses provide an invaluable resource for patient care, client relations and communication, provision of medical information and pet care support for clients and undertaking some diagnostic procedures within the clinic.

I

n some settings, nurses are involved with telehealth support, or undertaking some consultations within the clinic, such as nutrition guidance, dental health assessments, and patient rechecks, as some examples.

The pandemic has provided some significant challenges for veterinary clinics and veterinary care teams within these clinics. There were a number of challenges with attracting and retaining staff members (both vets and nurses), putting increased pressure on the available staff.

The Australian Veterinary Association has reported that there is currently a severe workforce shortage. Given restrictions, there were changes in the ways of work, with kerbside consultations that affected normal workflow and practices.

24

December 2023

In addition, there were increases in pet ownership and demand for veterinary services, further adding to the pressure on clinics and veterinary care teams. These challenges stretched across the realm of general practices, as well as specialist and emergency clinics, many of which were also overwhelmed with demand for veterinary services.

A group called Animal Medicines Australia do surveys of pet owners every three years and considers things like pet ownership, owner’s perception of pets, veterinary care, etc. In 2022, they released a report ‘Animal Medicine Australia Pets and the Pandemic 2022’. Here are a few relevant takeaway points from this: • There are an estimated 30.4 million pets in Australia.

• The number of households owning a pet increased from 61% before the pandemic to 69% in 2022.

• An estimated 7.3 million households would like to add a pet to their family, including 85% of pet owners and 43% of nonowners.

CLINICAL

of veterinary nurses • Thirty-seven per cent of pet owners had challenges sourcing veterinary care, food, etc.

• Nine per cent were not able to make appointments at veterinary clinics.

• Vaccinations (40%) and check-ups (38%) were the most common reasons for visits to clinics, with 6% each for nutrition advice and diagnostic testing.

• Twenty-four per cent of the cat population was obtained during the pandemic.

• Seventy per cent say having a pet improved their lives.

Some clinics have seen the demand for veterinary services start to settle somewhat, but others are still fielding high demand for these services, often with ongoing staffing limitations. As a result, there is increasing demand to try and find efficiencies within the clinic setting to help the veterinary team cope with the workload.

©shutterstock/Juice Flair

The focus of this presentation will be on diagnostics, but there are certainly other areas where efficiency can be increased.

For example, Practice Information Management Systems (PIMS) can have a significant effect on workflow efficiency within a clinic. These can include: • easy scheduling, clients making online appointments, appointment management • client communications, such as automated appointment reminders, SMS updates • discharge summary templates for clients • estimates and invoicing • wellness plans • master problem lists • inventory management and purchase orders • visit templates.

In addition, depending on the system, the PIMS can help with the management of diagnostics, such as requests made through the system for in-house testing, meaning depending on the equipment used, results and charges are captured, or in the case of the reference laboratory, requests can be generated from the system and results can automatically return to the system, with all charges captured. This type of technology really does help save time compared to having to manually enter results into the PIMS, or all results being in the form of attachments to the patient’s medical record, which just adds to the time in viewing results, and for nurses or front desk staff in having to add/attach pdfs to the medical record. Whenever results are manually entered, it opens the possibility of transcription errors, and therefore incorrect results in the medical record.

There are many aspects of laboratory diagnostics that nurses undertake or support in veterinary clinics, but the degree of responsibility will vary from clinic to clinic. In some clinics, the nursing team carries a large part of the responsibility for diagnostics, including sample collection, sample processing, and management of results. In other clinics, there may be less responsibility for sample collection.

Sample collection not only involves skill and technique but also an appropriate knowledge of sample handling and

storage. When considering samples for haematology, the tube of choice will generally be an EDTA tube. The authors are always reluctant to refer to tube colour, as while most EDTA tubes have a lavender/purple top, this is not universally the case – some EDTA tubes may have a red top, which many would consider the colour of a serum tube. Sample collection itself is important. If nurses are collecting samples, or assisting with sample collection, they play an important role in reducing the stress levels of patients. Samples collected from a calm patient, with a clean venepuncture and free-flowing sample will provide the best quality results. In cases where patients are very anxious, or resist gentle restraint for blood collection, other strategies such as premedication before a visit, or sedation before blood collection, may be considerations.

Samples can be collected from jugular veins or peripheral veins (such as the cephalic or lateral saphenous vein), but the authors’ preference is jugular vein collection. Ideally, a needle that is not too small should be used, with at least 23-gauge or 21-gauge needles used. If needles are too small, haemolysis (lysed or ruptured red blood cells) is more likely, which can affect the quality of results. If possible, patients should also be fasted, as lipaemia (fat in the blood, which can occur after eating) can also adversely affect results. Gentle negative pressure should be used on the syringe, as excessive pressure can increase the risk of haemolysis. When filling the tubes, the lid can be removed from the tube, and the needle can be taken off the syringe and the blood is gently dispensed. If using a vacutainer, ensure blood is not forced into the tube to avoid haemolysis.

Samples should be well mixed (gently) after the tubes are filled. If using the paediatric EDTA tubes, extra care must be taken with mixing, as the small-bore tubes make it harder to mix the blood well (we see an increased number of clotted EDTA samples when these tubes are submitted to the laboratory). Some other considerations for haematology submissions:

Continued next page

December 2023

25

CLINICAL

Workflow efficiency and the role of veterinary nurses Continued from previous page

Further training could be undertaken with making and staining blood films and then basic blood film review. The most common artefact on an automated CBC is thrombocytopaenia (low platelet count) because of platelet clumping. A brief review of the film can show platelet clumping, giving confidence that the platelet count is higher than reported.

For biochemical samples, the sample type may vary. For in-house sample processing, plasma is often used, which means collecting samples into a heparin tube (typically a green top), meaning the samples can be processed immediately after collection. Some laboratories prefer serum samples (often red top or even white top tubes). Here are some other suggestions for samples for biochemical analysis: • Please ensure there is no EDTA contamination of the serum tube, which can occur if the EDTA tube is filled first and the EDTA-treated blood comes into contact with the needle or syringe tip. If this occurs, you may have a false elevation in potassium (the EDTA contains potassium) and false reductions in calcium (which is bound by the EDTA).

• Lipaemia can contribute to haemolysis.

If possible, for elective samples, have the patient fasted. If fasting is not possible, separation of the serum from the cells once a stable clot has formed will reduce haemolysis.

• Haemolysis may also occur in transit. To minimise this, separation of the serum from the cells once a stable clot has formed if using a plain serum tube. Place the serum into a second tube but send us both tubes that are appropriately 26

December 2023

©getty images/DragonImages

• It is ideal to submit a blood smear as soon as possible after collection of the sample. Simply air dry the smear and place it into a slide holder. A fresh smear cannot deteriorate in transport and provides an accurate picture of the sample at the time of collection. The more smears you make, the better your technique in making them will become.

• Please do not put blood films (or any cytology slides) into the fridge as the condensation will damage the slide.

• Ensure the slides do not come into contact with formalin fumes.

labelled – the lab can always try to

extract extra serum from the cells if needed.

Remember, a moment

• Serum separator tubes are an alternative

completing the history can prove

a second tube. Once the sample has

invaluable in maximising the yield

to avoid the need for submission of

clotted, simply centrifuge the tube and

with your results. This will save a

is thereby protected from haemolysis

lot of time in having to contact

centrifuge that can hold a 2 ml tube,

the lab with more details when

the gel traps the cells and the serum in transit. These tubes do require a

and the samples are not suitable for

the interpretation of results has

assays.

been limited because of a limited

progesterone, digoxin or phenobarbitone When collecting urine samples, a

cystocentesis sample is often considered

or no history.

the preferred sample and certainly is if a urine culture or urine protein creatinine (UPC) is to be performed. However, for routine urinalysis, having the sample is more important than having a

cystocentesis sample. Therefore, a voided

sample, one from a clean litter box, or even taken off a tabletop or floor is preferable to no sample at all.

Sample labelling is also an important topic.

If sending samples to the lab, they need to be identified with the patient details at the time of collection. Blood films or cytology

slides should be labelled with the patient’s name and site of sample collection using a pencil. Even if processing samples

in-house, and the sample is going to be processed straight away, they should always be labelled. If repeat or follow-up testing is required, you need to be able to identify the correct sample. It certainly negatively impacts workflow efficiency to have to collect another sample, or even worse, have the patient return to the clinic for a repeat sample collection.

Vet nurses will often complete the request forms for samples being submitted to the laboratory, freeing up the vet to continue to see patients or undertake procedures.

There is often a question of what needs to be included in that history. Here are

CLINICAL

some guidelines for that. There are some cases in which the history is less vital – for example, some noninterpreted profiles in a well patient. However, if samples (blood or urine) are being submitted for profiles that require interpretation, the history is required for the pathologist to provide the best interpretation of the results. The history does not need to be extensive, but rather think ‘clarity and brevity’. A brief summary of the history and physical findings, any therapy or response to therapy, and any relevant previous illness. An example would include: ‘Inappetence and vomiting for two days.

Abdominal pain and dehydration noted on examination. Poor response to antiemetics and overnight fast. On NSAIDs for degenerative joint disease. Previous history of GI foreign body.’

For some samples such as urine, the lab also needs to know the method of collection to help interpret the results.

be processed as soon as possible after

collection. Ideally, there should be clear clinic protocols on sample handling to

maximise sample and, therefore, result quality. Depending on your in-house

biochemistry analyser, there needs to be a protocol on whether whole blood can be used in the analyser or whether the

heparin sample needs to be spun down

and the plasma extracted. If the plasma is placed into a secondary tube, then it

should always be labelled. If the sample

is spun down, and there is haemolysis or lipaemia, it is important to alert the vet

about this. If the haemolysis or lipaemia is severe, and it is an elective sample, a redraw after fasting, for example, may

be needed. If an urgent sample, it may need to be processed, but the results

interpreted with caution. Familiarity with

the in-house equipment in the clinic, and what the preferred sample types are, is

important. If whole blood can be used it will increase efficiency, but only if the analyser

When submitting samples for cytology and histopathology, the information provided is especially important, but again it can be clear and succinct. The information required is the location of the lesion, a description of its appearance, how long it has been present, changes over time, response to therapy, and any other clinical signs. If there have been similar lesions before, let the lab know what the previous diagnosis was. For skin lesions with biopsies taken, some digital photographs may also be useful. It can be invaluable to share what the clinical impression is too – remember you have the whole patient and the lab only has a small part of it.

can accurately process whole blood.

Remember, a moment completing the history can prove invaluable in maximising the yield with your results. This will save a lot of time in having to contact the lab with more details when the interpretation of results has been limited because of a limited or no history.

(dipstick) examination, and if the analysers

In many clinics, nurses have the primary responsibility for the in-house diagnostic analysers (if present). This can include processing samples, as well as routine procedures such as maintenance and quality control. Having good protocols in the clinic for training new nursing team members on the use of the analysers can prove invaluable. Ideally, samples should

Routine scheduled maintenance/care and quality control are central to obtaining

good quality results from the analysers, so

determine the schedule for this and ensure that there is a lead team member to take

responsibility for this. For any staff members who want to increase their skills with the

analysers, there are often online training courses available.

When processing urine samples it is

important to examine the urine as soon as possible, as changes can potentially start to occur from sixty minutes after

collection. There are analysers that can do a more automated urine chemistry are connected to the PIMS, can mean

results are automatically entered into the patient record. Microscopic (sediment)

examinations of the urine are somewhat

labour-intensive and time-consuming, but nurses certainly have the skills to prepare these if there is a standard protocol for preparation in the clinic. There are also

analysers available that can automate

urine sediment examination, and results

can be captured in the patient’s medical record.

Other tests that nurses can certainly be

FeLV, parvovirus, heartworm, for example), or things such as parvovirus. Nurses will often do faecal flotations in the clinic and assess blood glucose and PCV/TP levels.

Basic fluid analysis, such as checking protein levels, preparing smears, and preparing samples to send to the lab are also important skills.

There are certainly some other areas where nurses can play an important role in diagnostics within the clinic, and that is in the areas of discussing and recommending certain types of testing, and in the delivery of normal results to clients. Nurses are well placed to discuss recommendations for pre-anaesthetic blood testing with pet owners. This testing will vary based on the patient profile – young healthy animals may have smaller chemistry profiles and ideally a complete blood count. Older or unwell animals would ideally have a CBC and a more extensive chemistry profile. The reason for preanaesthetic testing is to try and minimise the risk of anaesthesia – it certainly does not mean there is no risk. A CBC, however, can ensure there is no anaemia or even reticulocytosis that could potentially flag underlying haemorrhage or haemolysis and can suggest if there is underlying inflammatory disease, and help ensure platelet counts are adequate to minimise the risk of haemorrhage. A biochemical profile can help assess the liver and kidneys (both of which metabolise or excrete some anaesthetic drugs) and ensure normal blood glucose and protein levels. Electrolyte abnormalities can potentially have an adverse effect on cardiac or muscle function, and blood volume. While the risk of anaesthesia is low, clients often want to be assured that the risk has been minimised for their pet.

Preventive care screening considers the inclusion of diagnostic tests, which would ideally include a CBC, biochemical profile, and potentially a urinalysis and faecal parasitology testing, to help assess pet health beyond what can be assessed on a history and physical examination alone.

A recent study looking at over 167,000 dogs and over 54,000 cats presented for wellness examinations that had diagnostics added (CBC and chemistry

performing in the clinic include rapid assay tests for things like infectious diseases (FIV/

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Workflow efficiency and the role of veterinary nurses Continued from previous page

or CBC, chemistry and urinalysis) showed the following numbers of pets that had changes that suggested further investigation was required: • Dogs • 1 in 10 young adults, or 1 in 7 if urine added • 1 in 8 mature adults, or 1 in 5 if urine added • 1 in 4 seniors, or 2 in 5 if urine added • Cats – 1 in 10 young adults, or 1 in 5 if urine added – 1 in 5 mature adults, or 1 in 3 if urine added – 1 in 3 seniors, or 3 in 5 if urine added

It is important in a clinic to discuss with the team what value the nursing team can bring. By upskilling and developing trust, increased responsibility can be given to diagnostics.

If pre-anaesthetic tests or preventive care results are all within the reference interval, then after consultation with the vet, it is certainly an option for nurses to communicate these results to clients. The good news should be celebrated, giving clients assurance that doing this testing was money well spent on their pet. As discussed before, these normal results may help build a baseline for the future. The results could be shared with the client, or some PIMS or result management systems may have options to share a ‘report’ with the client – not with results, but discussing what was tested (such as liver, kidneys, pancreas, blood cells, etc.), and that all the results were normal.

SUGGESTED READING Animal Medicines Australia: Pets and the Pandemic. https:// animalmedicinesaustralia.org.au/wpcontent/uploads/2021/08/AMAU005-PATPReport21_v1.4_WEB.pdf Accessed February 2023.

Promoting Preventive Care Protocols. 2018. https://www.aaha.org/globalassets/05pet-health-resources/promoting_ preventive_care_protocols.pdf Accessed December 2018.

Yagi K. What Can Veterinary Nurses Do for the Practice. Veterinary Team Brief, Oct 2017:21–25.

T H E AU ST R A L I A N V E T E R I N A RY N U R S ES J O U R N A L

THE AUSTR ALIAN VETERI

NARY NURSE S JOURN

AL

VOL . 28 • NO. 1 • MARCH

2022

Pet owners will place a lot of trust in vet nurses, and you can be a primary part of the discussion with pet owners on the value such diagnostics bring. If results are normal then it is even better, as these normal

results can help build a baseline for normal in the future, and even changes in results within the population-based reference interval over time may carry significance so disease can be detected sooner.

There are lots of options available – from clinical and research articles through to case studies, opinion pieces and the everpopular ‘Member Vitals’.

As a starting point, check out the Author Guidelines on our website at www.vnca.asn.au/resources/avnj/authorguidelines/ When you are ready to submit, or if you have further questions, please email us on media@vnca.asn.au – whether it is the first time or you are a frequent contributor, we’ll make sure your journey to publishing in AVNJ is rewarding.

28

December 2023

Inc. Reg. No. A0031255G Council of Australia

sure how to get started, we are here to help!

of the Veterinary Nurses

AVNJ as your next career goal but are not

The Official Journal

If you are considering publishing in the

ABN 45 288948433

Obstructive urolithiasis in a guinea pig

Cognitive needs of animals in urban society

Equine nurse’s role in lameness examinations

Distributive shock caused by a bee sting

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ACM10121 Certificate I in Animal Care Industry Pathways Do you have a strong interest in animal care and wish to acquire foundational knowledge before pursuing advanced qualifications? If the answer is yes, the ACM10121 Certificate I in Animal Care Industry Pathways serves as an excellent introduction to this field.

ACM20121 Certificate II in Animal Care Cultivate a strong foundation of knowledge to champion animal welfare and offer invaluable support to veterinarians. This qualification not only equips you with essential skills but also acts as your gateway to fulfilling the entry criteria for a Certificate IV in Veterinary Nursing, reinforcing your dedication to the well-being of animals and the vital role you play in being part of the veterinary healthcare team.

ACM40418 Certificate IV in Veterinary Nursing This nationally accredited qualification caters to students aspiring to excel in delivering expert veterinary nursing care for animals and offering professional support to their owners. You will cultivate personal and professional skills highly valued and sought after by employers. The ACM40418 Certificate IV in Veterinary Nursing stands out as not only the nationally recognised credential but also holds recognition as the standard in veterinary nursing education.

ACM50219 Diploma of Veterinary Nursing The ACM50219 Diploma of Veterinary Nursing is the next step to advance your knowledge and skills in veterinary nursing and leadership. AIRC offers Diploma specialisations in the fields of General Practice, Dental, Emergency and Critical Care, and Surgical.

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RTO CODE: 31424

CLINICAL

Fear-free in the clinic

by Zoë Markham

Cert IV VN, Diploma (ECC), AVN, RVN, TAE, FFCP (Veterinary) on behalf of Animal Industries Resource Centre

What can you do for your patients that will make their visit to your clinic better or even just less scary?

A

s we all know, so many animals that visit the veterinary clinic are nervous.

This can range from slightly nervous (green, orange) with some subtle body language signs, to extremely frightened (red), lashing out at staff as they know from past experience this behaviour makes people move away from them, and they don’t know what else they can do.

Now, what do I mean by green, orange, and red? These levels are an indicator for us as veterinary professionals. You might have seen this poster around or you may have it in your clinic.

Posters like this are a great reminder to us as professionals that our patients may be 30

December 2023

showing us signs that they are not happy in a situation, signs that might otherwise go unnoticed or ignored. These posters can also help owners better understand their pets’ behaviour and body language, resulting in owners changing their own behaviour to help their pets.

When patients are at the red level of fear, anxiety and stress (FAS), they will need some veterinary attention, and medications can be a starting point for these patients. But in this article, I want to discuss how we can help patients who are at the orange level move into the green, and how we can keep them there by identifying the different situations in which the FAS scale comes into use.

RECEPTION AREA Have you seen those canine patients in the clinic waiting for their consult who look calm but keep looking at their owner and licking their lips, panting or pawing at their owners? To the untrained eye, these might look like normal canine behaviours or that they love their owner, but we can see that the patient is at level one of FAS, and while they are coping at that moment, they could easily be pushed into a moderate or potentially high level of FAS if something isn’t changed for that patient.

Maybe that patient needs a bit more space. You could try seeing if the owner would like to wait in the consult room (if there is one available) for their appointment. Some clinics will allow these patients to sit in reception with the receptionists until it’s their consult time, or you might ask if the client would like to

CLINICAL

©getty images/AnnaStills

AVN and AVNAT Continuing Professional Development

wait outside in their car or go for a walk to help the dog become more relaxed. If none of these options are possible, offering the clients some treats and getting them to try and keep their dog’s attention on them might be an option, but if the original stressor isn’t reduced, this may not work for long.

Seeing cats in their carriers being placed on the ground or on seats with a strange dog sitting next to them increases my own FAS! Those cats cannot get away from that situation. Let’s think about what we can do to make them more comfortable because if we increase their FAS even before they reach the consult room, we are already starting out on the wrong foot and having to play catch up.

Make sure cat carriers are placed up off the floor. Ensure that cats are in an area away from the smells of other animals (as much as possible). You might even make one area of your reception area a catonly area. You could also put other small animals (guinea pigs and rabbits) in this area but make sure they are not near any cats as this will increase the small animals’ FAS! These are areas in the visual aspect of your patient’s visit!

IN THE CONSULT ROOM There are many things that we as nurses can do in the consult room to keep our patients’ FAS levels as low as we can.

Providing yummy treats for all animals, if they can and will eat good treats, is a must in consults. From roast chicken and peanut butter for dogs (as long as you check that there are no peanut allergies in the house before giving it), ‘cat crack’ (mousse tube) or roast chicken for cats, to green leafy vegetables for rabbits and guinea pigs, there is a lot we can treat our patients with.

Do you want to give your patient a thorough check-over? For cats and dogs, giving them their treats on a lick mat is ideal. Stick a lick mat to the wall, load it up with yummy treats and good luck getting them away from it at the end of the consult.

Get the owners to hold a bowl that has been smeared with cat crack or peanut

butter so you can give them a full checkup.

(But again, make sure you ask about any allergies in the house first!)

Need to take some bloods? Hold a cat crack tube above their head so they have to look up – you can do this for both cats and dogs. Often this strategy will allow you to get a great, low-stress jugular sample.

You can also use this for a peripheral blood draw. If your patient is happy to eat the cat crack, let them start licking the tube and slowly move it to the side away from your blood draw area. Hopefully their (adorable) little head will follow, leaving you space to take your sample.

Continued next page

December 2023

31

CLINICAL

Fear-free in the clinic Continued from previous page

Need to give our feline friends a checkover and they won’t sit still? Try putting a little ledge up for them to look out a window and do what you need to do while they are looking around. This can be in the form of a little window seat or even just popping a chair up next to the window for them to stand up on. Remember, this is for cats and kittens that are outgoing and want to look around, NOT for our feline patients that are high FAS. Allow your patients to come to you: • When you let a dog into the room, let it come to you. Don’t go straight up to it and be all over it (even if it’s a puppy or a kitten and you really, really want to!). Let

©getty images/AnnaStills

them come to you. Let them build up the courage and make the decision to come to you and not be forced to tolerate you.

You can tempt them with treats but do not be disheartened if they do not want to approach you. Remember they are not ours (as much as we want them to be sometimes!). We are strangers, and some animals’ stranger danger warning is a bit higher than others.

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• Open a cat’s carrier right up, take the lid off and let the cat come to you. Let it sniff you and become more confident, rather than you pulling it from its cage. Offer them some cat crack, have some catnip or cat mint handy, and rub the catnip/ mint over your hands. Spray yourself with cat pheromones and do what you can to try and make these amazing but fussy little creatures as comfortable as possible. Physically removing them from the cat carrier should be the absolute last option or only done in emergency situations.

• If a cat does not want to leave its carrier in a nonemergency, that is 100% OK! Leave it in there! It is amazing how much you can do with a cat in the bottom of its carrier with the lid off. Gentle and slow handling of your patients is the key, especially for cats!

• Extend your hand for the cat to interact with before handling/picking it up as this will allow you to assess the cat’s personality by reading body posture,

their position in the cage, and facial expressions. You’ll be able to tell if you can boop and scoop for a cuddle, or if you should go and get a towel in anticipation of a cat with higher FAS. • Wait for the cat to be ready and don’t rush to get it out from the cage or carrier. This can cause or escalate fear/ stress for the cat, resulting in the cat displaying ‘aggressive’ behaviours – which is actually their natural, instinctual behaviour when they feel threatened and have no way of fleeing the situation.

• Handle the cat in a closed (hopefully catonly) room with no other animals and reduce all sounds and smells and people traffic during the procedure (IV cath, blood collection, PE, etc.).

One big thing to remember: Those little paw prints that our patients can leave behind on the consult table that look oh so cute (as it is often better than the paw print you did for your last euthanasia patient). They are NOT good! They are pheromones that your patient has left for

CLINICAL

the next patient to sniff, but they are not good pheromones, they are your patient’s ‘Warning, this is a bad place, be careful whatever you do’ pheromones and it can take a fair bit of cleaning to actually get rid of the pheromone smell. This is one of the main reasons that I love putting blankets, mats, or towels on the consult table. Just remember to put a nonslip mat under it so your patient and the towels don’t slip off the consult table.

So, remember to use towels and clean very well in between your patients, and remember to wash your hands between seeing your patients so you don’t transfer any negative smells and to help stop the transmission of diseases.

TREATMENT ROOM The treatment room can be a scary place for many pets. But we can help reduce that for them. If your patient is allowed to eat and is happy to eat, use treats (the taste aspect of their stay!). As in the consult room, you can use Licki mats, cat crack tubes or even some peanut butter smeared on a plate (lick mat with a nonslip base or one of the kid’s plates with a suction cup on it to stop it from moving) to help distract your patient (otherwise remember to hold the plate or put a nonslip mat under it or your patient will be chasing that plate all over the treatment room!).

Make sure that all personnel in the treatment room use low and calm voices, their inside voices (the auditory aspect).

This is important because if the people in the room are loud, this adds to the already noisy sounds in the clinic – think about

machines, dental units, doors slamming shut, and people coming in and out. This noise can increase your patients’ FAS more than you might think it would. Although some patients will be used to having noise at home – with family, kids, and general household noises, the clinic is not home; therefore, they are not as comfortable there as they would be at home.

Having calming music playing, especially for our feline friends, has been shown to reduce a cat’s FAS and helps when handling that patient for their procedure.

There are many cat- and dog-specific music ideas on the internet, so go

There is no point in fighting your patient. This just increases their fear, anxiety and stress, which is going to increase at each clinic visit. If you can provide your patients with a relaxing and comfortable visit, you are going to set them up for a happy memory of you and your clinic.

searching and find one that your clinic is happy to play.

Pheromones are something that all clinics can have plugged in around the clinic from reception to the hospital area (the olfactory aspect of their stay). These are canine- or feline-specific pheromones that won’t upset your other patients. The good thing is that you can have both plugged in and they won’t interfere with one another.

You can also grab some pheromone sprays and spray your scrubs and the bedding that you are going to use. Just remember to give the alcohol in the spray time to evaporate before handling your patients or all they are going to smell is the carrier and not the pheromone!

Discuss medications with your vets.

Sedation is NOT a last minute resort, but an excellent way to restrain your patient. If you are in consult, think about sending the patient home if things are getting heated.

Ask your vet if they can organise some gabapentin or trazodone and reschedule an appointment when the patient has some sedation/anxiolytics on board.

There is no point in fighting your patient.

This just increases their fear, anxiety and stress, which is going to increase at each clinic visit. If you can provide your patients with a relaxing and comfortable visit, you are going to set them up for a happy memory of you and your clinic.

HOSPITAL Like in the treatment room, have that calming animal music playing. You can have a little radio in each of the wards i.e. one in the cat ward and one in the dog ward.

Low voices are crucial when your patients are in their beds recovering from a

procedure, waiting for their procedure, or waiting to go home. Would you want someone coming into your recovery room talking at the top of their voices, laughing or singing? I most definitely don’t! Be respectful of what your patients are going through.

Make sure you have the right bedding for your patient. Allow your feline friend to have a safe place where they can hide their heads, where they cannot see out or people cannot see in (or so they think) and you will be amazed at your feline friend’s stress reduction. Places to hide are important for cats, rabbits, guinea pigs and dogs, but most definitely for cats.

If a patient is not comfortable, they can become more agitated, increasing their FAS and potentially hindering their recovery.

A stressed patient is going to release more catecholamines and cortisol – these are the body’s stress hormones – fight/ flight/freeze/fidget. As we know, cortisol can decrease the body’s ability to heal appropriately and those catecholamines, although very helpful, can also decrease the body’s ability to mentally function.

When your patient is able, give them their appropriate nutrition in a slow feeder – Licki mat, game, etc., as soon as they can.

Eating releases the body’s happy hormone, dopamine. Dopamine is a feel-good chemical, and if we can make our patients feel good, why wouldn’t we?

Although this article has covered a lot, this is only scratching the surface of what you can do in your clinic to make the visit for your patients as smooth as possible.

Think about completing a free course yourself and learning more about fear-free practices. It really does change the way you work and see your patients.

December 2023

33

CASE REPORT

Surgical excision of dentigerous cyst

AVN and AVNAT Continuing Professional Development

by Lauren Thurgood Dip LM, Dip PM, Cert IV VN, RVN

PATIENT DETAILS:

foal grows, the cyst becomes nodular

Species: Horse

due to the increase of keratin. Clinically,

Breed: Thoroughbred

a noticeable swelling and are often

Age: 8-month-old Sex: Colt Weight: 296 kg

these structures are identified due to

associated with a draining tract at the

proximal aspect of the pinna (Butler et

al., 2002). A dentigerous cyst is reported as a tooth that failed to erupt, causing the development of a cystic structure to cover and encapsulate the crown

SUMMARY Dentigerous cysts can commonly present in equine patients with swelling over the temporal region and are often associated with a draining tract at the proximal aspect of the pinna.

Dentigerous cysts are benign structures but appear visually unpleasant and are often removed surgically at a young age. The following case report describes the surgical excision of a dentigerous cyst presented unilaterally on the right ear, diagnosable with radiographs and a draining tract.

INTRODUCTION Dentigerous cysts are reported as the failure of the first branchial cleft to close during embryo development, causing a fistula. A dentigerous cyst or a temporal teratoma contains dental elements, such as dentin and enamel, allowing the ability to radiograph the skull to determine the orientation. An accumulation of cells in an improper location permits the formation of dental arrangements enclosed in cystic structures (Auer et al., 2019). They are congenital defects; therefore, present at birth but often go unnoticed. As the

34

December 2023

of the unerupted tooth (Easley et al.,

2022, pp. 246–247). The presentation of a dentigerous cyst is more often

a cosmetic concern, especially in an

industry where young stock are sold at

Figure 1.1 – Head radiograph

CASE DETAILS

The physical and radiographic findings

auction.

An 8-month-old thoroughbred colt

presented with a small area of swelling at the right temporal region and a draining

tract at the medio-proximal aspect of the right pinna. The colt weighed 296 kg and

appeared in good health as the physical examination was within normal limits.

CLINICAL FINDINGS

are consistent with the diagnosis of a

dentigerous cyst. The colt was prepared for general anaesthesia for surgical excision of the cystic structure.

Broad-spectrum antimicrobials and nonsteroidal anti-inflammatories

were given preoperatively, facilitating

optimal absorption prior to anaesthetic premedication. The colt received

On palpation of the temporal region,

gentamicin at 6.6 mg/kg intravenously

revealed the swelling to be firm,

kg intramuscularly (IM). Systemic

draining tract was evident with a small

medications were given prior to induction.

the colt was not painful, but examination

(IV) and penicillin at 22 mg/

suggestive of a dental structure. The

nonsteroidal anti-inflammatory

hole on the medial aspect of the

Phenylbutazone was given IV at 4.4 mg/kg.

revealed a small bony growth that was

TREATMENT

its abnormal location and presentation.

and was maintained with isoflurane.

proximal pinna. Radiographic findings

consistent with a dentigerous cyst due to

The colt underwent general anaesthesia

The radiograph, Figure 1.1, illustrates the

The colt was positioned in left lateral

abnormal bony protrusion from the

temporal region, centred within the pinna.

recumbency and the temporal region, including the ear, was clipped. The ear

CASE REPORT

Figure 1.2 – Probe inserted into draining tract

Figure 1.4 – Penrose drain in place

Figure 1.5 – Dentigerous cyst

was packed with padding to ensure no fluid or chemicals could enter the ear canal.

The entire pinna was aseptically prepared to allow for manipulation during surgery. A probe was inserted into the draining tract, as seen in Figure 1.2, and an incision was made over the probe.

drain sutured in place. The image, Figure 1.4, illustrates the drain in place and the incision closed.

associated with risks of haemorrhage and or neurological deficit. The surgeon must always be aware of these risks, discussing them with the clients or owners, ensuring understanding and gaining informed consent prior to surgical intervention. The patient is at risk of nerve damage after the surgery if the cyst and dental structures are close to facial nerves influencing the movement of the pinna, eyelid or face.

These complications were not present in this case, but the patient was neurologically assessed pre- and postoperatively to ensure no changes were evident. The reduction of dead space during closure is vital to reduce the risk of infection and to promote aesthetic healing.

Proximal to the tip of the ear, the incision was extended down to the cystic structure.

The cyst was exposed with sharp dissection using curved Metzenbaum scissors, avoiding rupturing the sac. This is important to avoid contamination and reduce the risk of infection (Auer et al., 2019). With the cyst exposed, the ear tooth presented a solid attachment that was carefully elevated and removed with a small hammer and chisel. Figure 1.3 shows the dissection around the sac, maintaining its integrity.

The area was lavaged using 100 ml of sterile saline. The incision was closed with two layers of 3/0 monosyn and a penrose

The incision was covered with a sutured stent and no additional bandaging. In recovery, a nasal tube was placed with flow by oxygen provided at 10 L/min.

The colt was extubated once breathing independently and consistently. He recovered uneventfully, standing on the first attempt.

POSTOPERATIVE CARE The indwelling Penrose drain was removed 24 hours postoperatively with no evidence of discharge. The antimicrobials were discontinued and phenylbutazone paste was continued orally, once daily at 2.2 mg/ kg for the following two days. No bandaging was required.

The colt was to be confined to a box or small yard for two weeks and then to be turned out. The wound was monitored onfarm by the onsite veterinarian for any discharge, swelling or discomfort.

DISCUSSION The colt was reassessed six weeks later.

There was no swelling, pain or discharge.

The incision was healing well and the cosmetic appearance improved daily, according to the owner.

This case outcome was excellent with the patient recovering with no complications.

The colt was sold at a Thoroughbred yearling sale the following year and has

now begun his racing career with his new owners hoping for success.

References Easley, J., Du Toit, N., & Dixon, P. M. Equine dentistry and maxillofacial surgery. 2022;246–247.

Cambridge Scholars Publishing.

Butler, J., Colles, C., Dyson, S., Kold, S., & Poulos, P. Clinical Radiology of the Horse (2nd edn). Wiley, 2002.

Auer, J. A., Stick, J. A., Kümmerle, J. M., & Prange, T. Equine surgery. 2019, Elsevier.

Figure 1.5 shows the excised dentigerous cyst and the bony attachments.

Figure 1.3 – Exposure of the cystic structure

The surgical excision of dentigerous cysts poses a threat to the patient and is

December 2023

35

CLIENT FACT SHEET

The VNCA and VetCheck have supplied this information to assist vet nurses to educate, brief and assist their clients to care for and manage their pets.

Multiple cat households Intercat conflict represents a third of all behaviour problems with 54% of newly adopted cats relinquished within two weeks.

I

t can cause distress amongst all cats within the household, whether it is active fighting or passive aggression. Intercat conflict is a mental welfare problem that can prevent a cat from performing its day-to-day tasks and from feeling safe within its own environment.

SIGNS Signs of intercat aggression: • Blocking another cat from the litter box or food • Withdrawal • Scratching furniture • House soiling • Urine spraying.

UNDERSTANDING NORMAL SOCIAL BEHAVIOUR Unlike dogs, cats don’t need other cats to survive. Instead, they need a safe environment and essential resources e.g. food, water, safety.

Preventing intercat conflict: • Never adopt a cat because you believe that cats need a ‘friend’.

• Sibling kittens are most likely to bond for life.

• Cats don’t readily accept strangers so the introduction should be slow and gradual.

• Cats that were poorly socialised as kittens between 2–9 weeks of age are less likely to interact with other cats.

• There must be sufficient resources for all cats.

ADEQUATE RESOURCES

©getty images/Irina Gutyryak

For multiple cats to get along, it is important that they have enough resources to avoid squabbles. This means plenty of food and water bowls, litter boxes, resting areas, toys, scratching posts, and in the cat’s preferred location. Lining up all the bowls in a row or all the litter boxes in a row may not be ideal for the more timid cat.

NUMBER OF LITTER BOXES Generally, a household with one cat should have access to two litter boxes. Households with multiple cats can follow the historical rule of thumb to have at least one more litter box than the number of cats (e.g.

2 cats = 3 litter boxes). In a more social environment, multiple cats may need fewer separate litter boxes. In a multilevel home, it is good practice to have at least one litter box on each level.

INTRODUCING A NEW CAT Although a few cats may adapt well to a new cat, most will have a difficult time.

Introducing a cat should be done over weeks to months. As soon as fear is noted, separate the cats again.

1. Introduce the new cat to its own separate room with its own resources with a solid door in between.

2. Add synthetic feline pheromones to all cat areas.

3. Introduce a towel that has the other cat’s scent into the other’s environment.

4. Separate the two areas with a child safety gate so they can start to interact with each other.

SIGNS OF GOOD INTERACTION: • Grooming each other.

• Rubbing against each other.

Source: VetCheck is a powerful client education platform that helps veterinary teams save time, increase client engagement, and grow the practice through digital pet health summaries, handouts, digital dental charts, anaesthetic monitoring charts, hospital workflow, and forms with e-sign. To add your practice logo and start sharing directly to the pet owner’s mobile phone, visit www.vetcheck.it . © VetCheck Technologies Pty Ltd. ® VetCheck is a registered trademark. All rights reserved.

For digital case reports, handouts and request forms for veterinary teams visit www.vetcheck.it

36

December 2023

6 steps in designing and implementing nursing care plans in hospital 1. Teamwork and communication

• Understand the goals for each patient • Discuss presenting issue, pre-existing conditions, • Obtain the treatment plan, potential complications and desired outcomes from the veterinarian

2. Assessment • • • •

Vitals Behaviour Barriers – zoonotic or contagious diseases, aggressiveness, etc.

Ability – Assess normal functions

(3.5kg)

3. Design the nursing care plan

Based on patient history, consultation with the veterinary team, discussion with owner (where possible) and patient assessment, create a plan that ensures all patient care needs are met.

Document these on digital hospital charts for ease of team collaboration and task management.

Weight daily IV catheter: days in place Check IV catheter daily

Components of the nurse care plan Vitals (RR, HR, etc.)

Pain Assessment Nutritional requirements Care of drains, dressings, devices or lines.

Urination, Defecation Temperature Mobility Sleep, rest and self-grooming Mental health and stress management

4. Allocate a patient schedule

Hartmann’s maintenance 2 mls/kg/hr Flush IV catheter after walk PCV/TP Check wound

Buprenorph...

0.04 mg

0.12 ml

• Schedule patient medications, treatments, exams, diagnostics, surgery, etc.

• Review timings of treatments, medications, feeds and make adjustments where needed • Aim to optimise rest and sleep time • Where appropriate, plan for mental stimulation, time outside, visits, grooming or any other activities that would positively impact the patient’s wellbeing and reduce stress

5. Implementation

• Accurately document your observations, actions carried out and instructions to team members or clients • Document your tasks, administer medications as indicated, along with frequency and priorities • Note discharge planning to promote continued restorative care at home e.g. physical therapy, assistance with toileting

6. Evaluation

• Evaluation should be planned, ongoing and purposeful with the goal to achieve the desired pet health outcomes • Discuss patient progress with the veterinary team, allow for clear communication and continuity of high standard patient care • Update patient care plan as required and document changes to the patient chart • Re-evaluate daily or as per practice protocol

Use digital hospital care sheets to: Improve patient care Manage schedules and tasks Bring transparency across all team members Create treatment plan templates for consistency and high standards of care for all patients

© 2023 VetCheck Technologies Pty Ltd. ® Registered Trademark. All rights reserved.

https://www.vetcheck.it

VNCA HR ADVISORY SERVICE

VNCA HR Advisory Service

Unpaid work – Is it ever OK?

U

OTHER THAN STUDENT PLACEMENTS – ARE THERE ANY OTHER SITUATIONS WHERE UNPAID WORK IS PERMISSIBLE?

WHAT ABOUT UNPAID TRIALS?

employers a chance to train individuals

There may be other situations where work can be unpaid, but this is assessed on

The engagement should be brief (at a

npaid work, though occasionally contentious, can offer mutual

advantages to both employers and

individuals involved through various forms such as work trials or internships. It grants

new to the industry and assess a person’s job skills while providing individuals

with invaluable work experience and

training. But while unpaid work itself is

not inherently illegal, it is crucial for those

participating in unpaid work to thoroughly grasp the specific regulations and criteria governing it to ensure it’s used lawfully.

This article aims to deliver an overview of unpaid work, shedding light on the

distinctions between lawful and unlawful forms of unpaid work to not only help

employees understand their rights but to prevent exploitation.

UNPAID WORK – IS IT EVER OK? In short, yes, unpaid placements are

lawful under certain circumstances. One such case is when they are categorised as vocational placements linked to a

specific education or training course.

However, the law prohibits the exploitation of workers when they are fulfilling the role of an actual employee. This is because vocational placements are meant to

offer students valuable skills, facilitating a smoother transition from academic studies to the professional world.

If you have been offered a work

experience opportunity, it typically should be part of a genuine placement through your learning institution. If you still have

any concerns, it might also be prudent to contact the institution directly to discuss the finer details and whether it can genuinely be unpaid.

38

March 2023

a case-by-case basis and individuals

should check with the VNCA HR Service

before undertaking any unpaid work. As

a rough guide, when the work is not part of a vocational placement, some of the

major factors when considering whether work can be unpaid include:

1. Will the work be for the benefit of the individual, or the business?

Typically, an unpaid work arrangement should primarily benefit the person undertaking the role. If the work

primarily benefits the business, it is likely to require payment.

2. How long will the arrangement last?

The longer the arrangement, the

more likely it is to require payment.

An unpaid trial can be permissible if it is purely to demonstrate a skill or

skills associated with a particular role.

maximum of one shift, but sometimes

as little as 15 minutes is necessary) and the individual should be under direct supervision the entire time.

Let it be clear – this is unrelated to a

probation period. A probation period is generally between 3 to 6 months

and MUST be paid as an employment

relationship has already commenced.

Although a probationary period functions somewhat like that of a trial, in which it essentially provides a chance for both

the employer and employee to evaluate whether the employment relationship is right for them, it should be viewed

separately from a quick trial session to

quickly determine if an employee has the relevant skills to perform the job.

It is not uncommon for relatively

short engagements to be considered an employment relationship and therefore require payment.

3. What is the nature of the work?

When an arrangement primarily

consists of work productive for the

employer and the business, rather

than focused on meaningful learning, training, and skill development, it is more likely to require payment.

Considering the above, unpaid

work (when not part of a vocational placement) should almost solely

benefit the individual (not the business), should only be for a brief period, and should be largely observational.

If you have been offered a work experience opportunity, it typically should be part of a genuine placement through your learning institution.

VNCA HR ADVISORY SERVICE

WHAT HAPPENS IF UNPAID WORK IS FOUND TO BE UNLAWFUL?

of vocational placements, individuals

For more information about this article,

Where unpaid work is found to be

arrangement, its intended duration, and

on 02 8448 3266 or email helpline@

all is immediately lost. Individuals can

expected to undertake. Taking these

investigate, who may issue a Compliance

determine whether the arrangement is

should evaluate the beneficiary of the

unlawful, it is important to note that not

the specific tasks the individual will be

reach out to the Fair Work Ombudsman to

proactive steps will ensure that you can

Notice. If an employer still doesn’t respond,

lawful, which will help minimise exploitation.

please contact the VNCA HR Service myadvantage.com.au. Alternatively,

templates and other resources can be found online at the HR Portal available to members.

an employee can take action in the small claims court.

IN SUMMARY If you are considering undertaking unpaid

work, it is crucial to note that the employer

Find HR services here

has an obligation to ensure that the

arrangement is lawful and permissible.

©shutterstock/Luis Molinero

It’s important to bear in mind that, outside

December 2023

39

MEMBER VITALS

Member Vitals

Why did you choose veterinary nursing as your career?

For as long as I can remember I wanted to be a vet, and when I didn’t get the grades required for that I did the next best thing and became a veterinary nurse.

What has been your most memorable moment as a veterinary nurse and why?

Name: Annette Scott Qualification: Certificate IV & RVN Currently studying anything? No Experience in the profession: 35 years

There have been many highlights during my career, but I think for me it was this March when I did a solo presentation at an Apiam Conference in front of clinical leads and regional managers. I have never done anything like that before and I was very proud of myself as I was way out of my comfort zone!

If you could give other nurses one piece of advice or a tip you have learnt, what would it be?

Why did you choose veterinary nursing as your career?

Growing up on a farm meant always having lots of animals around. This developed into a keen interest in working in animal care and helping improve the lives of pets.

What has been your most memorable moment as a veterinary nurse and why?

Qualification: Certificate II in Animal Studies Certificate IV in Veterinary Nursing

Currently studying anything?

Not at the moment, but I am in the process of applying to enrol for Certificate IV in Training and Assessment.

The first time I performed a scale and polish. This began my love of dentistry; I remember feeling so satisfied once the procedure was completed and wanting to learn more. I invested my time in increasing my knowledge in the area and this helped me explain to owners abnormal findings and the importance of dental aftercare for their pets. As a result, I have developed wonderful client relationships, and I am able to spread my knowledge to the amazing nurses I work with.

Experience in the profession

If you could give other nurses one piece of advice or a tip you have learnt, what would it be?

I started working in the industry in 2018, when I completed one day a week of work placement at my local vet clinic in Leeton,

If you love what you do, you’ll never work a day in your life. Veterinary nurses go through a wide variety of emotions in

40

December 2023

How do you keep a work/life balance?

For me, I work 3 longer days per week and have a 4-day weekend, which is awesome!

This means I can keep up with busy work and family life.

What animals do you own?

Lots! – 1 dog, 3 cats, 2 birds, fish, a bearded dragon, 3 horses, 4 cows & a bull, 3 chickens.

How long have you been a VNCA Member?

I have just joined this year, but I was a member in the 1990s.

We don’t do this job because it pays well, we do it because we love it! It can be

NSW. Once I moved to Echuca, VIC in 2019, I was employed with Apiam and have been a vet nurse within the company ever since.

Name: Chloe Johnson

physically and emotionally exhausting so make sure you enjoy the highs and be sure to take care of yourself during the lows.

Find your own work/life balance and you will still love your job after 30-plus years like I do.

If you love what you do, you’ll never work a day in your life.

the industry, which can take a toll on mental health. Always confide in your team because they will be willing to listen and help. Also, knowledge is endless in this industry – learn and spread your knowledge to the younger generation.

How do you keep a work/life balance?

When I’m not at work, I prioritise quality time with my family, exercising, enjoying my hobbies and going on adventures.

What animals do you own?

I have three beautiful dogs. They’re all American staffy x. Max (6 years old), Harley (4 years old) and Athena (1 year old).

How long have you been a VNCA Member?

I have been a VNCA member since 2020 and joined the AVNAT Registration Scheme this year.

OUR PROFESSION

Congratulations Launched in 2002, the Accredited Veterinary Nurse (AVN) Scheme is a joint initiative between the VNCA and the AVA (working together through the National Industry Advisory Group for Veterinary Nursing – NIAG).

New Accredited Veterinary Nurse

Renewing Accredited Veterinary Nurses

Rachel Accadia

Tascha Baylis

Teresa Budge

Leanne Branford

Amy Donovan

Suzanne Chandler

Renee Hajek

Joanne Dowsey

Debra Laws

Kim Healy

AVNAT registration.

Corinne Power

Fiona Hooper

We recognise recently approved and renewing Accredited

Elizabeth Street

Katie Lyons

It recognises veterinary nurses who demonstrate currency of skills and dedication to the veterinary nursing profession and is the gold standard for clinical veterinary nurses, providing

an avenue for those who wish to extend themselves beyond

Veterinary Nurses:

©gettyimages/Julia_Sudnitskaya

Accredited Veterinary Nurse Scheme

Jessica Male Lee-anne Roe

The AVNAT Registration Scheme The AVNAT Registration Scheme has been established by the VNCA to set the standards of professionalism across the veterinary industry. Congratulations to our newest AVNAT registered veterinary nurses and technicians for their commitment to quality practice.

Teresea Bell

Mark Harris

Tsz Ching Mau

Kathleen Reid

Kristen Brown

Brooke Hislop

Mollie McArthur

Jessica Roesler

Erin Carter

Nikita Hood

Nicole McClure

Gabrielle Scott

Teneale Cole

Jacqueline Howden

Brooke McIntosh

Jennifer Scott

Elle Cropley

Sandra Kapitelli

Charlotte Mercer

Rose Sherlock

Elodie Deguilly

Man Sze Lam

Rhiannon Munari

Ainsley Sloman

Lisa Dmytriw

Ashleigh Leknys

Leslie Murphy

Melissa Thorley

Kirsty-lee Dunn

Courtney Liddy

Madalyn Nichols

Beth Wakefield

Amy Fernance

Millissa Lloyd

Amber Nix

Ashleigh Williams

Anita Gaerth

Anne Mackinnon

Chloe Park

Jacqueline Young

Tracey Girak

Jamee Martin

Rachel Ponce

Sarah Gregory

Athena Martinez

Chloe Ptolemy

AVNAT Registered Veterinary Nurses and Registered Veterinary Technicians demonstrate their commitment to their profession by: • meeting entry level education • completing ongoing continuing professional development • abiding by a Code of Professional Conduct and Ethical Practice and related standards.

Find an AVNAT registered professional today via the AVNAT Online Register

December 2023

41

Join the VNCA today and start enjoying all the benefits of belonging ...

There’s never been a better time to become a member of the VNCA and support our work to promote the interests of veterinary nurses and technicians across Australia.

You will receive huge discounts on AVNAT registration, education opportunities and everyday purchases like petrol!

50%

Discount on all Membership s

And … you will be rewarded with all the #benefitsofbelonging.

Follow the QR code to our website - www.vnca.asn.au to find out more and join online today!

E: admin@vnca.asn.au | P: 03 9586 6022 #myVNCA #benefitsofbelonging

Workplace Helpline Industrial Relations & Human Resources for vet nurses

Member Discounts

$

The AVNAT Registration Scheme: Demonstrate your commitment to your profession Did you know that the number of veterinary nurses and technicians voluntarily registered through the AVNAT Registration Scheme is increasing annually by more than 10%?

With mandatory registration a priority for the veterinary industry, now is the ideal time to commit to your profession by becoming registered. As well as guiding you through your career, being AVNAT registered will demonstrate your commitment to quality practice through standards and learning.

Maintaining quality practice through standards and learning www.vnca.asn.au/avnat