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It’s The Little Things That Count: A Spotlight on Patient Care

By Caitlan Koontz, DVM
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Seventy years ago, James Harriot was using barbiturates for anesthesia and performing phlebotomies on horses standing in icy rivers to treat laminitis. Today, we can treat kidney failure with dialysis, pneumonia with mechanical ventilation and cancer with chemotherapy. From the experience of veterinarians before us, ongoing research, and studying advances made by our human physician counterparts, veterinary medicine has come a long way. With the growth of our profession, the building of cutting-edge hospitals and ability to hospitalize all creatures great and small, we have been able to save the lives of animals we never imagined. However, when it comes to patient care and comfort, practicing the highest level of medicine is only part of the equation. Of equal importance to the sophisticated surgeries, ability to deliver supplemental oxygen and nutrition, and variety of analgesics available, are the non-medical therapeutics we can use to improve our patients’ comfort and quality of life. This piece will focus on the little things we as veterinarians and nurses can do to help enhance our patients’ comfort, well-being and perhaps even accelerate healing.

There have been numerous studies in the field of human medicine that correlate patient mortality, readmission to the hospital and overall feeling of health with satisfaction of patient care and symptom relief. A 2006 study revealed that when human patients in an ICU receiving ventilation were asked to evaluate their perception of nine symptoms (pain, dyspnea, thirst, nausea, hunger, tiredness, anxiety, generalized discomfort, and depressed feelings), one-hundred percent answered in the affirmative.1 This same study found that there are significant correlations between all symptoms, particularly unpleasant physical sensations and the feeling of depression. Another study in 2011 showed that when there is an appropriate patient to nurse ratio and nurses are able to provide appropriate patient care, the mortality rate was lower than when the staffing level fell below a target level.2 While we as veterinary professionals cannot ask our patients if they have a headache, dry mouth or depression, we can extrapolate that they feel similar physical experiences and emotions. In many cases we can measure these subjectively. Hypersalivation as a signifier of nausea, cowering in the back of a cage as a demonstration of fear or anxiety, or limping indicating pain. Unfortunately, many of the clinical signs our patients exhibit are due in large part to their disease and the reason they are hospitalized to begin with. It can be easy, therefore, to overlook the impact that specific patient care techniques may have. While advances in information, technology and medications have allowed us as care takers to alleviate patient discomfort in ways previously not possible, pain is not the only unpleasant sensation our furry, feathered and scaly friends experience. Below, developed from observation and experience, is a list of procedures and systems that while not new to the practice of veterinary medicine, when made routine, may improve our patients’ comfort and quality of life when in the hospital.

Steps to Improve Patients’ Comfort and Quality of Life While Hospitalized

  • Clustering treatments to minimize handling and allow patients to rest uninterrupted for longer periods of time
  • Removing food from the cages of anorexic animals after 20 minutes to help decrease the risk of developing food aversions
  • Placing booties or a light vet wrap bandage on the feet of geriatric patients or those with mobility issues thus allowing them to walk more easily on slick hospital floors and cage bottoms
  • Walking dog patients frequently that are on high rates of IV fluids, polyuric or having frequent bowel movements
  • Housing cat patients in a separate area of the hospital or ICU and not adjacent or above vocal dog patients
  • Periodic assessment of thirst for patients that cannot move to their water bowl, by holding the bowl closer to them
  • Use of safe sedatives and anti-anxiety medications for extremely anxious or fearful patients. Useful for planned visits and during hospitalization
  • Providing cat patients with a place to hide in their cage such as a box or bed with tall sides (with the exception of those with respiratory disease or seizures)
  • When appropriate, using soft e-collars in cat patients or other small animals
  • At night or when possible, turning down or dimming lights, or placing a towel or blanket over part of the cage to create a dark environment thus creating a more natural atmosphere for sleep
  • Implementing the use of pheromone diffusers or sprays, particularly in areas where cat patients are hospitalized
  • When appropriate, transitioning patients that have been hospitalized for long periods of time to larger cages or runs to allow for more freedom of movement and natural behaviors
  • Routine oral care in dehydrated, sedate or critically ill patients
  • In patients with intravenous catheters, frequent checks of paw size and comfort. Pain or swelling may indicate catheter tape that is secured too tightly or the development of phlebitis
  • Encourage owner visits and, when appropriate, allow owners to take their pets to a designated quiet area or outside
  • Increase the nurse to patient ratio

While many of these practices are dependent on the health status of the patient, temperament, hospital case load and staffing, they all represent a common theme: that the end goal is to help fulfill our patients’ needs. In 1934, Abraham Maslow created a model of needs that drive human behavior.3 The base of the hierarchy bears the needs of highest priority; the obvious physiological needs such as food, water, sleep and shelter. At the top are the needs which fulfill self-actualization. These include morality, creativity, meaning and purpose. While we imagine our animal patients do not require the same satisfaction of graduating from college or traveling to a foreign country, we know as fact that they require all of the same basic needs. We should, however, also assume they desire some of the needs in the middle including safety, social interaction and love. As veterinary professionals, we are driven by the power and capacity we have to heal. We are also frequently limited in our ability to do so, whether it be due to financial constraints or a poor prognosis. However, regardless of the tests, medications and life-saving treatments at our disposal, or the limitations set by a diagnosis or money, we all have the ability to prioritize patient care and maximize comfort. In the end, it is the quality, not quantity of life that matters.

Sources:

  1. Li, Denise T., and Kathleen Puntillo. “A Pilot Study on Coexisting Symptoms in Intensive Care Patients.” Applied Nursing Research, vol. 19, no. 4, 2006, pp. 216–219.
  2. Needleman, Jack et al. “Nurse Staffing and Inpatient Hospital Mortality.” New England Journal of Medicine, vol. 364, no. 25, 2011, pp. 2468–2469.
  3. Zalenski RJ, Raspa R. “Maslow’s Hierarchy of Needs: A framework for achieving human potential in hospice.” Journal of Palliative Medicine, vol. 9, no. 5, 2006, pp. 1120-1127.
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