Congress on Demand 2021: Veterinary Nursing

Vet perspective: Although the nursing care for the brachycephalic patient is the most vital part of hospitalisation and peri-anaesthetic care, there are recent clinical investigations that may help guide veterinary care for brachycephalics undergoing anaesthesia. This lecture helps to guide our anaesthetic care, provide brachycephalic checklists whilst incorporating the recent updates into our management to help minimise complications and provide effective treatment if they are encountered.

Vet nurse perspective: Brachycephalic breeds are now all too common in our veterinary practices whether it be general practice or referral. At some point, regardless of the reason, they will require anaesthesia for a procedure. This session aims to provide awareness of the common pitfalls we as nurses may encounter. The nursing responsibilities to these patients throughout all the stages of the anaesthetic are fundamental to ensuring these tricky patients survive and walk away! They can be some of the riskiest patients to monitor and manage during the anaesthetic period but with good preparation, a solid basic protocol and fantastic teamwork, there should be no reason why these patients need to be any more troublesome. Some key preparations and protocols needed to ensure the safety of these patients are discussed, together with increasing the awareness of common pitfalls that might occur and what to do during them.

This presentation considers CPR during anaesthesia in the context of the RECOVER guidelines.

Very rarely do we work alone in the veterinary profession and outcomes aren’t purely down to one person or one approach – but how do you manage the individuals within the team and keep them working together and towards the same goals? How to do encourage confidence, self-leadership but without egos, siloed working and poor behaviours? This session discusses the importance of trust, psychological safety and the power of constructive challenge within a team. It shares tools to help you consider the level of mutual respect, to consider how conflict and challenge is handled and how you ensure you team are pulling together rather than pulling apart.

Drug free management: Owners must understand that medical analgesia is often vital to reduce suffering, especially at the start of the treatment of chronic pain. We cannot, by explaining that chronic and acute pain are distinguishable by the threat they pose to survival, teach our animal patients to be to be unafraid of their pain. We therefore need to reduce both the sensation and the emotion of pain and this process sometimes needs medication. Where the pain field has become exaggerated and expanded, physical therapies may be contraindicated until that field has been reduced. Rather than ‘drug free’ (which tends to give ‘drug use’ a negative sense), the physical therapies should be thought of as integrated; relatively safe; and relatively free of side effects. Their use may reduce the use of medicines; may positively contribute to the animal’s health and mobility; and, often, indirectly contribute to owner compliance because the therapist can continue to educate and to build on the plan. Physical therapies include but are not limited to: acupuncture; physiotherapy and hydrotherapy; laser; manipulation; and myotherapies of various kinds. This lecture will briefly describe the most common therapies, their indications, advantages and possible drawbacks.

Foundations of drug therapy – building the plan and an overview of NSAIDs: Medical treatments provide the cornerstone of most pain management plans, but how effective are they in addressing chronic pain? Osteoarthritis is a major cause of chronic pain and it is an excellent example of the need to properly understand how pain is being generated before attempting to resolve it. Management involves controlling the local disease, a source of nociceptive stimulation, while at the same time separately addressing non-nociceptive mechanisms, neuropathy and central processing. NSAIDs have been used widely and successfully to address pain in OA. We almost know too much about these drugs and our knowledge restricts our use and client acceptance due to risk of toxicity. However, there are other limitations in managing chronic pain using NSAIDs. The use of unlicensed medications to treat chronic pain about has increased greatly. But are they safe or effective? Properties do not easily translate between species as we found in the past with NSAIDs and more recently with tramadol. Medical agents are important tools in building a management plan but due consideration must be given to therapeutic targets, effectiveness, duration of use, practicality and common sense.

Giving chemotherapy is too dangerous to the cat: Many clients are very unnerved when the prospect of chemotherapy for their cat is discussed, fearing that their pet will endure the level of adverse effects (AEs) that many human chemotherapy patients do. While this preconception is perfectly understandable, it is a highly inaccurate. The majority of cats receiving chemotherapy either experience no AEs, or mild, self-limiting AEs. This difference arises from compassionate dosing of our feline friends. Since most of the AEs of chemotherapy are dose-dependent, rather than idiosyncratic, it is perfectly possible to control the risk by altering the doses of chemotherapy the cat receives. Although this approach also compromises cancer control, it still produces an acceptable outcome since cats have a much shorter life-expectancy than people; a remission of 2-3 years is often very acceptable for a cat whereas a cancer-free interval of decades (at least) would be the goal for people. This lecture discusses avoiding and managing some of the common chemotherapy-associated AEs in cats, giving tips on how best to educate cat owners that chemotherapy is a safe and ethical treatment for their feline companion.

Giving chemotherapy is too dangerous to the dog: Chemotherapy is becoming more widely available and advocated as a treatment for many neoplastic conditions and is a generally well tolerated treatment which affords excellent quality of life in most patients. Some clients, however, are reluctant to pursue chemotherapy treatment for their dog due to concerns related to possible toxicity, often extrapolated from human medicine. This presentation outlines the risks, possible side effects and approximate frequency with which these are reported with the cytotoxic chemotherapy drugs commonly used in canine patients. The session discusses toxicities associated to vinka alkaloids, anthracyclines and alkylating agents commonly used in the treatment of canine neoplasia, and give practical tips on how to avoid these, and to manage them should they occur. The aim is to demonstrate that quality of life in veterinary oncology patients is paramount and to give practitioners the tools to recommend chemotherapy with confidence and to discuss the risk of chemotherapy toxicities in canine patients with clients.

Cytology first steps with Butty Villiers.

Cytology of common cutaneous and subcutaneous tumours with Paola Monti.

The unfair advantage – a digital strategy to fill your vacancies: Hiring clinical team members is harder today than ever before. A shortage of qualified and applicants has left many practices scratching their heads wondering where all the vets and nurses have gone. The old model of posting an advert on a job board and expecting the applications to roll in doesn’t work like it used to. Nowadays, successful recruiters must also be masters of digital marketing. To fill a vacancy, you are going to have to get a message that stands out, in front of as many vets and nurses as possible. You are going to need a campaign plan that ensures you deliver your message to the relevant places in a way that gets views, lots of views. Your advert is going to start life as a long-form written document that is the foundational piece of content. This one piece of content is then cut up into as many as 15 smaller derivative media types including video, Instagram, Facebook and LinkedIn posts, story arcs for Facebook and Instagram, cross-posting/sharing on to influencer networks, and paid traffic advert campaigns. This session covers how to take a basic advert and turn it into a veritable feast of derivative content offerings that will help you reach your desired candidates. Practices may find this slightly overwhelming, but it is worth the investment because being able to reach the employment market in this way allows you a very big competitive advantage when it comes to fills your vacancies.

Writing a compelling advert: A job advert is also an opportunity to market the practice and impress applicants and other interested parties. An advert will need to be designed that will attract candidates that meet the job description and should include: the job title, practice name, logo and website address; an eye-catching headline; brief description of the practice and what it does; summary of the job such as, responsibilities, duties and hours; the skills and abilities required to make an application considered; the benefits that go with the post and employment; ways to apply such as, either an application form, application letter or CV; contact details for further information if appropriate or required; The closing date for applications. You may also wish to include any additional relevant accreditations or awards that the practice may have.

Ask many veterinary professionals, especially vets, what they understand by Schedule 3 of the Veterinary Surgeons’ Act (1966) and they will probably mumble something about it relates to ‘surgery not entering body cavities’. Schedule 3 is however the legislation that underpins the ability of Registered Veterinary Nurses (RVNs) to work to their full potential as part of a vet-led team. Many veterinary practices fail to fully value and utilise their RVN staff by not training, encouraging and supporting them to undertake Schedule 3 tasks. This results in a lack of job satisfaction and career progression. Appropriate post-graduate training, both in-house and more formally, builds RVN competence and confidence. There is no doubt that veterinary surgeons need to acknowledge the skills of RVNs and communicate these more effectively to clients. RVNs working to their strengths and abilities, especially via protocol-driven systems within practices, can bring benefits to the whole team, patients and clients. As the RCVS Legislation Working Party considers enhancing the RVN role, there has never been a better time for the whole practice team to become more confident with Schedule 3.

How can Halsted’s Principles help me improve my surgical skills? Conceived in the late 19th century, Halsted’s Principles are as relevant for us in our surgeries today as they were then. Their central axiom is all about promoting wound healing; this seminar outlines some simple guidelines for incorporating the kind of tissue sympathy in our surgical technique that favours optimal wound healing.

Maximising the use of a scrubbed assistant in surgery: A scrubbed assistant benefits everyone involved in a surgical procedure, including the patient. As nurses we have a key role and need to understand how to support the surgical team. Developing our skills under schedule 3 of the Veterinary Surgeons Act 1966, also helps with our career progression and job satisfaction. It must be remembered though that all surgical procedures, however minor, have associated risk to the patient. This means it is important that nurses are fully trained and competent at performing surgical skills and understand the legality and limitations within their professional remit.