Journal of Feline Medicine and Surgery (2012) 14 , 337 –349 SPECIAL ARTICLE AAFP and ISFM Feline-Friendly Nursing Care Guidelines Nursing care: The term nursing care means different things to different people. The authors of these AAFP and ISFM Feline-Friendly Nursing Care Guidelines define nursing care as any interaction between the cat and the veterinary team (veterinarian, technician or nurse, receptionist or other support staff) in the clinic, or between the cat and its owner at home, Hazel C Carney that promotes wellness or recovery from illness or injury and addresses the patient’s physical DVM MS DABVP (Canine and Feline) and emotional wellbeing. Nursing care also helps the sick or convalescing cat engage in activities Guidelines Co-Chair that it would be unable to perform without help. Susan Little Guidelines rationale: The purpose of the Guidelines is to help all members of the veterinary team DVM DABVP (Feline) Guidelines Co-Chair understand the basic concepts of nursing care, both in the clinic and at home. This includes methods for keeping the patient warm, comfortable, well nourished, clean and groomed. The Guidelines provide Dawn Brownlee-Tomasso numerous practical tips gleaned from the authors’ many years of clinical experience and encourage RVT veterinary team members to look at feline nursing care in ways they previously may not have considered. Andrea M Harvey Overarching goal: The primary goal of feline-friendly nursing care is to make the cat feel safe and secure BVSc DSAM (Feline) DEVCIM-CA throughout its medical experience. MRCVS Erica Mattox CVT VTS (ECC) Principal goals of nursing care Sheilah Robertson The art of nursing care of the feline patient BVMS (Hons) PhD DACVA DECVAA Make the cat feel safe and secure in CVA MRCVS the clinical setting and at home following Veterinary medicine is a combination of science Renee Rucinsky and art. Science uses research evidence and discharge DVM DABVP (Feline) data to guide it, while the art of healing relies Minimize stress to the patient during in-clinic and at-home treatment Donna Stephens Manley on clinical experience, observation, patient- DVM or client-directed feedback and the ability to Contribute to successful recovery from interpret the patient’s state of mind. The illness, surgery or other treatment, and injury patient’s behavioral response to treatment is the central focus in the art of nursing care. To provide optimal support to a well, sick, injured or recovering cat, the art of nursing essential primary information regarding the care is as important as medical science. importance of reducing the stress that cats Most cat owners can readily detect which experience before, during and after the vet- members of the veterinary team truly connect erinary visit. 1 These Feline-Friendly Nursing and exhibit empathy with their cats. Vet- Care Guidelines supplement the recommen - erinary team members who apply both the art dations of the predecessor Feline-Friendly and science of veterinary nursing care will not Handling Guidelines by placing greater only deliver optimal healthcare to the cat but emphasis on the art of veterinary medicine earn the confidence and appreciation of the delivered by the veterinary team in the clinic practice’s clients. Involving the cat owner is a and by the cat owner at home. The primary key aspect of successful feline nursing care goal of these Guidelines is to make the cat feel The AAFP and ISFM welcome and requires client education, guidance and safe and secure throughout its medical experi - endorsement of these guide - support from the veterinary team. ence. By making the cat feel safe and secure, lines by the American Animal The previously published AAFP and ISFM many challenges of handling the feline patient Hospital Association Feline-Friendly Handling Guidelines provide subside or disappear altogether (Figure 1). (AAHA). DOI: 10.1177/1098612X12445002 © ISFM and AAFP 2012 JFMS CLINICAL PRACTICE 337 SPECIAL ARTICLE / AAFP/ISFM guidelines on feline-friendly nursing care Understanding fear and stress from the cat’s perspective Upon entering the clinic and throughout their visit, cats perceive a gauntlet of predators (reception area, exam room, treatment/surgery, hospitalization) Without a sense of security Figure 1 Ensuring and wellbeing a sense of safety and security is the ultimate Frozen fear Aggressive ‘bad cat’ goal for managing feline patients in the veterinary With appropriate nursing clinic. When cats do not feel safe and secure, care and handling they display behaviors associated with fear or aggression. Both fear- induced withdrawal (left-hand arrow) and Does not move Content patient Vocalizes Does not eat Bites/scratches aggression (right-hand Does not drink Cat feels like it has arrow) make treatment difficult or impossible. In Cat lo oks like it does not no other options addition, the physiologic need care, but it does effects of stress impair recovery from illness or injury. ‘Frozen fear’ and ‘Content patient’ images courtesy of Hazel Carney. Goal: To make our feline patients feel safe and secure ‘Aggressive “bad cat”’ ©iStockphoto.com/ Anna Sematkina While most veterinary medical guidelines Making the cat feel safe address the veterinarian, these Guidelines and secure contain nursing care concepts and methods that will also benefit other members of the Veterinary team Understanding fear and stress veterinary team, especially the veterinary from the cat’s perspective technician/nurse. An appreciable number of members who Anticipating stressful situations veterinarians are not comfortable working apply both the Cats are notoriously sensitive to their sur - with cats or do not consider the feline patient roundings and have a well developed fight-or- to be their first preference. An important goal art and science flight response. These self-protective respons - of these Guidelines is to provide practical es, normally essential for survival, may be recommendations for veterinarians and other of veterinary detrimental in a veterinary clinic or domestic members of the veterinary team who find nursing care setting or when they persist for a prolonged working with cats challenging. Many feline period of time. Unfamiliar circumstances (see practitioners will find that the Guidelines will not only box below) that cats encounter in veterinary cover familiar territory. However, the authors clinics may lead to the adverse effects of anxi - hope to provide insights that even experi - deliver optimal ety and fear. These adverse effects suppress enced clinicians may find helpful. healthcare to normal behaviors (such as rest and feeding), Clinical improvement in the hospital is only and increase vigilance, hiding and dysfunc - one aspect of treatment success. The ability of the cat but earn tional signs such as anorexia, vomiting and 2,3 the cat owner to provide a continuum of care the confidence diarrhea or even lack of elimination. at home will contribute substantially to a Undesirable physiologic responses to stress successful case outcome. Thus a key focus of of clients. include hyperglycemia, decreased serum these Guidelines is how to involve the owner potassium concentrations, elevated serum in the proper handling of the cat, both in the creatinine phosphokinase concentrations, clinic and at home following discharge. The lymphopenia, neutrophilia, erratic response to veterinary team that fails to provide home- sedation and anesthesia, immunosuppression, care education or initiate communication with hypertension and cardiac murmurs. 4–6 These the cat owner after discharge may compro - changes can complicate clinical evaluation and mise even the best hospital treatment. treatment of cats, and prolong hospitalization. Common stressors for cats in veterinary hospitals Other animals and humans A cage environment that does not allow hiding Noise (eg, medical equipment, telephones, barking, human Unfamiliar caretakers conversation) Unfamiliar food and feeding routines Smells and odors (eg, other animals, disinfectants) Sensory overload from busy hospital environments 338 JFMS CLINICAL PRACTICE SPECIAL ARTICLE / AAFP/ISFM guidelines on feline-friendly nursing care While the veterinary team cannot eliminate Anesthetic complications are more common all stressors, it can identify at least some in cats than dogs and are associated with factors to modify or eliminate. The Feline- health status, age, weight, procedure type and Friendly Handling Guidelines contain more urgency. 9,10 Careful attention to patient assess - information on environmental factors affect - ment and management before anesthesia can ing hospitalized cats. 1 reduce perioperative complications. However, the cat’s response to fear and anxiety may Recognizing fear and anxiety complicate or even preclude a thorough Fear and anxiety in cats may first manifest as preanesthetic evaluation. Reducing or pre- changes in ear position, eyes and facial expres - Avoiding empting stress in hospitalized cats can sion, body posture, sweating from the paw excessive facilitate the presurgical examination and pads, and tail movement. Fearful cats may preoperative laboratory testing, ultimately attempt to escape. Vocalization (eg, mewing, restraint of the improving patient safety. growling, hissing, spitting) may indicate an escalating stress reaction. Some cats then show fearful cat is Satisfied owners and increased feline visits overtly aggressive behavior such as biting, very important. Recently published studies have revealed an scratching or attacking. Others