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Behavior basics for the emergency clinician and technician

Keeping patients free from fear, anxiety, and stress in even the most trying clinical situations

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Emergency and/or critical care workers are often faced with urgent cases and fast paced environments. Unfortunately, this setting is not always conducive to caring for patient’s emotional needs. Here are some easy ways to help patients in even the most trying situations.

1. Keep patients with their owners as long as possible. Being in an unfamiliar environment can cause fear. Having a familiar person there is one way to help minimize fear, and therefore, anxiety and stress.

2. Control pain. Pain can contribute to fear, anxiety, and stress. (Remember, acepromazine is contraindicated for treating anxiety and aggression.1)

3. Provide a comfortable kennel. Providing adequate bedding goes a long way for patient comfort. Provide lots of padding for large dogs. Inexpensive bolster beds are easy to wash, and small dogs usually love them. Cats like to hide. Provide a box, or cover part of the kennel with a towel or blanket. Giving cats their own, quiet space in the clinic will help lower their stress levels.4

4. Keep things quiet. If there is a howler in the hospital, do something about it. Not only for the howler’s sake, but for the rest of the hospital’s sake, as well. Humans included. Loud environments cause anxiety and stress in humans and animals.4

5. Move pets out of recovery kennels. “The House of Pain” can become a real thing. For patients that come to you post-operatively, they are often not only in pain, but fearful as well. In some cases, moving the pet out of the recovery kennel a day or so after will help negate the pain and fear they recall upon waking up.2

6. Go slow. True emergencies require a deft hand and haste! But, not everything that walks through the door will be an emergency, requiring immediate care. If it doesn’t, take the time to make that pet comfortable. When trying to move too quickly, inevitably patients get handled more roughly and this will lead to fear, anxiety, and stress. It can also lead to a bite or other injury for an employee.

7. Tap out if needed. Getting frustrated? It happens to everyone. When you begin to feel the frustration rising, ask someone fresh to take over. Patients can feel your frustration and will respond, sometimes violently.

8. Ditch the cloth muzzles. Cloth muzzles greatly reduce the pet’s ability to pant and breathe normally. Think about how it would feel to try to breathe with your mouth taped shut during a high-stress event. Opt instead for basket muzzles. There are a few different styles on the market. For cats, the Air Muzzle® is a great option for keeping staff safe and cats less stressed.

9. Minimize temperatures and other stressful handling. If a patient isn’t febrile or at risk for it, there’s just no need for rectal temperatures every four hours. Yes, there are cases where Q4h temperatures are warranted, but in these cases, perhaps use an ear temperature probe instead. Think of what treatments and monitoring cause patients the most discomfort while in hospital. If it is possible to minimize or change how these are done, it will go a long way toward making your patients less stressed.

10. Take care of basic needs. Food, water, and bathroom breaks seem like easy enough things, but often, due to case load or other reasons, these things are overlooked or skipped. These care essentials will keep your patients more comfortable and less stressed.

Fear and anxiety are not the same thing. Fear is a natural response to a potentially dangerous stimulus. Fear leads to anxiety and prolonged anxiety leads to stress. Stress also can be caused directly from stressors like pain and discomfort.4

Patients that are stressed are less likely to eat while in hospital. Patients that do not eat are often hospitalized longer.

Patients that are less stressed in the hospital setting will recover faster, leading to faster dismissals, higher employee satisfaction, and happier clients.3

In summation, using techniques to reduce fear and stress are to everyone’s benefit. The client will feel better about how their pet is handled, a faster recovery, and less cost associated with longer stays. Staff will feel better about how patients are treated, enjoy more job satisfaction, and suffer less injury. The hospital owner will profit from fewer workers’ comp claims, more clients from satisfied client referrals, and less employee turnover.

Melissa McLaughlin, CPhT, RVT VTS (ECC), KPA-CTP, who has more than 21 years of experience in veterinary medicine, is the owner-instructor for Proper Pets LLC and works at Colorado State University Veterinary Teaching Hospital in the critical care unit. She shares her life with five dogs, four cats, two birds, two guinea pigs, a betta fish, and a very patient and understanding husband.

References

1. Frank D, Gauthier A, Bergeron R. Placebo-controlled double-blind clomipramine trial for the treatment of 
anxiety or fear in beagles during ground transport. Vet. J. 2006;47, 1102 -1108.
2. Grandin T, Dessing M. Distress in Animals: Is it Fear, Pain or Physical Stress? Accessed 12-6-12 at it/2FSYGZS.
3. Hekman J, Karas A, Sharp C. Psychogenic Stress in Hospitalized Dogs: Cross Species Comparisons, Implications for Health Care, and the Challenges of Evaluation. Animals. 2014;4(2), 331-347. doi:10.3390/ani4020331
4. Lloyd J. Minimising Stress for Patients in the Veterinary Hospital: Why It Is Important and What Can Be Done About It. Veterinary Sciences. 2017;4(2), 22. doi:10.3390/vetsci4020022

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