The role of the veterinary nurse as the patient advocate is such a significant one, and nurses are skilled at detecting and monitoring pain, and assessing and promoting the factors affecting quality-of-life.
Pain and comfort management, and evaluation of quality-of-life of the patients in our care is one of the most essential roles of the VN in practice. In terms of analgesia, patient pain assessment is an ongoing process, and communicated with the veterinary surgeon in charge of the patient so that appropriate action can be taken – even if this is just to confirm that the regimen is effective, and to continue to treat the patient in the same way.
The nurses’ role in pain management
Often nurses may feel that whilst they are ‘qualified’ to monitor pain, they don’t and shouldn’t have an input to the patient’s pain management options, but this is simply not true – nurses play a core role as patient advocate, and many nurses have extensive knowledge and experience in assessing pain, considering analgesic options in conjunction with the veterinary surgeon, and promoting quality-of-life through multiple strategies.
Linda Ryan, who tutors our Veterinary Oncology – ‘Managing Quality of Life for Cancer Patients’ course, which is suitable for vets and nurses, is passionate about the veterinary nurse’s role in pain management. She spent several years as an oncology nurse, gaining her VTS (Oncology), and working with patients who relied on her acting on their behalf, and as she says:
‘Untreated pain is deleterious for many reasons, not just because of the physiological and behavioural impact it has on our patients’ welfare, but also because it can exacerbate the clinical condition and confuse clinical signs. This makes monitoring and treatment more ambiguous.
Identifying pain in our patients has an ethical side to it – our job is to prevent suffering wherever possible and we have a responsibility to be our patients’ advocate.’
It’s not all about the drugs!
But of course it’s not ALL about the drugs we use, and Linda quite rightly identifies, ‘non-pharmacological options include GREAT NURSING! I.e. keeping the patient clean, comfy, well nourished, providing appropriate social contact, allowing rest, etc.’ and these considerations, alongside others, are addressed in the course that we offer on this topic. There are other practical ways we can help too, such as providing basic physiotherapy.
‘Use of certain physiotherapy techniques can help relieve discomfort acutely, or chronically, e.g. by building core strength, ability and confidence.’
Cancer and wellness clinics – providing care beyond the practice
So what about beyond the clinic? Thankfully most patients are discharged, and in the case of cancer patients, where the clinical signs and associated pain may continue or even deteriorate, it’s really important that we continue that care into the home environment. Have you ever thought about running clinics to support these patients and their owners? In Linda’s experience,
‘Cancer and wellness clinics may really help the whole care team, and may benefit the patient and owner. Good knowledge of the common cancers and their treatments, as well as the individuals you are seeing is essential.
Building a great relationship with owners, built on honesty and trust, can help hugely during therapy, in keeping the patient well and active, educating the owner and in making end-of- life decisions.’
It makes so much sense doesn’t it, and yet often we may overlook this simple yet integral step in caring for our patients – teaching their owners to do it too. They are the ones who look after the pet day-to-day, know them better than any of us, and care so deeply about ensuring their pet has the best life possible. As Linda advises:
‘In-home care is vital – we want these patients at home and living as normal life as possible for as long as possible. We can help owners understand pain, what it looks like and what to do about it. We can also offer tips on general care of elderly/chronically ill patients, including on diet/weight, exercise, physio, training/enrichment (this is hugely important – just because they have cancer doesn’t mean they shouldn’t have fun!), environmental modification and planning ahead.’
Would you like to set up clinics to support cancer patients?
Does this sound like a service that your practice could offer? Could you be the nurse or vet to lead this? If you have an interest in pain and quality-of-life management and implementing new ideas to make patient’s lives easier in the face of disease, then the answer will be yes.
All practices deal with cancer patients, and all vets and nurses are cancer vets and nurses – and there are lots of tools and ideas we can gain to make out patients lives easier and better.
If you’d like any advice on how to achieve this, then contact us anytime.
