The art of nursing: 10 steps for better patient care

Getty ImagesMedicine is fun, but it's critical for technicians and nurses to look beyond their clinical skills to grow in the art of helping pets heal, said Megan Brashear, CVT, VTS (ECC), in her recent presentation "The Art of Nursing" at the International Veterinary Emergency and Critical Care Symposium in Grapevine, Texas.

Nurse responsibilities are expanding. Brashear points to The Kirby Rule of 20-a checklist of 20 critical parameters to evaluate at least daily in critically ill animals. And, she says, there's a reason nursing care and TLC are included on the list with other critical parameters such as blood pressure and heart rate. They're just that important.

She says in veterinary medicine, the medicine stuff is fun-for example placing catheters or hitting a vein on that crusty old diabetic cat. Just make sure to focus on the nursing part as a whole.

“I want you to be equally excited about TLC-even if it's changing diarrhea blankets,” she says.

Her first piece of advice? Don't be a sheep.

“The death knell is, ‘We've always done it this way.' Think about what and why you're doing this to your patient," Brashear says.  

Don't do anything “just because.” Triage every patient, every time. "Think ahead and plan ahead. Know your normals. Know your expectations. And get the whole story. Take pride in understanding what's going on with the animal," she says.

Next, she encourages technicians to ask always why. Why is the patient tachy? Why is there an arrhythmia?  "Continue to challenge and ask questions about patients and learn," Brashear says.

"I know there's a lot of pressure to get through treatment," she says. But she still wants nurses to stop and think and take time. She offers these 10 tips to boost your nursing skills:

• Set the scene. Take your own pulse first. Think about the patient with attention. Be prepared and be aware to the space, sounds and your own body language.

"When you think of body language, think of flight attendants," she says. "When it's bumpy and they're keeping cool and rolling their carts and passing out drinks, you feel calmer.

"We're all flight attendants and we need to stay relaxed during the turbulence. Be the calm flight attendant. You are the barometer for pets, so be the calming effect. Take a deep breath."

• Leave notes for each other to smooth the path for patients. If you're working in ICU and you finally get a pet to finally sleep, leave a note to let coworkers know to let the pet relax.

• Don't have loud conversations in the ICU, where you may disturb resting patients. For patients with anxiety, physiologic changes can lead to wasted energy and increase their oxygen needs. Try turning the lights down and timing treatments to let them rest and lower their anxiety. You might even consider moving a noisy pet who's distracting other patients.

•  Spend time interacting with patients in ways that aren't just for treatment. Taking time to give pets and attention and letting the pets get to know you will pay off later when you're palpating the bladder or offering other uncomfortable treatments.

• Remember chemical restraint. 

Tips to approach dogs

• Focus

• Speak quietly

• Open doors slowly

• Avoid eye contact

• Gain trust

• Move slowly, and get low

• Remove them from the kennel

Tips to approach cats

• Focus

• Speak quietly

• If the cat isn't aggressive, offer your hand

• Keep the cat in the kennel for care when possible

• Ask, "What can I do?" Think of ways to calm your patients. For example, cats may like boxes to hide in. A pet might appreciate his owner's sweater to curl up in. Towels hung on the outside of a kennel can give some needed privacy for anxious cats. And finally, let pet owners bring in those blankets and stuffed loveys. Sure, you're worried that they'll get lost or dirty, but Brashear says it's worth it. The pet will be more comfortable, and she says she's never had a client complain when she's returned the peed on blanket in a plastic bag at the end of the pet's visit.

• Be creative. For example, consider the cat with a catheter and an ecollar who isn't eating. You might try removing the ecollar to see if she eats and supervise her until she's done so she doesn't groom the catheter out. Or if you're facing a dog who needs a blood draw, does he have a toy he loves? Is it possible he'd be so distracted with the ball in his mouth that he doesn't notice the draw? Or will that pooch who refuses to lie down change his mind if you give him a towel or blanket to target when he sits? And maybe that cat with a feeding tube WILL eat if you try to offer food.

• Don't forget the outside therapy. Outside therapy one time a day is often all you need to do. Patients can get depressed in hospital, and Brashear says she's taken her lunch outside to sit with hospitalized pets and give them fresh air.

5 tips for peer conflict

Team work is evident to clients, and it affects efficiency and patient care. Use these five tips to effectively address conflict.

1.  Take conflict off the floor. Step away from the treatment area and talk.

2.  Don't blame or use “you” statements.

3.  Ask questions. "What can I do to make it better?"

4.  Don't involve manager first. Try to work toward resolution yourself first.

5.  Be direct, or you won't communicate well.

• Practice client compassion. You may need to fake it till you make it. Just remember, don't make decisions for the client.

• Assume good intent from coworkers and clients and your life gets easy. "Don't jump to the worst case scenario," Brashear says. "My Pollyanna attitude is why I can still work in this profession 17 years later. Choose a positive mindset. Live in the present. Fix your insecurities. Have an emotional reserve. Communicate. Practice self-care. And be happy."