Who is the veterinary hospice care team (Proceedings)

In many ways veterinary hospice takes its lead in delivering end of life and palliative care from the human hospice model. After several decades of delivering this type of care, our colleagues in human medicine found the best way of helping terminal people live their lives to the fullest is by providing care, comfort and medical expertise through a team approach. This collaboration of care involves professionals from many areas and skills to include registered nurses, patient's primary doctor, hospice medical director, chaplain, volunteer, bereavement staff, certified nursing assistant, social worker and friends. By providing a wide scope of skilled professionals the hospice team can be assured of meeting the complete needs of the patient and their family. Registered nurses with expertise in pain and symptom management are available to provide care and information about care giving and end of life options 24 hours a day, 7 days a week to meet hospice care needs. Often, the attending physician directs medical care in collaboration with the hospice medical director. Certified nursing assistants support the activities of daily living and personal cares (bathing, etc.) in an individualized manner. Dedicated groups of trained volunteers share time and talents to provide companionship and caregiver relief and support. Social workaers and chaplains assist families and the dying person in matters of emotional, financial and spiritual concerns as well as offer support and coping strategies related to the patient's unique issues. And, a bereavement staff provides support and education to families and significant others commonly for one year following the loss of their loved one. This model of care goes a long way to deliver the type of compassionate, palliative care that is a complete focus on comfort and dignity to persons and families who can no longer benefit from curative treatment. This is 'patient centered' medicine. Dedicated veterinary professionals, committed to delivering this same type of care to terminal companion animals and their families, are providing variations of this same theme and are finding a similarly structured collaborative approach beneficial. Palliative care and 'patient centered' medicine are foremost in delivering this type of end of life care to pets. The largest strengths of delivering veterinary hospice care come from the veterinarian and the veterinary nurse. These professionals are accustomed to wearing different hats to accomplish their mission. To add to this circle of care it is vital to corroborate with other healthcare professionals within a given community to lend additional support in areas of grief and bereavement, respite care and possibly clergy. However, it is worth exploring the option of educating those within our ranks with a special interest in psychosocial support. There are many educational avenues for a veterinary professional with a special interest in this area to seek out and receive this training. This may be an added benefit as it is not unusual for the public to not only feel safe with their feelings about the bond they have with their pet with veterinary professionals but often they've come to expect that support.

The hospice veterinarian

It is critical of the hospice veterinarian to uphold the laws of their state, to establish doctor-client-patient relationship with each case and oversee the medical care being delivered to the terminal patient. The veterinarian working in the area of end of life and palliative care must have a clear understanding that many of the tools they are accustomed to using will not often be necessary. There is no longer a reason to research ways to cure this patient and, as such, many of the procedures that may happen in the hospital setting, exploratory surgery, monitoring blood parameters, etc., will not be done depending on the structure of the particular hospice program. This position requires a hospice veterinarian to have a good basis of their own ethical views because from time to time ethical perceptions may come into question. When the hospice veterinarian is practicing in a team environment, she/he must have a good working relationship and trust in the veterinary nurse(s) who are part of the care team. Frequent team meetings where hospice patients and families are discussed make it essential that the hospice veterinarian has the confidence in the veterinary nurse on the team to value opinions shared. The hospice veterinarian must also possess exceptional communication skills and understand the complexities that accompany the scope of end of life care. Seeking out additional education can be a valued supplement to the medicine being delivered. The successful hospice veterinarian will have a natural interest in palliative care and want to participate in keeping in touch with what is cutting edge in pain control for companion animals. It is core that the hospice veterinarian has a special interest in honoring and nurturing the human animal bond. This is a person that intrinsically takes the time to establish a relationship with her/his clients that goes beyond the average hospital setting. It takes a unique set of qualities to make an exceptional hospice veterinarian.

The veterinary hospice nurse

The veterinary hospice nurse is in a position to bring her/his set of skills from the ICU into the home setting, or wherever the hospice care is being delivered, as this type of compassionate care speaks to the core of nursing. Each pet is unique to itself as is each disease process and, like the hospice veterinarian; the veterinary hospice nurse understands this. Veterinary medicine has required professionals to be creative and think 'outside the box' in everyday veterinary medicine. In end of life care, this type of thinking can be very helpful in many ways including the dying pets' environment, medication and nutritional care to name a few. The veterinary hospice nurse's role can be divided into 3 core competencies. Examples are as follows: As a skilled clinician this role requires the veterinary nurse to be able to assess pain and discomfort and know when and how to use other health care resources. It also requires this person to be able to intervene to keep the patient comfortable. Additional education is beneficial to a veterinary nurse to appreciate the unique set of language skills needed to be effective in this area of medicine. As an advocate, the veterinary nurse has the opportunity to obtain the best care she/he can for the patient. Using advocacy skills, the veterinary nurse can be the bridge between patient, family and veterinarian. And, being able to effectively communicate with both is an added value. Working in the capacity of a guide refers to the knowledge, communication, intuition and empathy ability a veterinary nurse needs in order to walk with a family during that final last journey with their pet. In this way a veterinary nurse can help prepare and educate the family for the pets' death as well as be there for their time into bereavement. Compassionate and comprehensive nursing care can ensure that the pets' needs are met during this period of time before death. This type of patient centered care can also reassure the family that they will not be abandoned and that their wishes and goals will be respected. It is the non-judgmental approach of this care that requires the veterinary nurse to be familiar with a family's personal belief system and, with the proper guidance, ensures that the high standards of veterinary ethics be upheld. Facilitating hospice care goes beyond medical care and requires the veterinary nurse along with the veterinarian to have a firm and solid background in the areas of supportive psychosocial care. Having a good interdisciplinary resource list within the given community is also essential to be able to network and/or refer to when specific skills are needed especially in the areas of spiritual support, bereavement counseling and respite care. The veterinary nurse in the role of a hospice caregiver should have already examined her/his views on death and dying, for themselves as well as their loved ones. A veterinary nurse, well trained in end of life care, understands how taxing and, at times, draining delivering this type of care can be and having a firm footing in their own views of death and dying will go a long way to support them through trying times and challenging cases. It takes a certain maturity as well as security to be willing to recognize that there may be times when a veterinary professional delivering this type of care will be in need of Compassion Fatigue counseling, which is necessary at times in most areas of healthcare, although, not always acknowledged in veterinary medicine.

In conclusion

Veterinary hospice care is an emerging specialty requiring, as any specialty, additional education as well as a certain passion on the part of the professionals delivering the care in order to achieve the goals they set out to accomplish. The main concern of most families facing the imminent death of their pet is that there is mitigation of pain and suffering. It is at this time that many of us would like these families to be able to turn to and depend on veterinary professionals to deliver this care. That requires a cohesive medical team well prepared and well trained to assist them with a knowledgeable and informed set of skills. Initiative and leadership, caring and compassionate, honesty and integrity – all these and more encompass the components needed to deliver end of life care. At this cornerstone of their lives, our families need to know that their veterinary support system genuinely cares so as to give them a safe sense of community. We have asked them to and they have trusted us to guide them in preventing illness and treating illness, and there is no doubt that our pet families are in need of this type of specialized care. Rather than having to look outside the veterinary community to provide end of life and palliative care it might be said the veterinary community has a certain obligation to deliver it. Cicely Saunders, Hospice Founder, has been quoted as saying, "You matter because you are you. You matter to the last moment of your life, and we do all we can, not only to help you die peacefully, but to live until you die." This is a creed that the veterinary hospice team understands fully.

References available upon request.