Module 2 E Booklet PDF

Module 2 Terminology Disinfection –Destruction of micro-organisms (not necessarily spores) Disinfectant – Chemical agent which kills & inhibits growth of micro-organisms Sterilization – Complete destruction of all microbes including bacterial and fungal spores. Antiseptic – Agent which destroys or i...

Module 2 Terminology Disinfection –Destruction of micro-organisms (not necessarily spores) Disinfectant – Chemical agent which kills & inhibits growth of micro-organisms Sterilization – Complete destruction of all microbes including bacterial and fungal spores. Antiseptic – Agent which destroys or inhibits micro-organisms on living tissue Contact Time – The length of time the surface must remain wet with disinfectant for it to be effective Micro-Organism – Organism of very small size – microscopic (bacteria, fungi, protozoa) Virus- Non-cellular microbe Bacteria – Prokaryotic (single cell) microbe Fungi + Protozoa- Eukaryotic (multi cellar) microbe Zoonosis/Zoonotic – Infection or infectious disease which can be passed from animal to human – human-animal under normal conditions.(Leptospirosis, Giardia, Ringworm, swine flu, (H1N1), bird flu (H5N1) Vector – Invertebrate animal (tick, mosquito, mite) capable of passing an infectious agent to vertebrates Fomite/s – Inanimate objects which have potential to harbour disease agents (towels, food bowls, utensils, carrier cages, toys)\ Asepsis – Free from infection Sepsis – Presence of infection. The presence of pathogens or their toxic products in the blood or tissues of the patient. Also known asinfection. Sanitize – To reduce the amount of microbes to within a safe level -cide - is a suffix meaning kills. eg. Bactericide – substance that kills bacteria. Fungicides - are chemical compounds or biologicalorganisms used to kill fungi or fungal spores. Sporicide – A substance used to kill spores (fungi & bacteria). -stat- is a suffix meaning preventing growth or multiplication.eg. Bacteriostat - inhibits the growth of bacteria, virustat inhibits the growthof viruses. Safe working practices Animals Any person working in an animal care facility is very likely to come into direct contact with animals at some time. It is important to know how to handle these animals in an appropriate manner in order to keep yourself and other people safe (and the animal). This involves knowledge of some handling and restraint techniques, the appropriate use of restraint equipment, and at least a basic understanding of animal behaviour. If you are unsure how to handle an animal, or you are unsure about the behaviour of an animal, seek assistance from someone more experienced. While bites and scratches are the obvious hazards we think of when working in small animal practice, do not forget other potential sources of injury such as damaging backs with poor animal lifting techniques and even noise. A dog bark can often exceed 100 dB (Jackhammer = 110 dB). OSH regulations consider anything about 90 dB damaging. You must protect your hearing! In large animal practice, the size of the animals adds an extra dimension to the safety precautions you must employ when working with them. For animals that are known to be difficult, adjust their computer/paper records to include a warning e.g. "warning: aggressive" Use signs on the front of cages to warn other staff as well as communicate to them about the animal. Task 1: Watch: Labelling kennel cards (0.16 mins) LINK TO VIDEO: https://www.atdove.org/video/labeling-kennel-cards Tick once the section is complete. Hazardous Chemicals Animal care facilities will have a variety of hazardous substances that you may potentially be exposed to Cleaning products Anaesthetic gases Sterilising chemicals Radiography chemicals (for x-ray film processing) Certain medications You should never come into contact with some, like anaesthetic gases, unless all safety precautions are adhered to. It is important to know what chemicals/products your workplace has, and how to keep yourself safe around these substances. What safety precautions are required when using/handling these chemicals e.g. personal protective equipment (PPE) (masks, gloves...), ventilation? If an accident occurs when using a product what do you do e.g. if it splashes into your eye? How to safely dispose of the chemical when finished with it (can it actually be tipped down the drain?) What do you do if a spill occurs? Can you just clean it up and put it in the bin, or is more involved? Where do you find information about the chemical products you are using? You can look up the product's Material Safety Data Sheet (MSDS) A MSDS sheet for each chemical product stored or used at your workplace should be held in the OSH manual for the business. Example of an MSDS for commonly used anesthetic agent Isoflurane: Data sheet example: Isoflurane (for review purposes only this will; not be assessed) The MSDS sheet contains essential information on the safety aspects of that product for OSH purposes. Follow this link for a searchable MSDS database: http://hazard.com/msds/index.php Do not forget to look at the product container for guidelines/warnings. Storage of Chemicals Store all chemicals according to the manufacturer's instructions/legal regulations: look at the MSDS. Locked away if necessary for that product. Note whether they are flammable or reactive with other chemicals. Keep below or away from any shelf or cupboard in which food, drink or medicines are stored. Handling Chemicals Prepare chemicals for use in accordance with the manufacturer's instructions and use the PPE recommended (request it from your employer if it is not provided to you). Chemical products must not be packaged or prepared for use on any food/drink surfaces or rooms. Pay attention to international hazard symbols. All dangerous chemicals should be labelled with a HAZCHEM symbol. Fumes: consider the requirement for ventilation. Dig deeper: Managing your hazardous substance: Safety data sheets LINK TO WEBPAGE: https://www.worksafe.govt.nz/topic-and-industry/hazardoussubstances/managing/safety-data-sheets/ Safety data sheets provide important information about your hazardous substances. It is mandatory to have a current safety data sheet for each of the hazardous substances in your workplace regardless of the quantity you hold. Tick once the section is complete Radiology These are only some brief notes. Students doing the DVN will learn more in their second year. X-ray machines and taking radiographs Veterinary clinics use x-ray equipment as an essential part of the diagnosis of illness and injury in animals. There is the potential for staff working in veterinary clinics to be exposed to x-ray radiation if the appropriate safeguards and operating protocols are not in place (these should be explained to you at your workplace). Note radiation is not the same as radioactive. No person under the age of 16 should participate in assisting with an x-ray procedure X-rays are invisible and painless; exposure causes long-term damage over time (not seen immediately), and exposure to repeated low doses can be as harmful as one larger single dose. Only somebody competent and trained should operate the x-ray machine Avoid being in the room with the animal when the actual radiograph is taken (anaesthetised/sedated animals make this possible to do) If you have to be present, then lead-lined PPE must be worn (gown, gloves, thyroid/neck guard). Also, you must not put any part of your body under/near the x-ray machine's primary beam. eep as far away as possible. Dosimeters are monitoring devices that look like badges worn by staff when performing radiography. They have inserts that detect exposure to x-rays and are ,periodically sent away to be checked by the appropriate authority. Task 2: Watch: Donning and Doffing Radiology (8.11 mins) LINK TO VIDEO HERE: https://www.atdove.org/video/donning-and-doffing-radiologyppe Dig deeper: Radiation Safety: Code of safe practice for using x-rays in veterinary diagnosis. This is a 30-page document. Do NOT read the entire thing. Read the following sections: 1, 2, 3, 4, 5. (Do not memorise numbers/dimensions etc) 8, 10, 11 Protective Equipment section (page 25) https://www.health.govt.nz/system/files/documents/publications/code-of-practice-veterinaryradiation-ors-c9-30june2020.pdf Tick once the section is complete Sharps and cutting implements Sharps such as needles, glass vials, scalpel blades and glass microscope slides should always be disposed of in appropriate 'sharps' containers. This container should be leak and puncture-resistant and should be incinerated by an approved company when full. Sharps include: needles scalpels broken glass ampoules/vials knives glass bottles microscope glass slides Instruments: Do not carry a needle and syringe around in your mouth or pocket. Care when carrying scissors and other surgical equipment Task 3: Watch: Safely Handling Sharps LINK TO VIDEO HERE: Safely Handling Sharps Note: Here at Unitec, we do teach to recap your needles post-use Task 4: Get familiar with the one-handed needle capping technique. Tick once the section is complete Manual lifting When lifting anything heavy, it is essential to use proper procedures. Task 5 Watch: Safe Lifting by AT Dove (0.16 mins) LINK TO VIDEO: https://www.atdove.org/video/safe-lifting Tick once the section is complete Miscellaneous Hair: Tie it back. Consider vision obstruction, hygiene, entanglement in equipment or by animals. Footwear: Comfort and protection. Closed, flat shoes that are comfortable, non-slip, steel toes if dealing with large animals. Jewellery/Piercings: Kept to a minimum. Necklaces, rings, and long and/or hoop earings are risky when handling animals/equipment. Contact lenses: Debris, chemicals and other contaminants can severely injure the eyes. Wearing eye protection, especially if you have contact lenses is vital. A working eye wash station should be available at all times. Computer workstations: Ensure that workstations are set up properly and that you take short, frequent breaks from computer work (this is not usually an issue in a vet clinic or other animal facilities!). Accidents Accidents and injuries must be recorded in your workplace's OSH accident register, brought to the attention of employer and possibly ACC/government department notified Evaluate any incident or "near miss" to prevent recurrence. Ensure further staff training if required Consult your GP if you are injured. General housekeeping hazards: Clutter free work areas Well maintained Attend to spills immediately Mop floors first and last thing in the day (less foot traffic at these times)- use signage to warn others Using signs Post appropriate signage e.g. Wet Floors Also be aware of other hazards... Fire Burglary Driving (if required for the job) Natural Disasters Earthquake In 2009, a total of 42 earthquakes of magnitude 5.0 or greater occurred in New Zealand. 392 earthquakes were reported felt on the GeoNet website. In 2010-11 we had a graphic demonstration of the destructive potential of earthquakes in Christchurch. Tsunami Each workplace must have an emergency and disaster plan, including evacuation contingencies for situations such as fires and earthquakes. It is important to plan ahead. Task 6 Bring it all together and read chapter 14 of Internal Medicine for Veterinary Technicians. Read LINK TO CHAPTER: Occupational Health and Safety Tick once safe working practices are complete Hand Hygiene Animals presenting in the clinic may have infectious diseases, that are not always symptomatic. This means that a patient may already have an infectious disease, but not yet show any signs of that disease. Some diseases have a lengthy incubation period (the amount of time between contracting the disease and displaying clinical signs). Poor hygiene practice between handling patients means we run the risk of passing on an infectious disease between patients. Tick once the section is complete Maintaining sterility in theatre Protentional from you're first day in the clinical placement you will be observing surgery. It's of utmost importance to understand where the sterile field is found in the operation theatre and how to maintain sterility during a procedure. The aim of maintaining sterility in theatre is to minimise infection as much as possible. Contamination of the operating theatre can be a cause of nosocomial infection. Good hygiene practice in veterinary clinics and in operating theatres is mandatory to minimises nosocomial postoperative infections. Task 1 Watch the following video on maintaining sterility to develop an understanding of Watch the sterile field. LINK TO VIDEO: Sterile Techniques: Sterility in the OR Data sheet example: Isoflurane Occupational Health and Safety Hygiene - a primary tool in infection control Animal Welfare in the Veterinary Clinic For a veterinary nurse (and veterinary nursing assistants) taking care of animals in a clinical setting in a competent and compassionate manner provides a great sense of job satisfaction and professional pride. A critical part of this role is maintaining a high standard of animal welfare at all times. This includes addressing not only the animal patient's physical requirements but also their behavioural/psychological needs. Any aspect of nursing care not done correctly or left uncompleted has the potential to adversely affect the patient(s) involved and could compromise their recovery and well-being. Maintaining a high standard of Animal Welfare in the Veterinary Clinic is a vital for: The animal patients The veterinarians The veterinary nurses Any other employees/work experience individuals involved in animal care at the clinic. The veterinary clinic's reputation Veterinary professionals should be setting an example for the public and be a reliable source of education and information that promotes good animal welfare practices. Owners who entrust their pets to a clinic want to be secure in the knowledge that their animals are being cared for appropriately. Animal welfare is not a topic to be complacent about and the veterinary team should always be vigilant for signs that suggest that a pet's welfare may be compromised (either in the clinic or at home). The Five Freedoms The "Five Freedoms" are internationally recognised standards for animal welfare. They outline what animal carers and owners must provide for animals under their care, they are incorporated into the New Zealand Animal Welfare Act 1999. Needless to say they are important. The five freedoms are preoccupied with preventing negative welfare states and helping us to think about what to provide animals the domains of welfare. The five freedoms Freedom from hunger and thirst (Provision of appropriate and sufficient food and water to maintain good health) Freedom from discomfort (Provision of an appropriate living environment including adequate shelter and area to rest in) Freedom from pain, injury and disease (By prevention or prompt diagnosis and treatment of injury or disease, also incorporates the provision of a safe and hazard free environment) Freedom to express normal animal behavior (Providing the animal the opportunity to display normal patterns of behavior e.g. suitable space, facilities, others of its kind...) Freedom from fear and distress (Ensuring conditions and treatment which avoid mental suffering and/or unreasonable/unnecessary pain or distress e.g. good handling techniques) The five domains of Welfare Nutrition Environment Health Behaviour Mental Some examples of how these "Five Freedoms" can be applied in a veterinary clinic The following are just some of the ways that a veterinary team can apply the "five freedoms" in a veterinary clinic (it is not an exhaustive list). It is important to realise that each of the five freedoms does not exist in isolation, they are interlinked and you cannot abide by four and ignore the fifth. 1. Freedom from hunger and thirst (note: in a veterinary clinic oral food/water is sometimes with-held for specific medical reasons/cirumstances). Water Continuous access to fresh clean water at all times Provide suitable water containers e.g. "Sippy" bottles should be available for guinea pigs and rabbits. Food Provide food that meets all the patient's nutritional needs in a manner that does not cause obesity, unnecessary hunger or frustration. The food should be suitable for the species, condition and lifestage of the patient. Have an understanding of what constitutes an appropriate diet for the species you have in, or get the owner to bring food with them. For example, rabbits and guinea pigs have different nutritional requirements and guinea pigs should not be fed a commercial rabbit food (it does not contain enough vitamin C for them). The amount fed should be appropriate. Overfeeding as well as underfeeding is a welfare issue. Work-out how much food a patient should be given per day and make a note of it on their chart (do not just fill their bowl to the brim). The food provided at the clinic should be stored in such a way that its quality is maintained. Refrigerate or keep in air-tight containers where necessary, take care to label food containers well so diets are not mixed up. In hospital sometimes you need to be patient and take your time to gently persuade sick or nervous animals to eat. Ask the owner what type of food an animal is used to eating (e.g. wet or dry…). Warm wet food, hand feed the patient or place food on their paws to help encourage them to eat. Use appropriate bowls. Some animals prefer a certain kind of bowl, ceramic, stainless, plastic, deep dish or a shallow dish (try different ones). With long stay patients ask owners and if necessary get them to bring in the animal's normal bowl from home if you are having feeding issues. 2. Freedom from discomfort o o Animals should be housed and managed in a veterinary clinic so that they do not experience: Thermal discomfort Physical discomfort o Poor hygiene o o Provide appropriate and clean bedding. Take into account the animal's species, age, size and condition (consider the different needs of a dog with a broken leg versus a rabbit in for a vaccine). Check bedding at least twice a day for dryness. "Dry beds" are designed to feel dry on the top (lift it up and check the newspaper under it). With non-ambulatory animals or those which have lost bladder/bowel control, you will need to be check far more regularly in order to provide appropriate care (potentially every hour depending upon severity). Recumbent animals require turning at least two hourly to prevent decubital ulcers. o o The environmental temperature should be suitable Warm the room if its cold, cool if it’s a hot day. No drafts (care with windows). o Observation, watch your patients. Become familiar with the signs different animal species may exhibit when they are experiencing discomfort. o o o 3. Freedom from pain, injury and disease o o o Animal housing/management in the clinic should ensure that: Patients are not exposed to danger (which could cause injury or disease) Potential hazards are removed or at least minimised Good hygiene and infectious disease control practices are implemented and maintained. o o Pain relief is provided where necessary It should be adequate and appropriate Patient's should be monitored and the veterinarian notified immediately if there are any concerns that a patient is suffering from pain. Any abnormality or disease noted is promptly investigated and treated. Records should be made about when, why and what was done about it. o Handling techniques When animals have injuries, we need to be extremely aware of: ▪ Where this injury is. ▪ How our handling techniques need to change depending on the injury site and other factors which may be involved. ▪ Safety of the handler and animal. This is paramount. ▪ Does the patient require pain relief before handling/transportation? o Observation As mentioned for the previous freedom this is key to providing good patient care. Be observant and diligent about your nursing. 4. Freedom to express normal animal behaviour o o o o Animals should be housed and managed in a way that allows them to: Have enough space to perform a range of behaviours Engage in social contact (where appropriate) Perform behaviours that let them cope with stress Perform behaviours that are enjoyable What are some examples of allowing a patient to display normal behaviour? o First remember what normal behaviours the species you are dealing with has. If the cat is scared and insecure, it will probably want to try to hide or get somewhere up high. Provide somewhere to hide in their cages (e.g. a box) or try to put them in cages off the ground (unless the cat is very difficult to handle, then putting them down lower can aid removal from cage, simply put a towel over the front of the cage to add privacy). o o o o o Provide patients with enrichment such as: toys play-time food hunt in their cage time out of cage for a dog to express normal toileting habits or to go for a walk scratch post for a cat Be sure you note down any signs of abnormal behaviors and communicate them to the veterinarian 5. Freedom from fear and distress o o Animals must be housed and managed in a way that provides them with: "Feelings" of safety and security A good human-animal relationship o Using appropriate and safe handling techniques for the species you are dealing with (VITAL) Be flexible. Sometimes this may mean a deviation from your normal handling techniques in order to tailor your practice to a particular individual. o o o Avoid unnecessary handling in nervous animals/those not accustomed to handling Be organised so procedures and treatments can be completed in a timely manner. Talk to your patients, spend time with them doing non-painful handling/restraints such as petting, feeding and gentle grooming. Reduction of stress in animals at the veterinary clinic is important. Visits to the veterinary clinic can be very stressful for the owner and the animal. Allow an anxious animal some time to adjust to the clinic before approaching/handling them. Reduce noise/smells Educate/communicate with owners regarding what can help their animals deal with stressors in the clinic. Use appropriate positive reinforcement (praise, treats). o o o o o You can use products such as Feliway, DAP (pheromones) to assist with providing a calming environment in the clinic (and at home). Keep cats and dogs away from each other in the waiting room, and in the clinic wards (at minimum avoid placing them in cages where they can directly see each other). Rabbits, rodents, birds– have separate options for these species too. o Guide to Professional Conduct Ethic in Veterinary What are ethics? The Oxford English Dictionary (OED) online provides the following description as one of the definitions of the word 'ethics': "The rules of conduct recognized in certain associations or departments of human life." (OED online, 2011) A simple way of defining ethics for a veterinary nurse assistant, veterinary nurse, or animal manager is doing what is right in a professional sense, however the nature of your profession will shape 'what is right'. It is interesting to contemplate the OED definition, which suggests that what is right can be defined by rules of conduct. In society we extend these rules of conduct into the laws that govern our society, however the law alone does not contain all the rules that help us exist in society and do what is right in all our daily business. Code of Conduct Veterinarians and veterinary nurses have codes of conduct that are described by their respective professional associations. As such a vet nurse can be guided by the Code of Conduct. Animal managers whether they work for organisations such as MAF, SPCA or are perhaps farmers, or simply animal owners can consult the NZ Codes of Animal Welfare as a guide to appropriate behaviour when managing, or owning animals, these codes (which can be downloaded from MPI at this link) describe the rules of conduct for a range of animal owners, and are enshrined in NZ law. Ethics and Me How do ethics apply to me? Veterinary nurses are guided by ethics at several levels, e.g. if you read the Guide to Professional Conduct you will find suggestions of how to work with your veterinarian, and what duties a veterinary nurse should or shouldn't perform. For instance, a veterinarian is required to supervise some duties of the veterinary nurse, others are a normal part of the veterinary nurse's role for which they are trained. As a veterinary nurse, you have responsibilities to the client (the pet owner) as well as the patient, these are defined in your Guide. You should read and be familiar with what your training allows you to do. Professional ethics and behaviour often include just sensible ways to behave in the workplace, as well as how to work with animals. E.g. if you are on work placement or work experience, arriving in good time to start work in the morning, being suitably clothed for your job including any uniform you are required to wear is an expected behaviour of any employee, not just a vet nurse. You should be rested (i.e. not straight out of a night club and still intoxicated!) and ready for your job. It is not appropriate to arrive at work and spend the first half hour of work eating your breakfast or putting on your makeup; however these matters also fall into the realm of common sense, business etiquette and ethics. Ethical Behaviour When we talk about 'demonstrating ethical behaviour', what do we actually mean? Let’s think about what makes people behave in the way they do. There are four main concerns that might be used to justify their actions: 1. They may take a certain action because they feel it is wise to do so - or unwise not to do so (prudent behaviour) 2. They may take a certain action because, having thought through the issues and looked at all the effects of the action, they feel it is the "right" thing to do (moral or ethical behaviour) 3. They may do something because that is what they are legally required to do (legal behaviour) 4. They may do something because it’s something they've always done - and perhaps because it’s something that is normally done within their particular culture (conventional behaviour) To act or behave ethically is usually seen as "the effort to guide one's conduct by reason, while giving equal weight to the interests of each individual who will be affected by one's conduct" (Rachels, 1993). Your professional behaviour should ensure that: 1. Animals are treated with all due care and respect to their well being 2. Work is carried out to the BEST of one's abilities 3. Relationships with both the public and with other staff members, including the employer, are maintained and enhanced 4. Respect is shown in relationships with other animal care organizations, whether in the same line of work or another. Some examples of important qualities you should have when dealing with animals and people include: Ability to listen Communicate effectively Empathy Loyalty Patience Promptness Presentation Commitment Ethics and Co-Workers What kind of behaviour is expected towards co-workers and employers? Where your other TEAM mates are concerned, these things might be important to get right: 1. Time Management - Be on time, be honest about the number of hours worked 2. Efficiency - Putting in an "honest day’s work", maintaining your working standards at high levels 3. Following Instructions - Your employer needs to be sure that his/her instructions are being followed. Be sure to communicate if you are unable to do so & why, to ensure animal welfare is not compromised. 4. Record Keeping - Full and accurate notes of animals and clients, and their requirements and treatments must be maintained daily as required. Records must be kept for a minimum of 7 years by law. 5. Loyalty- As an employee, you are expected to show loyalty to the business in which you work. This means then, that it is unethical to talk about the work of another staff member with anyone outside the business. 6. Comments regarding competence - This can create hard to manage situations within the business. If you have concerns in this area, check out all the specified protocols the business has for dealing with these situations. It is vital that procedures and protocols are followed to ensure efficiency and to minimize potential conflicts. If there are none in place, perhaps suggest the need for them. Ethics and The Public What kind of Professional Behaviour is expected in relation to the public? Whenever you are dealing with the public, it’s important for you to remember that the experience they have with you, in your workplace, is the window through which they view both the business and profession you represent. No company/business, whether it is a veterinary clinic or another type of animal-based business, can survive without clients. Therefore, the treatment people receive by YOUR HANDS can make the difference between them returning as a client or moving on to another business. The public is entitled to be treated with respect and courtesy, and, so do their animals. Many people think of their pets as a family member and often feel vulnerable and upset if they are sick or being left for boarding while they are on holiday. It’s vital that you focus your attention on the clients and animals when you are at work. There are a few important terms & issues you should be aware of in dealing with the public: 1. Confidentiality - ALL information collected regarding an animal, within the animal facility, whether it is person-person, over the phone, or email, MUST be regarded as CONFIDENTIAL. This means it cannot be passed on to anyone else without the permission of the owner of the animal. It’s an integral part of the "trusted relationship" the owner has with their Veterinarian/Animal Care worker and this trust must be maintained. 2. Informed Choice - Owners must be given appropriate, accurate information to enable them to make an informed choice, concerning their animals’ treatment/care. This means giving them ALL the options available, regardless of whether you think they can afford it or not. E.g. If a veterinarian is unable to come to a diagnosis or is unable to decide on the best course of treatment, he/she should give the option of a second opinion or a referral to a veterinary specialist. It is unacceptable to mislead them with false information, whether through omission. 3. Second Opinions at Veterinary Clinics - These can be sought by: Supersession - This occurs when a client takes an animal which is already under treatment for a specific problem by one veterinarian, to a second veterinarian, without requesting a second opinion through the original veterinarian. Clients often present this as "wanting a second opinion", but without involving the first veterinarian in the process. They are actually asking the second veterinarian to "supersede" the original one. In such a case, the second veterinarian must notify the original veterinarian, preferably before examination of the animal takes place, or at least as soon as possible afterwards. The animal's welfare is very important here, as it must be established what treatment the animal has had thus far. Including diagnostic tests, medications and treatments. It is also very important to get the other veterinarian's "side of the story". It may be that it is a simple lack of communication that has resulted in the client seeking a second opinion. Clearing up the misunderstanding may shed a whole new light on a case. If there is ever any doubt about the ownership of an animal, who is about to be euthanized, then a consent form MUST be filled out. 4. Referral - This is the recommendation the client consults with another colleague, who may have special disciplines/skills or special equipment, or who can perform a service not possessed by the first veterinarian. The referral veterinarian or specialist must notify the original veterinarian of the appointment, the exam, results & treatment given. The owner of the animal remains the client of the referring veterinarian. Ethics and Animals What kind of Professional Behaviour is expected in relation to animals? Professional behaviour requires that any animals', for which humans are responsible, are treated with all due care and respect to their well-being, and to the carers’ BEST ability. This means the physical health and behavioural needs of the animals should ALWAYS be met, and that any sick or injured animal receives treatment, as soon as possible, to alleviate any unreasonable or unnecessary pain or distress. So if you have gone home after a day’s work, and then realised that you had forgotten to medicate a patient, you MUST turn around, return to that place of work and animal and complete the appropriate medications as per instructions from the veterinarian. These requirements are not simply professional behaviour, but are an integral part of the NZ legislation in the form of the Animal Welfare Act 2022. Animal Ethics - The Five Domains of Welfare Nutrition Physical Environment Health Behaviour Interactions Mental state When working with animals it is vital that you complete your work to "the best of your ability". This also means that you are able to recognize your limitations too. Do not carry out procedures beyond your capabilities unless you are in training or supervised situation. As an animal care worker no matter what the business, you have the opportunity, by keeping up the high standards, to enhance the image of your profession, both in the eyes of the other animal care organizations and the public. In the eyes of the public, your professional image will to a large extent depend on: 1. The focus on and concern for, the welfare of the animals shown by staff. 2. The knowledge and competence displayed by staff members. 3. The respect & courtesy shown to clients. Tick once Professional Ethics is complete Personal ethics Personal ethics are an interesting area of ethical behaviour, and may fall outside of coverage of professional bodies such as the New Zealand Veterinary Nursing Association; however there is often some overlap. It is also interesting to observe that different societies may have divergent social norms or personal ethics; you should try to be aware of what is acceptable wherever you live. It is possible that your personal ethics may clash with professional ethics, e.g. an individual may not agree with the euthanasia of animals, however if your professional association provides guidelines of when euthanasia is appropriate, you may need to adopt those views while you are at work. You may find that a discussion with your employer may help you understand why some standards of behaviour or actions are expected in a workplace if they are at odds with your previous experience and personal ethics. We all have our own personal code of ethics and these influence our behaviour towards other people. It changes and develops, as we change and develop and gain more knowledge and experience, and maybe more openness to other points of view for example. But our own personal ethics shape the basis of how we behave on a daily basis, as parents, employees, employers, and as veterinary nursing assistants, veterinary nurses or animal care workers. And there isn't always agreements about what is ethical behaviour on a personal level as the views on what is "right" will vary widely. However, it’s vital that the view is backed by logic. ASK YOURSELF THIS: "WHAT PERSONAL QUALITIES DO YOU VALUE IN YOURSELF AND OTHERS IN YOUR EVERYDAY LIVES"? Honesty, reliability, hardworking, knowledge, diligence, considerate, helpful, etc. Decision Making is a vital part of reason. If ethical decisions are also, based on reasoning, it's important to be able to reason LOGICALLY! Reasoning is a thinking process that progresses, logically from one idea to another. Logical reasoning advances towards a conclusion in such a way, as to be understood and accepted by others. The below statements show how two basic facts can be used to come to an illogical and then a logical conclusion, showing that even if you have the right facts, your reasoning can still be incorrect. "All dogs breathe, I breathe, and therefore I am a dog". "All animals breathe, I am an animal, and therefore I breathe". Ethical decision making however, is not so straightforward. There are a number of theories that are used: 1. Utilitarianism - Acting in a way that will produce the greatest amount of overall good in the world. 2. Act utilitarianism - Looks at consequences of each individual act and calculates the "usefulness" each time the act is performed. 3. Rule utilitarianism - Looks at the consequences of having everyone follow a particular rule and calculates the overall utility of accepting or rejecting the rule. 4. Virtue Ethics - Asks the question not "How should I act"? But "What kind of person should I be?" Of course the concern here is with the question of character. Rather than a theory, which provides rules for conduct, virtue provides the wisdom necessary for applying rules in particular instances. Bring it all together Utilitarianism: Crash Course Philosophy #36 LINK TO VIDEO:Utilitarianism: Crash Course Philosophy #36 Codes of Welfare and Law Codes of welfare and other aspects of NZ law are useful guides for behaviour that apply in the wider community of New Zealand when dealing with animal ownership and welfare in general. Animal managers in any NZ circumstance can use the codes of welfare that are derived from the Animal Welfare Act (1999) to guide their behaviour. Regulatory bodies will also apply the guidelines from the codes in determining if animal owners or managers are in breach the Animal Welfare Act (1999) and may use these codes (ethical guidelines) to charge offenders with breaches of the act. It is important, however, to realise that very often the law provides for minimum standards of behaviour and a nurse or animal manager who is working under best practice guidelines will normally go beyond the minimum standards in the codes. For instance, if you read any of the codes of animal welfare you will find they describe both minimum standards as well as best practice, and as professionals in the animal industry you should strive to meet best practice standards whenever it is possible. We hope you enjoy learning about ethics and professional behaviour. If you would like more resources to help learn and understand ethics you will find some tutorial resources, articles to read, links to definitions and videos about ethics in the "Additional Resources" chapter. Euthanasia According to the House of Lords Select Committee on Medical Ethics, the precise definition of euthanasia is "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering." Euphemisms Put to sleep Put down Sending them to live on a farm But always remember, your choice of words is important. Make sure the client understands what is happening and that you and the client both mean the same thing. This is a good article at helping to understand why the wording is important. https://www.dvm360.com/view/quality-life-and-death The morality of euthanasia The vast majority of pets do not “go quietly in their sleep.” They may have lingering, debilitating illnesses. We cannot make moral decisions for our clients. We CAN refuse to euthanize healthy pets, but must also be careful with this decision as well. We can suggest euthanasia as an option. Opting for euthanasia is often a very kind decision and a proactive way for us to end suffering. Legal implications There are a few legal considerations surrounding euthanasia, and most relate to the Animal Welfare Act, and the appropriate administration of euthanasia. Record keeping is important with any medical procedure, including euthanasia. Although consent is required by law (verbal or written, and then documented), physical written consent forms are not. That said, euthanasia consent forms are a good idea for a few reasons. Euthanasia consent forms help to clarify the procedure to an owner, and can avoid confusion especially when terms like "put to sleep" are used, and the owner may assume some surgical procedure is taking place instead. It provides a clinic with proof that an owner did in fact consent to euthanasia, should the owner try to retract their consent and change their mind afterwards, or accuse a clinic of misleading them. It allows a clinic to explain the options of cremation/burial without a client having to talk too much at a very emotional time. Following disclosure of the required information, the client's consent must be obtained. Consent can be expressed orally or in writing. Obtaining consent is a process that should be documented and preferably validated with the client's signature. Sample forms are available from NZVA. Consent forms should be stored and kept as a part of the medical record. Obtaining consent may be delegated to staff, especially when consent relates to relatively straight forward procedures such as routine desexing of companion animals. Quality of life The decision to end a pet's life can be life-altering. It is often difficult for owners to decide when it’s time for euthanasia. Although we can provide our clients with guidance and support, no one knows their pets better than they do. This Quality of Life Scale can also be helpful. - Senior Pet Questionnaire Using a scale of 1 (poor) to 10 (best), patients can be scored. Scores are monitored by owners for downward trends, indicating a decline in their pet's quality of life. Pet euthanasia - how do I know it is time (brochure for owners) - pet_euth_brochure Tick once the section is complete What to expect with euthanasia What happens during euthanasia? Loss of physiologic function during euthanasia must occur in the following order to help prevent fear and distress: 1. 2. 3. 4. Rapid loss of consciousness Loss of motor function Arrest of respiratory and cardiac function Permanent loss of brain function If loss of motor or respiratory and cardiac function precedes loss of consciousness, animals become fearful and experience distress. In some species, particularly rabbits and chickens, tonic immobility may be induced by fear, and care must be taken to not confuse this behavioral response with loss of consciousness. Acceptable methods for euthanasia - Injection Intravenous Intra-peritoneal Intra-cardiac Intra-hepatic Intra-renal Inhalant anesthetic Other forms Cervical dislocation - not recommended and not used in companion animals Captive bolt or bullet - Large animal only Will go badly if you don’t know what you’re doing Preparation for euthanasia Euthanasia appointments should be the last appointment of the morning or just before closing. Plenty of time should be scheduled to accommodate anything unexpected. Chose a quiet room, and inform all staff members there is a euthanasia. Financial dealings should be taken care of prior, or billed at a later date. Clients should be sent a sympathy card the next day. Make the room inviting and comfortable Dim lights Nice blanket Tissues What to expect Clients should be counseled that the injection is an overdose of an anesthetic agent (for cats and dogs this is normally administered intravenously into the cephalic vein of the front leg). It acts on the pain centers of the brain so all they will feel is a “bee sting” when the needle goes in. Within a few seconds respiration will stop, the heart will stop soon after. Some animals may take deep breaths after they have passed, and will often urinate and/or defecate. Some animals may vocalize. Some animals may do what is known as an 'agonal gasp'. This sounds like the animal is struggling to breath and gasping, but it occurs once the animal is unconscious, and the animal is not aware of it. It can however, be very distressing for an owner, especially if they haven't been warned it may happen, as they may think they animal is conscious but can't breathe. Unlike what they have seen on television the eyes will relax open. Any of these things may be very distressing for some clients so it is better that they are prepared for the worst. You must reassure them that the pet losses consciousness within seconds of beginning the injection so they are not aware, and are not in pain. After NEVER do anything with the body until the client has left the car park! Also be conscious of where other clients are in the building. Be respectful and get as much help as you need to bag and move the body. If the owner is taking the animal home for burial you can close the eyes for them (eyes will not close naturally due to the way the muscles work) Client Requests Clients requests should be accommodated whenever possible. Some of the things they request might seem odd to you, but euthanasia, and the place the pet had within the family makes this an experience that many owners want to share with their family and memorialise; 1. Owners may want to schedule a time when children and other pets can present - be sure to explain to the parents that they will need to prepare their children for what is going to occur. 2. A piece of the pet's fur kept as a memento 3. Collars and tags may be asked to be kept 4. The client may request the pet is cremated with a favourite toy 5. Memorials to remember a pet by, or acknowledge another person's loss of a pet are available What to do with the body? Many options exist: Private Cremation - may be done with ashes being returned, or without ❖ Ashes may be kept, or scattered by the owner in an area special to them and/or the pet e.g. under a favourite tree in the backyard Communal Cremation ❖ Animals are cremated with others. No ashes can be returned. Burial ❖ This can be done at a pet cemetery or at home. ❖ Many councils have laws about the disposal of bodies and it may be illegal. However, if the owner wishes to do this just make them aware of the law and let them know that the decision is up to them. Recycling/composting ❖ Becoming more common internationally ❖ Bodies are broken down in a controlled biological environment It is important to remember this is a sensitive topic for many clients, in some cases the client may need a little time to make a decision regarding their options especially if the euthanasia was due to an emergency, for example, a client may ask to get back to the clinic the following day. In this case, many clinics will keep the body chilled and carefully labeled until the client has made a decision. If you are involved in filling out forms to send a body to a crematorium be absolutely sure you have ticked the correct boxes for the owner's request, and have all the correct details on the form AND the correct animal (ask somebody senior if you are in doubt). Make sure you follow the instructions specific to whichever company your vet clinic/business uses (they might not all be the same). What if the client has questions? Be as honest and sincere as you can, while still being considerate. It may surprise you how open people are to the truth. They just want to know what's going to happen so they can be prepared. Many resources are available to help answer questions Skylight - Grief support in NZ - https://www.skylight.org.nz/resources/loss-and-grief/loss-of-a-pet Argus Institute - https://vetmedbiosci.colostate.edu/argus/ Does it always go smoothly? If something can go wrong at some point it might. This is where planning and preparation are key. It is always best to place an intravenous catheter first if it is possible, this saves searching for veins in front of the owner. This also enables the owner to be at the animal’s head to pat and comfort them throughout the procedure. An intravenous catheter also enables the euthanasia solution to be delivered quickly. If the solution is delivered too slowly the animal may become dysphoric and possibly violent. Some euthanasia solutions are very thick, making them difficult to pass through the needle quickly. These can be diluted with warm tap water. What to do if something goes wrong? Always be prepared Stay calm and always remain calm in front of the owner If you have extra supplies ready, including another syringe with more euthanasia solution you can quickly get these to the veterinarian. Tick once the section is complete Dealing with grief and compassion fatigue Grief The human/animal bond can be profound, especially now that more people are choosing to make pets members of the family. The majority of clients will experience grief in some form but different people experience grief in different ways. Besides sorrow and loss, clients may also experience the following emotions: Guilt May occur if you feel responsible for your pet's death-the "if only I had been more careful" syndrome. Guilt is pointless and often erroneous to burden yourself with guilt for the accident or illness that claimed your pet's life, and only makes it more difficult to resolve your grief. Denial Makes it difficult to accept that your pet is really gone. It's hard to imagine that your pet won't greet you when you come home, or that it doesn't need its evening meal. Some pet owners carry this to extremes, and fear their pet is still alive and suffering somewhere. Others find it hard to get a new pet for fear of being "disloyal" to the old. Anger May be directed at the illness that killed your pet, the driver of the speeding car, the veterinarian who "failed" to save its life. Sometimes it is justified, but when carried to extremes, it distracts you from the important task of resolving your grief. Depression A natural consequence of grief, but can leave you powerless to cope with your feelings. Extreme depression robs you of motivation and energy, causing you to dwell upon your sorrow. When your animal dies (understanding your feelings of loss) when-your-animal-dies Severe or prolonged grief Do not under-estimate or make assumptions about the severity of grief. Some clients may not be comfortable acknowledging their grief. If you suspect that a client may be having a particularly difficult time dealing with the loss of their pet, support services are available. There are also mental health counselors who deal specifically with human/animal bond issues. There are also a lot of online support forums available. Owners can share stories and photos with other pet owners Pet grief – do animals grieve? We can’t know for sure, although there is strong observational evidence to show that animals do mourn the passing of a family or group member. Animals behaviour does change when their family structure changes. The photograph is of a home euthanasia. As soon as the family moved away from the body the remaining dog, who was a littermate of the dog being euthanised, laid down next to him for quite some time. What should you be feeling? Euthanasia of a client's pet may affect you more than you expect. It may bring up memories of your own pet, or you may have developed a relationship with the pet or client through the pet's illness. Sharing a client’s grief is fine, blubbering over the body is not. Some staff resort to inappropriate humour as a coping mechanism. This is fine as long as it is confined to the staff room and never around clients. If your feelings become intense, or do not improve, seek counseling. Remember that your co-workers may also be having a difficult time. Compassion Fatigue Compassion fatigue is commonly described as emotional and physical exhaustion. It can be triggered by traumatic events such as cruelty cases, or major trauma event, but can also be triggered from constant exposure to euthanasia, and the feeling of loss and grief that you may feel towards your patients. These feelings are completely normal, but problems can occur when the emotional toll starts to impact your life outside of that moment. Tick once section is complete Senior Pet Questionnaire Reference: McMenamin C. Senior pet questionnaire. LafeberVet web site. July 29, 2022. Available at https://lafeber.com/vet/senior-pet-questionnaire/