Nz vet nurse journal 83

THE NEW ZEALAND

VETERINARY

NURSE

I SS U E 8 3 V O LUME 2 3 S P R IN G – SEPTEM BER 2017

www.nzvna.org.nz

Role of the Veterinary Nurse Assistant Triage of the emergency patient Best practice standards Dilated cardiomyopathy in the Doberman Creating your professional portfolio

CELEBRATING

we got into the paperwork, I also d a franchise specialist lawyer and nt and can’t recommend that highly It made things very simple and clear.”

ve said her business is off to a great h huge support from the Paws at mily. Her home life has become ful because she has far more y to work her own hours.

Home founder Sarah Stockdale said ve’s story was one she was hoping throughout New Zealand. Vet ere proving outstanding at working eveloping the franchises. Their and their proven affinity with all was invaluable, she said.

ses already have an extremely good ng in animal care and have strong ce in working with animals, es in stressful situations. So they are assets for Paws at Home and for ts because they provide an extra confidence,” she said.

ents are very comfortable with vet dministering medication, providing ative care and checking teeth and e’ve had some vet nurse franchise offering wellness checks, microand administering flea and worm ts. It makes life easier for the nd is a good outcome for the pets.”

NZVNA

Thanks to our sponsors for their support of the NZVNA Conference 2017

vet nurse to ess-owner!

loyed friends who weren’t afraid to ard questions.

OF THE

Gold Sponsors

Paws at Home offers a wide range of services including feeding, exercise, nutrition, grooming, socialising, providing home pet care, private doggy day care and holidays and a pet taxi service. A range of animals can be cared for.

“In terms of franchise owners, we look for people who are animal lovers, are clear communicators and have a strong work ethic. Our experience is that vet nurses have all that – and more – and they’re smart so they make very good business owners.”

A Paws at Home franchise is an affordable way to get into your own business, based from home, with support from a head office in Hamilton. Owners with children can build up a viable business around childcare responsibilities for a modest one-off capital investment.

Silver Sponsors

“The opportunities are significant given that the pet industry in New Zealand is worth $1.58 billion per year,” Sarah said.

“There are five million companion pets in New Zealand and 77 per cent of households have pets. There is a big market out there.”

Paws at Home provide huge support including documentation, branding and marketing plus stationery, uniforms and other materials. A website and facebook site are both managed from head office.

Other support for business owners includes a business set-up guide, step-by-step operating guide, lead generation tools and sales scripts and ongoing training and support, including systems and policy manuals. Head office staff handle all bookings, invoicing, payment processing and debt collection and also provide marketing support.

For information on franchise possibilities, call Sarah on 0800 729 749.

Bronze Sponsors

Paws AT HOME

Call Sarah Stockdale 0800 729 749

www.pawsathome.co.nz

Supporters

NZVNA COUNCIL President

Julie Hutt

PO Box 35831 Browns Bay

Auckland 0753 021 599 059

president@nzvna.org.nz Vice-President Amy Ross

021 852 664

vicepresident@nzvna.org.nz Treasurer & Membership Secretary

Kathy Waugh 021 843 277

treasurer@nzvna.org.nz National Secretary Fiona Hastie 021 993 045

secretary@nzvna.org.nz COUNCIL MEMBERS

THE NEW ZEALAND

VETERINARY

NURSE

I SSU E 83 VO LU ME 2 3 SP RI N G – SE P T E MBE R 2 0 1 7

The New Zealand Veterinary Nursing Association strives to PROTECT, PROMOTE and PROVIDE the highest standard of veterinary nursing care.

ISSN 1177-3553

President’s report by Julie Hutt......................................................................

4

Letter from the editor by Mary Fawcett..................................................

5

CPD corner: Creating your professional portfolio

by Patricia Gleason............................................................................................................

6

Vet Nurse of the Year 2016: A year on by Kate Leveridge....

8

Clinic cat series: Martha and Marvin: A year on

by Jason Harris....................................................................................................................

10

NZVNA AGM report by Fiona Hastie...........................................................

12

Report on the general meeting of the IVNTA

by Ginny Thomas................................................................................................................

13

Best practice standards by Marie Hennessey......................................

15

Jennifer Hamlin

Triage of the emergency patient.............................................................

20

Christina Jenkins

Student corner: Dilated cardiomyopathy in the Doberman by Billie Fletcher.................................................................................

26

The Veterinary Nurse Assistant role by Catherine Rice..........

31

Interview with Miranda Samson by Antoinette Ratcliffe...........

36

Conference 2017 by Luanne Corles..............................................................

38

Increase your word power..............................................................................

42

Laura Harvey

safety@nzvna.org.nz regulation@nzvna.org.nz cpd@nzvna.org.nz Antoinette Ratcliffe

antoinette.nzvna@gmail.com JOURNAL EDITOR Mary Fawcett

journal@nzvna.org.nz Assistant Editor Candi Fletcher

candifletcher@gmail.com COVER CREDITS In the BESTPRACTICE surgery. Image by Marie Hennessey

PRODUCTION Printed by Fisherprint www.fisherprint.co.nz

Design by Murray Lock Graphics

murray@mlgraphics.co.nz

NZVNA forms

The registration or list badge order forms, merchandise order forms and new membership forms can now all be found on the website www.nzvna.org.nz or by emailing membership@nzvna.org.nz The New Zealand Veterinary Nursing Association would like to thank Hill’s™ Pet Nutrition NZ, our gold sponsors, for their continued support of the NZVNA and the veterinary nursing profession.

DISCLAIMER The New Zealand Veterinary Nursing Association Journal is published by the New Zealand Veterinary Nursing Association Incorporated (NZVNA). The views expressed in the articles and letters do not necessarily represent those of the NZVNA or the editor, and neither the NZVNA nor the editor endorse any products or services advertised. The NZVNA is not the source of the information reproduced in this publication and has not independently verified the truth of the information. It does not accept any legal responsibility for the truth or accuracy of the information contained herein. Neither the NZVNA nor the editor accepts any liability whatsoever for the contents of this publication or for any consequences which may result from the use of the information contained herein or advice given herein. The provision is intended to exclude the NZVNA, the editor and its staff from all liability whatsoever, including liability for negligence in the publication or reproduction of the materials set out herein.

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

PRESIDENT’S REPORT ‘Best Practice’ is a term we often hear in the veterinary industry. So, what does it mean? In a nutshell, Best Practice is the method of doing something that is widely accepted, due to research and experience, to produce optimal results. This then becomes the way of performing tasks (in any industry), which then become a standard way or doing things or a best practice benchmark. In the veterinary industry, we strive to be the best and make our clinics exemplary.

Earlier this year (in issue 81), Susan Holt wrote about how the veterinary clinic and hospital she works at in England had just become accredited, as part of the voluntary Practice Standards Scheme (PSS), run in conjunction with the Royal College of Veterinary Surgeons (RCVS). Currently half the practices in the UK are accredited under the voluntary PSS (RCVS, 2017).

In New Zealand we have a similar scheme known as BESTPRACTICE, which is run by the New Zealand Veterinary Association (NZVA). Clinics can seek accreditation as a veterinary hospital, or as a clinic, and in companion animal medicine, large animal medicine, or as a mixed practice (NZVA, 2017). By gaining voluntary BESTPRACTICE accreditation, clinics are able to demonstrate that they believe in the quality of all aspects of their veterinary clinic or hospital, as the standards cover a wide range of veterinary care including surgical and medical standards, nursing care, diagnostics, safety and professional development (NZVA, 2017).

We have a number of BESTPRACTICE accredited clinics and four BESTPRACTICE accredited hospitals. You can read about the accreditation process at one of those hospitals, Humanimals in Dunedin, on page 15.

What else can best practice mean to you as a veterinary nurse working in the industry? Good operating practice, good clinical practice? How often do you review protocols making sure they are up to date with the latest guidelines or research?

Small changes can make all the difference 4

to your patient. When did you last review your anaesthesia preparation check list?

Do you even have one? You do not have to start from scratch – Veterinary Support Personnel Network (VSPN) have one you can use as a guide (Dziedzic, 2017). I think clinics need to improve consistency (everyone following the same guidelines or protocols). If we do not have this we, as humans, slip into bad habits and may use short cuts that are not in the best interests of our patients.

anaesthetic is increased. It requires far less effort to take a breath from a nonrebreathing circuit than from a rebreathing circuit. To take a breath from a rebreathing circuit, the patient must be able to generate enough negative pressure to overcome resistance of the hoses, lift the unidirectional flow valves, and draw it through the soda lime.

A smaller bag will register respiratory movement more efficiently during spontaneous breathing in small patients, compared to using a large bag, but it needs to be large enough to allow breathing without restriction. In general, use small bags for small patients and large bags for large patients.

Breathing bag size To calculate an appropriate bag size, you need to know tidal volume (TV), the volume of air inhaled and exhaled with each breath by your patient. TV is 10-20 ml/kg (average of 15 ml/kg).

Take the TV and multiply it by six to get your bag size. The number that you get will be in millilitres, so just convert it to litres, and that is the size bag that your patient needs.

How many of you look at the size of your rebreathing bags? Is your selection based on the patient’s tidal volume? Do you do a calculation for this for your patients?

As an example, a 20 kg dog has a tidal volume of 15ml/kg or 20kg x 15 ml/kg = 300 ml per breath. 300ml x 6 = 1800 ml.

You would select a 2L bag for this patient.

It is important to get this right. Can a patient be too big for a small bag, non-rebreathing (paediatric) breathing circuit? The answer is yes. Even though we think of the non-rebreathing system as delivering fresh gas to the patient via the fresh gas tube, the reality is that they inhale using the volume of fresh gas that has flushed out the exhalation tube of the T-piece (or other circuit). The bag must hold enough gas to allow for a full inhalation and exhalation. Try this by blocking off the inflow and outflow side of the circuit – can you fully inhale and exhale with the small bag volume?

I am not an anaesthetic technician but I do care about our patients’ wellbeing, and every small step we take towards a successful outcome is working towards best practice. Maybe it is time to review your clinic’s policy on anaesthesia preparation to assist you to prepare your machine and select the breathing system according to animal's size.

Can the bag be too big for the patient? In theory the answer is no, but if the circuit and bag are too big, the volume of the system is increased and the time required to change the inspired concentration of

References Dziedzic, J. L. (2017.). Anesthesia preparation check list. Retrieved from http:// www.vspn.org/Library/Misc/VSPN_ M02713.htm NZVA. (2017). BESTPRACTICE. Retrieved from http://www.nzva.org. nz/mpage/BPbenefits RCVS. (2017.) Practice Standards Scheme.

Retrieved from http://www.rcvs.org.uk/ practice-standards-scheme/

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

LETTER FROM THE EDITOR Spring is sprung, the grass is ris I wonder where them boidies is They say the boid is on the wing But that’s absoid The wing is on the boid.

Anon.

When I was young, my grandfather used to chant this at this time of year and it’s one of those rhymes I’ve never forgotten.

It is wonderful to be sitting in my garden overlooking the sea, with Martin and Starbuck (my feline assistants) basking nearby and the sun on my back as I write this; Spring has definitely sprung!

In this edition we celebrate the 25th anniversary of the New Zealand Veterinary Nursing Association, and the annual conference marked the occasion beautifully.

Huge thanks to all the industry sponsors whose support not only makes the conference possible, but their individual expertise also adds another very welcome dimension to the event. I would like to acknowledge the hard work the NZVNA executive committee have done over the past year to bring us such an amazing conference. The speakers were inspiring, and the masked ball offered a fabulous opportunity to dance and to celebrate how far veterinary nursing has come. You can read Luanne Corles’ account on page 39.

Congratulations to Billie Fletcher on being the first student to have an article published in Student Corner. Her in-depth account of dilated cardiomyopathy in Dobermans is informative and interesting. If you are a student, or have

students on placement in your clinic, please consider sending me a case report for publication.

Whether you are a student or not, Patricia Gleeson’s CPD Corner on creating your professional portfolio is useful reading and is full of handy hints on how to get started and what to include in it as well as why it’s such an important thing to keep.

Catherine Rice has provided a descriptive account on the role of a Veterinary Nursing Assistant, which is particularly relevant in the current climate of changes in qualifications in the industry.

We take a look at Best Practice and visit a veterinary hospital that is one of only four in the country that has been awarded BESTPRACTICE status. Marie Hennessey’s account of the process is inspiring.

What a fantastic achievement – well done to all the team at Humanimals, Dunedin.

If your clinic is considering going for accreditation, or is already in the process, this will be a very useful read.

I particularly enjoyed reading Jason Harris’ article on Marvin and Martha the clinic cats from CareVets, Kilbirnie. You may remember reading about them a year ago, so it was great to check in with them again.

If you have a clinic cat (or other animal) and think they need fame, please send me a write up.

Also in this edition, Ginny Thomas reports on the general meeting of the International Veterinary Nurses and Technicians Association, and Sarah Fulton gives us

Manuka surveys the advent of Spring from her vantage point up a tree

Photograph by Hadyn Kiff

an informative account of what it’s like to work in a busy emergency department.

Antoinette Ratcliffe's interview with photographer and locum veterinary nurse Miranda Sampson is accompanied by some of her fabulous photos - I look forward to using some of her work in future editions of the journal - and we catch up with Kate Leveridge one year on from being awarded Vet Nurse of the Year 2016.

And don't forget, Vet Nurse Day is on October 13th. It's a day to celebrate all that's good about being a veterinary nurse.

If your clinic celebrates with balloons, flowers and cake, please send me your photos for the next journal.

Happy reading!

If you are planning to submit an article to the journal (which would give you 10 CPD points) please email me at journal@nzvna.org.nz.

How are you celebrating Vet Nurse Day? Share your celebrations with us on Facebook and Instagram #NZVNAVetNurseDay2017 #NZVNDay 5

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

CPD CORNER SPRING 2017

Your story

Creating your professional portfolio By

As you develop and progress as a vet nurse, it is important to keep a record of your development and career journey. Creating and maintaining a professional portfolio is a great way to document your formal and informal education, professional development plans, goals and evidence of your skills and accomplishments.

The evidence that goes into a professional portfolio is referred to as artefacts. These are the bits and pieces that show who you are, what you know, what you can do, and how you have grown over time. Maintaining this evidence of CPD is important – you upload pieces each year to your portal on the NZVNA website, but your own portfolio allows you to make sense of this and to tell a story, which is of longer-term benefit to both you and your career, wherever it takes you.

What are professional portfolios?

If you think of a CV as a summary of your education, skills, experience and achievements, a professional portfolio is evidence to validate what you have put in your CV. Your professional portfolio shows your journey to reach the current point in your career. It is a collection of evidence, or artefacts – documents, pictures, video, and attestations – that clearly tells your personal story. For example, your CV might talk about your ability to write clinic newsletters, but your portfolio would contain an actual newsletter you’ve written.

6

Patricia Gleason RVN, AVPRC

How do I use my portfolio?

There are two main uses for your professional portfolio. First, to help you plan and track your career, and second, to market yourself.

Creating a well-organised portfolio means you would have your personal professional development plans here, showing your personal goals over time, which then link to evidence and artefacts showing what you have done to achieve these goals.

In terms of a marketing tool, the reality is that each of us is a business of one. When a clinic or company chooses to hire us, that business is purchasing our service for an agreed rate and with agreed terms and conditions (our contract). If you think of your portfolio as a tool that represents YOU, it is your own marketing tool which showcases your skills, abilities, and demonstrates what makes you different from all the other vet nurses out there, either those within your own team or within other clinics.

When used in this way, you can show your employers and potential future employers what services you offer, how they have been useful to other businesses and show the value you bring. This helps support your own selfconfidence to make a strong impression, and support your professional image.

When you have a professional portfolio that you can share with your current employer,

it can help support performance reviews, reminding your employer of the value you bring. If used with a prospective employer, it demonstrates a high level of professionalism, reinforces what is in your CV, and will go a long way to setting you apart from other candidates because you are able to prove your skills.

Why should I bother?

If the marketing and tracking of your development is not enough to convince you of the value of professional portfolios, they can truly help you to develop a mindfulness of yourself through an in-depth understanding of yourself and your goals. This can enhance your self-esteem and help build confidence in who you are as a vet nurse and as a professional. It is also a great way to link skills/ talents from different professions, to show the transferable skills you have developed and bring to a role.

Doing the reflection and work required to choose evidence to support what is in your CV, you are well-prepared for any discussion with your employer or in future interviews.

Self-awareness is something any employer is seeking in their staff, and your level of preparation would set you apart as highly credible.

What do I put in my portfolio?

The best part of a professional portfolio is that it is YOUR story. You can organise it in a way that you believe demonstrates who

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

you are. Try to use evidence or artefacts that are objective.

Examples of information to put in your professional portfolio include: • Your CV • Transcripts from formal education • Certificates/evidence from continuing education • Licenses or specialty certifications • Letters of appreciation from employers, peers, clients, committees, etc • Copies of any work you have created (templates, forms, protocols, procedures, patient-education plans) • Awards and recognitions • Professional organization membership(s) • Scholarly publications or presentations • Your personal philosophy of veterinary nursing/nursing care • Annual performance appraisals • Dates of promotions • Letters of recommendation from current or previous employers or colleagues • Your current and previous job description in your portfolio if possible • A record/list of the CPD you’ve completed each year and has been submitted to the NVNA portal If you have a lot of experience, your portfolio may be very big. You can always select

portions to share with specific people / for specific reasons. It is better to have more evidence over time than not enough. Set good habits to reflect and collect artefacts which recognise and show your own growth over your career.

Tools and resources for getting started A little bit of easy research on the internet will bring you to sites with examples of professional portfolios and free software that can be used. While there is plenty of specialised software available for creating e-portfolios, you can also use simple tools such as Google Apps to create an organised portfolio of your artefacts.

Have a look at some of the human nursing portfolios out there to get an idea of the types of things you can include in your own.

Remember, this is all about taking responsibility for your own career and professional portfolios are a way to celebrate who you are and what makes you unique.

As discussed in a previous column, take responsibility for your career. Track your own achievement and draw attention to your abilities.

Selected references Bell, S.K. (2001). Professional nurse’s portfolio. Nursing Administration Quarterly,

25(2), 69-73.

Cayne, J.V. (1995). Portfolios: a developmental influence? Journal of Advanced Nursing, 21(2), 395-405.

Davis, C. (2015). Developing a professional nursing portfolio. Nursing Made Incredibly Easy, 13(1), 4.

Dennison, R. (2007). What goes into your professional portfolio and what you’ll get out of it. American Nurse Today, 2(1). Retrieved f rom https:// w w w. a m e r i c a n n u r s e t o d a y. c o m / what-goes-into-your-professional-portfolio-what-youll-get-out-of-it/ Oermann, M. (2002). Developing a professional portfolio in nursing. Journal of Orthopaedic Nursing, 21(2), 73-78.

Priest, C (2010). The benefits of developing a professional portfolio. Young Children, 65(1), 92-96.

Revalidation 5: The benefits of keeping a portfolio. (2015, November 16). Nursing Times. Retrieved from https://www. nursingtimes.net/revalidation-5-thebenefits-of-keeping-a-portfolio/7000198. article Scivicque, C. (n.d.). Why you (yes, you) need a professional portfolio. Retrieved from https://www.themuse.com/advice/ why-you-yes-you-need-a-professionalportfolio

New Zealand Veterinary Nursing Association Journal Rates for 2017 Rates

Single edition

Annual – four editions

Quarter page advertisement

$475

$1800

96mm wide x 135mm high

Half page advertisement

$600

$2300

192mm wide x 140mm high

Full page advertisement

$800

$3000

Non-bleed advert: 192mm wide x 279mm high Full-bleed advert: 218mm wide x 305mm high

Inside covers** (Full Page)

$3500

Full-bleed advert: 218mm wide x 305mm high

Back cover** (Full Page)

$4200

Full-bleed advert: 218mm wide x 305mm high

Advertorial article (2 pages)

Sizes

$1400

**Taken for 2017 Journal printed in March, June September and December. The deadline for each journal is the 1st of the month prior, i.e. February, May, August and November.

Flyer insert in journal (Copies supplied by advertiser – confirm with journal editor on numbers required) ......................................................................................... $350 Direct mail-out, same flyer as above if provided with prepaid envelopes ............ $350 Note - Individual Employment Opportunity = One month’s advertising free on the website if an advert is placed in the journal for employment, as per rates above.

Website opportunities: • Classified Employment or CE advert emailed to member database..... $150 per email • Classified Employment or CE advert on webpage ........................$120 per month • Classified Employment or CE advert on webpage and an e-mail to member database .......................................................................$250 per month

Multi-media Package deal: One e-mail to member database, webpage advert (one month) and quarter page advert in one journal......................................... $580 per quarter

One e-mail to member database, webpage advert (one month) and half page advert in one journal .............................................. $720 per quarter One e-mail to member database, webpage advert (one month) and full page advert in one journal ............................................... $820 per quarter Other opportunities: E-newsletter................................................................................................... $150 Please contact the journal editor or refer to our website www.nzvna.org.nz All prices are GST exclusive.

Please contact Journal Editor – journal@nzvna.org.nz c/- NZVNA, P.O. 35831, Browns Bay, Auckland 0753

7

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Vet Nurse of the Year: A year on By

Kate Leveridge RVT RVN VNOTY 2016

This year will mark four years of the New Zealand Vet Nurse of the Year (VNOTY) title being awarded. The winner will be formally announced in October, on Vet Nurse Day, to celebrate the success and profile of veterinary nurses in New Zealand.

awesome and investing in your nursing career) that you are an amazing veterinary nurse! Maybe this was why I was so shocked to discover I was even nominated as a finalist for the award last year and yes, the tears did flow. A lot!

In 2012, Marcia Fletcher was awarded the New Zealand Veterinary Nursing Association's prestigious award for excellence, following her successful completion of her overseas boarded exams. Making her New Zealand’s very first Veterinary Technician Specialist in Anaesthesia and Analgesia.

Marcia is also a member of the academy of Veterinary Technician Anaesthetists and represents herself and New Zealand on a global scale. Her devotion to anaesthesia and veterinary nursing, along with her continual contributions to teaching, inspiring students and colleges made her the ideal candidate for this award. She set the benchmark extremely high and left a precedent for the award winner(s) to follow. Following the presentation of this award Hill’s Pet Nutrition NZ™ took on the sponsorship, and the VNOTY award was born. The first Hill’s sponsored VNOTY was awarded to Tania Fernandez, in 2013, followed by Lisa Jamieson in 2014, Wendy Jarnet in 2015 and myself in 2016. I would like to say huge congratulations to all the previous winners and finalists.

I wouldn't be the veterinary nurse I am today without some very extraordinary teachers, veterinary nurses and veterinarians who have significantly impacted and inspired my career. I want to thank them from the bottom of my heart and hope I can inspire others, like they have done for me.

The following weekend I ran an emergency and critical care practical Continued Professional Development event for veterinary nurses. A lot of planning and organising had gone into this, with months of behind the scenes work to pull it off. To my joy, it was so popular and successful that it sold out within the first two weeks of being advertised. The day itself was full of interactive labs, with guest speakers and lectures. It was a great turnout and an awesome experience was had by all.

Life after the award The very next day I was back to work at 6am with an intensive care unit filled with patients, and life was back to normal – well almost. I was still the same veterinary nurse, but I had this extra bounce to my step, because I kept thinking about the people who had nominated me for the award. I still couldn't believe it. Slowly the news got out and I was getting hugs, calls, flowers and emails from people congratulating me. It was so lovely and something I will treasure and remember for the rest of my career. The

After this the time flew by. I decided that it would be now or never to move to the United Kingdom (UK) following my dream to become an emergency and critical care veterinary nurse. I discovered that I needed to sit a national UK veterinary nursing practical exam to become registered before I could legally work as a veterinary nurse in the UK. While I started investigating the requirements for this, I saved a litter of six kittens that were due to be euthanased.

I nursed them back to health and found loving homes for them all. It was about the

What the award meant to me I'm sure many of you, like me, have a huge passion for animals and didn't just stumble into nursing. Firstly, it's not a job, it's a career and secondly, we worked hard studying for our title and then continued to work even harder once we were in real-world nursing. Day-in and day-out, the demands of veterinary nursing can be both challenging and rewarding. On a daily basis you put your heart and soul into your patients, but often no one really stops to tell you, or says: ‘hey you’re doing a great job’. But I'm here to tell you now (especially if you are reading the NZVNA journal, as it means you are already 8

Kate at work

greatest satisfaction came from the feeling of being truly valued.

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Kate volunteering in Europe

time that these little kittens went to their new ‘forever homes’ that my partner and I booked our tickets to the UK. Four days after first arriving in London I travelled out to Bristol, where I sat my registration exams. Following my exams, I then left to travel Greece and Turkey for six weeks. The

animal welfare in Greece truly broke my heart.

I then decided to sign us both up to volunteer at the local animal rescue shelter in Paros, Greece. I was so amazed with the facility and how the animals were cared for. I thoroughly enjoyed volunteering and seeing the animals in such a wonderful environment. I came back

to London to open my exam results, and I’m pleased to reveal that I passed. I will write an article on the exam process for those interested in working in the UK shortly. But, now it's nearly time to see who the VNOTY will be for 2017 and for you to think about what you need to do to be in the running for next year!

9

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

CLINIC CAT SERIES

Martha and Marvin – A year on By

Jason Harris CVN Carevets, Kilbirnie

Following on twelve months after their initial interview and minor brush with fame, turning them into the Catdashians of the feline world, we once again catch up with Martha and Marvin from Kilbirnie Carevets to see how life is treating them.

Says Marvin now aged seven, “Lots has changed for both Martha and myself over the last year. We've taken on a few new responsibilities to help the humans and ensure the smooth running of the clinic, and we see our roles as pivotal to achieving this. I myself am in charge of the valet parking (pictured recently helping a customer park her mobile scooter). I like to meet and greet our visitors to the clinic (often seen sitting at the front door eagerly anticipating their arrival), although if they are of the large canine variety, they can meet and greet themselves,” he says with a wink. Marvin also likes to help out with merchandising, often seen sitting in amongst the sales displays to give them a more realistic interactive look, drawing the attention of the shopper to the in-store promotions and competitions.

Not to be outshined by Marvin, Martha also now aged seven, shares: “As head receptionist, I like to assist with administration duties and support the humans by running my tail across the computer touch screen, helping them flick between programs and screens (even if they don't require my help). I also like to make the clients feel special and 10

give them that little bit of extra attention, by watching them put their PINs into the Eftpos machine,” which is also now one of her favourite pastimes, she adds, “but I am discreet and wouldn't share their personal information.” Martha also helps out with sales. She was once seen walking along the top of the reception, lovingly looking at a customer who in turn was looking lovingly at her, when she took a paw and quite purposefully pushed a container of dog treats into her path! When the staff member who was picking them up looked up at Martha, she gave them a look as if to say, "just wanted to bring her attention to those delicious looking treats,” with a grin.

their chilled, laid-back, unfazed view of life.

Martha still hasn't quite lost her kleptomania habit of pilfering the occasional sachet of food, much to Marvin's disapproving waistline, although she would see it more as ‘quality control’. And Marvin still likes to occasionally indulge in his tap-licking habit, and even though the tap has since been fixed, he begs to differ saying that he is doing his bit for the environment making every drop count.

Behind the scenes, Martha and Marvin are an integral part of the team with various mutual duties, ranging from helping with office duties, where Marvin likes to rake through papers to let the staff know that it's time for filing or keeping the receptionists’ seats warm, to Martha performing maintenance testing by inspecting the clothes dryer from the inside. They both like to keep a close eye on the staff themselves to ensure they are keeping up with their hygiene obligations by inspecting the human toilets, to ensure they are up to their cat litter tray standards.

Whether it’s Marvin being banned from the theatre where he's been known to snooze on the heat-mat, or being "shooed" out of the consult rooms where he likes to assist the veterinarians with their consultations, or Martha walking across the tops of the cattery cages taunting the guests or, as Martha would put it, keeping the ‘inmates’ in line, the clinic simply wouldn't be the same without its mascots. Marvin and Martha are a wonderful asset to the clinic, they are a pair of very well adjusted cats who adore one another, they offer so much unconditional love to everyone they come into contact with and ask for so little in return. They add a sense of warmth, sincerity, character and charm to the atmosphere of the practice, which in turn personalises the clinic and reflects the staff 's genuine interest in animals.

Both Martha and Marvin are a constant source of amusement with their quirky, unique and endearing personalities, and

One customer recently asked, “Wouldn't Martha and Marvin be better off in a conventional home?” At Kilbirnie Carevets,

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Martha and Marvin are fed a well balanced diet of the highest quality cat food, have 24-hour professional veterinary medical care, have spacious comfortable heated sleeping

quarters, have woven their way into everyone's hearts, and are loved and adored by staff and many customers alike (with many clients asking where they are if they aren't

visible at arrival). When asked the same question, both Martha and Marvin reply with an emphatic, “No, Kilbirnie Carevets is our home, it’s purrfect.�

Martha thinks she is a competition prize

Martha looks after reception

Marvin attends to valet parking

Martha oversees the laundry operations

Have you got a clinic cat with a story to tell?

Please email journal@nzvna.org.nz for more information 11

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

NZVNA

AGM Report 2017 By

Fiona Hastie NZVNA National Secretary and member of Executive Committee

As is the case every year, and a constitutional requirement, the New Zealand Veterinary Nursing Association (NZVNA) holds its Annual General Meeting (AGM) – in recent years this has been done at conference. The AGM is the yearly meeting of members, where all members of the association are welcome, and a time where the executive committee report on the events of the previous year. This is also the time when elections take place.

At this year’s AGM, the executive was pleased to have over 90 members in attendance, along with the executive committee.

Holding the AGM during conference enables many more members to be present, and helps increase the awareness of the day-today workings of the association.

This year a particular focus of the AGM was around election of executive committee members, and in recent years it has been unusual due to numbers of nominations to require a vote. However, this year there were five nominations for the executive committees’ two vacant positions. It was pleasing to see nominations from all over the country, with the following members being nominated: Holly Kendrick Nikita Woodhead Alice Gasnier Lynette Hobbs Lauren Prior It’s great to see so many members expressing support for these nominees by voting, and valuable members willing to be nominated in the first place by putting their hand up to assist the association in a voluntary capacity.

Following an online and paper ballot, Jennifer Hamlin, the chair of the AGM announced Lynette Hobbs and Lauren Prior as the successful candidates. Lynette 12

and Lauren will join the existing members of the executive committee, listed in full below: Officers President: Vice President: Treasurer: National Secretary: Executive Committee Members:

Julie Hutt Amy Ross Kathy Waugh Fiona Hastie Laura Harvey Robyn Taylor Luanne Corles Antoinette Ratcliffe Christina Jenkins Libby Leader Lynette Hobbs Lauren Prior

According to protocol, the executive committee are required to present reports detailing the activities of the past year.

Julie Hutt delivered her president’s report and Kathy Waugh delivered the treasurer’s report, which were followed by members of the executive committee that currently hold a portfolio.

Since we are celebrating the 25th anniversary of the NZVNA Julie Hutt made some special thanks during her report. She acknowledged those who began the NZVNA, and of course the past presidents: Angela Payne, Steph MacPherson, Val Lee, Janet Molyneaux, Jan Bedford, Marie Hennessy, Kathy Waugh and Sarah O’Hagan. In addition, she thanked the NZVNA’s ongoing sponsors, in particular Hill’s Pet Nutrition, and the current executive committee.

We have had a huge growth in membership and now exceed 1000 members, and with more members there are challenges in terms of costs, as detailed by Kathy Waugh during her report. The largest cost, aside from conference, is the ongoing production of the New Zealand Veterinary Nurse Journal, which provoked some discussion from the floor around the concept of having an online

journal to help reduce those costs. The committee took a show of hands, and will be investigating this option further by canvasing the wider membership.

The other major cost goes to supporting the Allied Veterinary Professional Regulatory Council (AVPRC), the voluntary body set up to establish standards and procedures that support self-regulation of allied veterinary professionals in New Zealand.

Amy Ross gave a great summary of the massive growth in the NZVNA’s social media presence, with Facebook being the largest platform with over 2800 people liking our page. This is used as an outlet for the executive committee to provide updates, as well as sharing items of interest to our members.

Christina Jenkins heads up the Continuing Professional Pevelopment (CPD) portfolio, which takes the lead on a huge area of growth for the NZVNA, in particular the MyCPD record on our website, and those members being eligible for voluntary registration. Christina reported on a huge growth in this area, from 216 in 2016, to 387 in the current year (2017).

Other portfolios reported on during the AGM included, Human Resources, Health and Safety, Vet Nurse of the Year, Vet Nurse Day, New Zealand Companion Animal Council, New Zealand Companion Animal Health Foundation, Website and Journal Liaison. The executive committee all share the responsibilities of these areas, and new members are expected to assist and eventually take on portfolio responsibilities.

The meeting started just after 11.30am and was finished just after 12noon, with all formalities completed. The next AGM of the NZVNA will take place during conference next year in Hamilton, on 21st June 2018.

If you require any further information, or would like to read the minutes in full, please email secretary@nzvna.org.nz.

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Report on the general meeting of the IVNTA By

Ginny Thomas VN, IVNTA Secretary General

The International Veterinary Nurses and Technicians Association (IVNTA) is a federation of national veterinary nurses and technicians associations. The permanent members are the British Veterinary Nursing Association (BVNA), the Irish Veterinary Nurses Association (IVNA), the National Association of Veterinary Technicians in America (NAVTA), the New Zealand Veterinary Nursing Association (NZVNA), the Registered Veterinary Technologists and Technicians of Canada (RVTTC), and the Veterinary Nurses Council of Australia (VNCA).

The IVNTA was founded in 1991, but became dormant for ten years between 2004 and 2014. The Association was revived in 2014, and a general meeting was held in England in 2015. General meetings are now held biennially, with the IVNA hosting this year’s meeting during their congress in Galway at the end of May. As part of the congress’ scientific programme, the IVNTA was invited to chair a panel discussion regarding veterinary nursing internationally. Speakers were Melanie O’Donoghue, representing veterinary nurses in Ireland, Hilary Orpet, representing veterinary nurses

in the UK, Virginia Thomas, representing veterinary nurses and technicians in New Zealand, and Kenichiro Yagi representing veterinary technicians in the USA. Each speaker gave an overview of veterinary nursing/veterinary technology in their country including; governance and structure of the profession, national qualifications, continuing professional development, scope of practice and utilisation of VNs/VTs, areas of specialisation, current challenges facing the profession, and forthcoming or future developments. Having representatives from four countries presenting consecutively meant that common themes and points of similarity could be highlighted, and it was interesting to be able to compare and contrast the various approaches to the profession taken in each country.

In particular, some of the challenges facing the profession of veterinary nursing and veterinary technology seemed to be common to all countries; low wages, high attrition, shortage of experienced staff (including shortage of qualified and/or registered staff in countries where this in not a legal requirement), underutilisation, and lack of

opportunity for specialisation. This last point drew considerable attention since Ireland and New Zealand have no opportunities at all for specialist training, and only limited opportunities for specialist employment.

The USA and the UK by contrast do offer specialist qualifications, and there are greater possibilities for specialist employment. It was felt that increased opportunities for specialisation, both in terms of qualification and employment, could reduce underutilisation and improve job satisfaction, therefore potentially lowering attrition rates.

If experienced VNs and VTs can be retained in clinical practice this would help to address the skill shortage that the industry is experiencing. Equally, if higher qualifications could be rewarded with increased remuneration, this would go some way to mitigating low wages in the sector.

At their general meeting, the IVNTA identified efforts to address shared challenges faced by VNs and VTs internationally as a long-term goal: following on from the issues raised in the panel discussion, perhaps one of the most practical steps it can take to achieve this goal is to support specialisation for veterinary nurses and technicians.

13

Looking for interesting courses to gain CPD points?

Search the Continuing Education Portal for over 800 courses on our website www.nzvna.org.nz Record your completed courses under My CPD record, then submit at the end of the year to gain a place on the list or register for the coming year.

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Best practice standards What are they and why do they matter to me?

By

Marie Hennessey VN, CATA, Practice Manager Humanimals, Dunedin

BESTPRACTICE is New Zealand's ONLY quality accreditation programme that ensures a high standard of service and professionalism for veterinary clinics and hospitals in New Zealand.

It's a quality assurance programme, modelled on overseas best practice standards and adapted to suit the New Zealand veterinary environment.

Previously it was thought that Hospital Standards was only achievable by large, purpose-built clinics. Humanimals broke that mold last year when it became the first practice to achieve Hospital Standards in a retro-fit building – an old bank. This is their story.

At the end of 2011, Humanimals (then Dunedin South Veterinary Clinic) set

themselves a lofty target to be recognised as a world class small animal, primary accession clinic by 2016.

The staff thought long and hard about the steps that would be required to achieve this big goal, and set different goals for each year, stepping up each year. We illustrated these aspirations to our clients and suppliers with a giant poster of Mount Everest in our waiting

There are two levels of BESTPRACTICE standards: • BESTPRACTICE Clinic Standards these stipulate the standards of service, facilities, equipment and management considered essential in veterinary practices in New Zealand. Clinic standards are set at a level that should be achievable by most veterinary practices.

• BESTPRACTICE Hospital Standards these are more demanding and represent an advanced level of veterinary treatment and care.

Practices are audited every two years.

So, do they matter?

If you are looking to do the best job you can for your patients and clients then yes, they matter, and they should be incorporated into every aspect of veterinary care that happens in your clinic and your working day.

How achievable are they?

More so than you might expect.

There are approximately 53 practices with Clinic Standards (this number fluctuates a little with corporate takeovers and amalgamations). Currently there are four practices that have been accredited as having achieved BESTPRACTICE Hospital Standard level: Halifax Veterinary Clinic in Nelson, Massey University Veterinary Teaching Hospital in Palmerston North, Humanimals Veterinary Hospital in Dunedin, and Rangiora Veterinary Centre in Rangiora, North Canterbury.

Sara Best and Lisa Boddy taking a blood sample 15

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

room, with each annual step equating to a ‘camp’ on our journey to the top. We saw BESTPRACTICE Accreditation as a logical foundation stone (‘base camp’) towards that goal for many reasons, including that it is independently audited and so enabled us to be bench-marked against other practices.

We 2012 spent de-cluttering the building and upgrading our software and hardware, and generally sprucing ourselves up and getting our house in better order, preparing for the journey ahead.

We decided that 2013 was our year to target BESTPRACTICE Standards and contacted the NZVA to get the ball rolling. The management team’s first step was to have a thorough read through of the standards and make comments about what we thought we needed to do to meet the standards (or not, if we already met or exceeded them.) Much of the Clinic Standards relate to compliance with legal matters, and there were a number of recommendations as to how a practice should run.

Dr Alison Myers and VN Yoko Yamada in surgery

The waiting area is separated into different sections according to the species of patient 16

Next we informed the rest of the staff of our target and printed off a copy of the standards for each staff member, where we had assigned staff initials to the various standards according to their expertise or special interest.

Policies and procedures, and practical tasks were shared. Veterinarians were matched with veterinary nurses and other support staff, so that all perspectives were covered in each area. It would be dishonest to say there weren’t a few grumbles, “when will we fit it all in?”, “but what’s the point?” Thankfully it didn’t take long to get everyone on board and pointing in the right direction. We set a final target date of November for our proposed Accreditation visit, with smaller target dates throughout the year. However, it wasn’t plain sailing and we stalled a couple of times. Our biggest issue was that some of the standards overlapped and staff were not sure what others had done. We overcame this obstacle by printing a giant spreadsheet with all of the standards, who was doing what, what had already been achieved, and what still had to be done. It was displayed for everyone in the staff room and referred to during our daily team meetings.

It was recognised that our kennel and cattery areas needed to be upgraded. This was no small or cheap task as it involved five separate areas (separate hospital and surgery areas for both dogs and cats), including our

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

isolation area, in a leased converted bank building. We knew that we wouldn’t be in this building for many more years so were reluctant to invest on items that would be regarded as permanent fixtures. Fortunately we found some great local builders who were up to the challenge and helped come up with some great ideas. Another gem was Jim, from Creature Comforts Cages, who went over and above the call of duty and not only sourced stainless steel gates for the cages we purchased from him, but also for the custom-built cages our builders created.

The building work was staged over three months so that we caused as little disruption as possible to the everyday running of the clinic. The results are amazing and work well for both staff and patients.

During this time we also rebranded and changed company structure from a partnership to a limited company, and whilst the effect on our Best Practice application was minimal (we had to change the name on all of our new policies and procedures), it did add more work to an already pushed schedule.

I suspect that, like many practices, we had a lot of corporate knowledge but not a lot of it written down in a structured cohesive format. Writing policies and procedures is not the idea of fun for most people, however once they are done they are very valuable.

The writing and checking of policies and procedures was the biggest job of all. We achieved this by all staff having access to a digital drop box where all of the documents were stored and reviewed, with track changes used so that good discussion could be had without compromising momentum or having multiple copies floating around.

Once the documents were agreed upon, we outsourced some of the formatting to ease the load and ensure consistency and clarity.

Staff had been asked to write all policies and procedures with the thought that the reader would be new to the clinic. Having an external advisor, a veterinary nurse educator, read and format meant we got good honest feedback that pointed out deficiencies in our information when some assumptions had been made (“well everyone knows that!”).

Then it came time for all of the information to be co-ordinated and reviewed by all of the staff. “Read and sign, read and sign” became the catch phrase for the few weeks before the Accreditation visit.

Preparing a feline patient for surgery

Having everything written down in one place (albeit within five binders: Health and Safety, Clinical Procedures and Protocols, Staff Manual, Laboratory, and Radiation Plan) has already proved its worth when we have had new staff members start. Everything they could need was at their finger-tips and we set aside two days for them during their induction to “read and sign”. It has made introduction into the clinic faster and smoother for both the new employee and other staff members, and ensured nothing was missed.

The audit visit itself rolled around and there was a bit of last minute touching up and tidying. We were all excited and nervous, as we would have been had we been sitting an academic exam. However the auditor was great and although the visit was long, at five and a half hours, it wasn’t onerous.

In 2014 our next target or ‘camp’ was CFC, through the International Society of Feline Medicine, which is a division of the International Cat Care charity. We were absolutely thrilled to have been awarded Cat Friendly Clinic status. We were the first veterinary clinic in New Zealand to be awarded this international accreditation. Sadly our long stay hospital cages were a fraction too small (5cm!) to attain gold standard status, but we are still proud of this achievement. Having BESTPRACTICE clinic standards certainly aided in achieving CFC, as a number of the standards are similar, with only a small handful of additional policies and procedures required to be added.

Working towards BESTPRACTICE accreditation has helped us focus our efforts, grow as a team, and increase and target our capital expenditure for improvements within the clinic for the betterment of our clients and patients.

Our reaccreditation visits soon rolled around in 2015. With a very busy first half of the year behind us, we started reviewing what was required. In September, with almost all of the work done for the reaccreditation, we made the momentous decision to attempt Hospital Standards. This really was momentous as it only gave us only three months to carry out the necessary improvements to our facilities.

The toughest bit of all – waiting for the result of the audit!

Hospital Standards are divided into 19 categories and standards range from 24 hour 17

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Upgraded cages for our patients makes for a more spacious recovery for this canine patient

emergency cover, surgery and anaesthesia to dentistry, endoscopy and ultrasonography.

Others relate more to the premises, health and safety and personnel. Each category is further divided into multiple detailed points, leading to literally hundreds of requirements to be met.

One of our first tasks was to repurpose a number of rooms. Our current dental and radiography rooms had to move to our presurgery examination area. That room was then split in half with the side nearest our theatre converted into a scrub bay. The other half was converted to our sterile supply area, with two-sided Perspex® cupboards at either end of the new dividing wall (along with a viewing window) to allow for a one way cycle for sterile items entering the theatre area, and contaminated items exiting for cleaning and re-autoclaving. New sinks, lighting and electrical outlets were also installed.

New vinyl was laid in our physio room and part of our waiting area, that had remained with carpet tiles from its old bank days. Monitored smoke detectors 18

were also installed throughout the building. Significant investment was also made for equipment such as endoscopy and piped oxygen. Piped oxygen has often been a stumbling block for practices due to the expense and potential disruption.

We were fortunate that our local plumbers were able to install this, with surprisingly little disruption, and for considerably less that we had been originally quoted by the oxygen supplier, although it still had to be signed off by a certified technician from the oxygen supplier. This also meant we moved from small D-size cylinders to large G-size cylinders, cutting down on both rental and travel costs for oxygen supply, which in turn helped offset the cost of installation.

Our tradesmen cannot be spoken of highly enough. They (electricians, joiners, plumbers, painters, flooring installers) worked around us as we worked around them, causing minimal delays and interruptions to our day-to-day business. Some days there were up to five sets of tradesmen in various parts of the building!

What did this mean for our patients?

Our patients can be assured that every care is taken to assist in their care and well-being.

For example, they have: • A fully equipped surgical suite • Large, comfortable cages with care plans for their time in the hospital that meet their medical and nutritional needs • Detailed pain relief plans • Qualified and knowledgeable staff who are dedicated to their specific roles and are thorough and exacting in their theatre practice protocols. Staff who always have the best interests of their patients in mind.

Humanimals checks the hygiene of the theatre suite with a quality control programme that includes assessment by an external laboratory. All of this means that we do not give antibiotics as a matter of routine to prevent infection – we are confident in the protocols that we run.

What did this mean for our clients?

Achieving BESTPRACTICE Hospital Standards gives our clients confidence in

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

the knowledge that the staff and clinic have undergone rigorous checks and balances, and have been found to have met those very high standards. That the staff are committed to continuing education (one of the standards requires at least two of our veterinarians have completed post graduate qualifications – Dr Alistair Newbould and Dr Alison Myers have achieved this, with their Masters in Veterinary Medicine and for Alistair with his Membership of the Australian and New Zealand College of Veterinary Scientists), and the clinicians have immediate access to a wide variety of equipment to help diagnose and triage our patients.

What did this mean for our staff?

Hard work? Yes! However all our staff are committed to maintaining BESTPRACTICE Hospital Standards, and continuing their own professional development within Humanimals.

They are confident that Humanimals supports them in their learning and professional careers, as well as ensuring their day-to-day health and safety is not compromised, and that Humanimals will provide new and upto-date equipment and learning tools. Let’s not forget the humour and fun, and the enormous pleasure of seeing our patients recover.

We find it a privilege to care for other people’s pets, from puppy and kittenhood through to their twilight years.

We were thrilled and very proud that we passed with only five minor points to tweak (one being measuring airflow from our theatre to the new scrub bay to ensure adequate filtered, positive pressure air changes per hour and no back draft – yes they are that exacting!).

Karen Leckie on reception

What pleased us most was the auditor’s final comment - “staff are relaxed and interacting with patients and clients in an excellent manner”, which was astonishing considering the staff all knew the inspection was happening and were very nervous.

If you are interested in how your clinic can achieve BESTPRACTICE standards, then please contact the BESTPRACTICE committee or Trish Thorpe at NZVA. The author is also the newest member of the NZVA Best Practice standards committee and is happy to help or answer any questions you may have.

She can be contacted on marie@humanimals. co.nz or 03 456 2345.

Multiparameter monitor in surgery 19

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

difference between life and death for the critical patient.

Triage

of the Emergency Patient By

Sarah Fulton DipVN, RVN Massey University Veterinary Teaching Hospital

Introduction In the veterinary clinic, not all patients are expected. Some conditions have a very acute onset, or may develop in a hidden manner before bursting into focus at a later stage.

Additionally, some owners may not pick up on the more subtle signs of illness or injury, and others may want their animal 20

seen immediately for conditions that are relatively minor in nature. Either way, it’s the role of the triage nurse to identify which animals must be seen immediately for lifethreatening emergencies, and which may be better suited to an appointment either that day, or later that week. Being able to determine which is which can mean the

Phone triage Triage often starts on the phone, when a client calls for advice. This is a prime time for the nurse to shine, with the quality and delivery of their advice. Phone triage consists of gaining enough information to determine how critical the animal’s condition is, and when they need to be seen. This allows everyone to focus their resources on the most critical patients first, and helps spread the workload evenly to prevent staff fatigue and burnout, or missed treatments for inpatients due to crowding. Most owners will have a reason they are calling, and most will state this shortly after the conversation starts, but some may need prompting - asking “What is your pet’s current issue?” or “What am I able to help you with today?” often helps to elicit this information. Sometimes the issue is immediately obvious, as in the owner that calls after backing over their cat in the driveway. Other times, it is a lot more subtle, for example, a dog that has vomited several times, but still seems happy. Further questions revolve around determining the

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

severity and duration of the injury or illness, keeping in mind that many clients are not medically trained, and are unable to perform a full examination of their pet themselves.

However, most owners are able to give an idea of respiratory function, level of consciousness, and describe their pet’s current actions, as well as give some form of history.

Common complaints Some common complaints that require emergency attention include: • Seizures, either new or lasting longer than five minutes - especially if the animal is currently seizing • Dyspnoea or choking. Cats that are open mouth breathing deserve special attention, as they are extremely fragile. They should be brought in as soon as possible for assessment, and kept calm on the journey in • Acute trauma, including road traffic accidents and dog fights, among others.

Owners should be instructed to take care handling agitated animals, as they may lash out at their owners in pain. Safety comes first, and owners can be instructed to use towels or blankets to prevent or mitigate bites • Sudden collapse, especially if paired with difficulty breathing, inability to rise, or loss of consciousness • Unproductive retching, particularly in deep chested breeds, and especially if the abdomen appears distended • Male cats straining or unable to urinate.

Some owners may confuse this for constipation, so be sure to get additional information if they are asking about a constipated cat • Acute ataxia, paresis, or paralysis. Many conditions that result in these signs are time-sensitive, and the sooner they are seen, the better their chance of recovering function • Known or suspected toxin ingestion, especially if it’s within the last four hours.

Owners should always be advised to bring in any remaining packaging or substance for analysis • Difficulty giving birth, especially if the animal is in active labour without producing offspring in 90 minutes or longer • Acute, severe, abdominal pain, ongoing vomiting or diarrhoea, or copious frank blood in either vomit or feces (Silverstein and Hopper, 2015)

Client management Client management is a large part of triage as well. Assessing the client’s emotional state, rationality, and their ability to provide accurate information will allow you to tailor your approach to the individual. This can vary from calming a client that may be on the verge of tears, to keeping a client determined to tell you their pet’s life story focused on its current issue. Other clients may have made up their mind about what they want to do, and may need to be convinced to do what is best for their pet instead. Yet others may be unwilling or unable to pay for more than the bare minimum. Building rapport and presenting factual advice in a confident and friendly manner allows clients to trust in your judgement while making their decisions, and feel secure in the knowledge that their pet will be cared for in the best possible way with the best value for their money.

Additionally, judging what information is needed now and what can be collected later saves time, and makes clients feel like their needs are being met. No one likes feeling like they’re just filling out forms, and even less so if their pet is in dire need of medical attention! At the very least, if it’s immediately obvious that the pet needs to come in and the owner is itching to get going, try and ensure that you have a phone number, and a general idea of the size of the animal.

The phone number allows you to reach the client if necessary, and knowing whether your incoming dog is a Great Dane or a Chihuahua means you can start to set up size appropriate equipment. Knowing how far away they are and whether they know how to get to the clinic is also important, and every nurse should have a basic idea of how to get to the clinic from nearby main roads, so that they can give clear directions to those who need them.

We must also have an idea of client expectations and funds, and they must be able to make informed decisions. Keeping clients informed of costs each step of the way can prevent them from having unrealistic expectations about how far their funds will stretch. It is extremely important for us to remain professional and reserve judgement when helping clients make their decisions.

Very often, the entire visit is a surprise, and many clients are in some degree of emotional distress, whether or not that is clear from their actions. These clients may be volatile,

and care should be taken not to escalate a discussion into an argument. Part of our role is to support these clients, offer the available options in a calm and rational manner, and help them come to a decision that fits their needs and the needs of their pet. Unfortunately, sometimes the outcome of that discussion is euthanasia. It can be tempting to decide that a client is a bad person for their decisions, but we must remember that we don’t know what they’re dealing with outside of the vet clinic. We don’t have the right to make that choice for the client, or abuse them for making what we feel is the ‘wrong’ decision, as long as the animal’s welfare is being cared for.

Incoming setup When setting up in advance, it’s important not to overdo it. Cluttering the workspace with every possible thing you may need will leave no room for the animal itself, and may lead to people missing things in the chaos.

Additionally, clients must consent to treatment. While it may be tempting to open packaged items, the clinic must absorb the cost of these if they aren’t used. Having a stack of items on hand but unopened saves the time of digging them out of drawers, but they can be returned and used another day if they aren’t needed.

Setup will vary depending on your patient’s known signs, your veterinarian’s preferences, and your clinic’s equipment, space, and staffing levels. Some general things to prepare in advance if you know an animal is on its way include: • Your veterinarian! They must be informed as soon as you’re aware of the incoming case. In a multi-vet practice, knowing which vet will see the case is important, so that other obligations can be shuffled or rescheduled.

• Yourself. Emergencies are stressful, especially if they’re not routine in your clinic.

Take a moment to take a deep breath.

Have that snack you’ve been meaning to finish for the last hour, nip to the loo if you need to, make sure any other patients are taken care of, then focus in on what needs to be done to prepare for the case at hand. If you’ve got multiple nurses to work with, ensure you all know who’s on the emergency case, and who’s looking after other inpatients and consults.

• A clear bench for your animal to be worked on. Many emergency practices 21

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

have a designated emergency station, but if you have multiple cases at one time, you need multiple benches.

• IV catheter equipment, including blood glucometer, PCV tubes, and slides so that a minimum database can be collected from the catheter hub once placed.

• Fluid therapy equipment, with fluids and line already flushed through and set up in a pump where available. Pumps should have the volume infused cleared, and could have a rough rate entered for a shock bolus if a weight is known or can be estimated - this is then adjusted once the patient has been examined.

• Ultrasonography machine, if available, especially for any acute abdominal pain, trauma, collapse, retching, or dystocia cases.

• Blood machines and radiography machines should be woken from standby mode.

Oxygen cages, if available, should be given time to fill.

• An emergency monitoring chart and/or triage form to record initial vitals, medications given, history from the owner, results of diagnostics performed, and ongoing vitals as necessary.

• A crash cart or crash box should be close to hand, and should include emergency drugs, intubation equipment, and equipment for emergency procedures. This should be checked and restocked after every use, and periodically if unused in a while.

• A trolley with a non-slip mat or Vetbed at the entrance to the clinic, for medium, large, or giant breed non-ambulatory dogs.

Primary survey The primary survey starts when the client arrives at the door with their animal. This should take thirty seconds or less, and consists of rapidly assessing the respiratory, circulatory, and neurological systems. Alterations in these systems can lead to sudden deterioration and death. These animals should be seen by the veterinarian immediately, and often need to be removed to the treatment area for stabilisation. If in doubt, it’s best to err on the side of caution and get your veterinarian’s assistance. If respiratory or cardiac arrest are suspected, CPR efforts should begin immediately. At this time, a very brief history of the current issue and any other known medical problems can be received from the owner, either by the triage nurse or another staff member, while 22

the animal is assessed in the treatment area.

If at all possible, a CPR code should be determined, so that if the animal suddenly deteriorates, the staff and owners are ‘on the same page’ and everyone is clear on how far to proceed with treatment. If the animal must be removed to the treatment area, it is important to update the owners as soon as possible, and gain additional information when a staff member is free to do so without putting the patient at undue risk. This will help keep clients in the loop, and allow them to make informed choices.

Airway First and foremost, the patency of the airway should be confirmed, as well as ensuring the patient is breathing spontaneously. The rate and effort of breathing should be considered - is the animal displaying a normal breathing pattern, but the rate has changed?

Is there abdominal effort, paradoxical movement, or open mouth breathing? Under no circumstances should dyspnoeic animals be stressed, as this increases metabolic oxygen requirements, and can cause rapid decompensation in a patient that is already marginal. These animals should be placed on supplementary oxygen immediately through whatever means cause the least stress to the patient, and given time to acclimate to the clinic before a full hands-on examination is attempted (Silverstein and Hopper, 2015). While handling these patients, low stress methods should be used, and the patient should be given frequent breaks if they become stressed (Lane, Cooper and Turner, 2009). If respiratory function continues to deteriorate, intubation may become necessary.

Some common emergencies with a respiratory component include: • Choking • Brachycephalic airway disease • Diaphragmatic hernias • Feline asthma or severe respiratory infection • Pleural effusions • Laryngeal paralysis • Tracheal collapse Cardiac Secondly, cardiac function and blood volume should be rapidly assessed through heart rate and rhythm, pulse quality and synchronicity, mucous membrane colour, refill time, and hydration status. Is the rate normal for the size and species of the animal? Is a murmur or arrhythmia present? Are there pulse defi-

cits? Is there obvious haemorrhage from a wound? Any arrhythmia warrants evaluation with an ECG, and blood pressure should be assessed to determine whether cardiac output is sufficient to maintain perfusion (Silverstein & Hopper, 2015). Severe bradycardia can indicate imminent cardiac arrest, and steps should be taken quickly to gain venous access and maintain perfusion.

Pressure should be firmly applied to any sites of active bleeding, as long as this can be done safely. Animals may need analgesia to permit this if they are nervous or painful (Lane, Cooper & Turner, 2009). Fluid resuscitation should be goal-driven with frequent assessments, and is definitely not a one-size-fits-all treatment plan. If shock is suspected, a 10ml/ kg bolus of crystalloids over 15 minutes is often a good starting point, but this may need to be adjusted upwards in severely compromised patients, or downwards if cardiac dysfunction is suspected (Silverstein & Hopper, 2015).

Some common emergencies with a cardiac component include: • Ruptured masses, particularly splenic masses • Thromboembolism • Gastric dilation and volvulus, in which VPCs may be present • Traumatic cardiomyopathy • Acute blood loss • Urethral obstruction leading to hyperkalemia and bradycardia/arrhythmias Neurologic Finally, neurological function should be examined. An unresponsive patient is much more critical than one that is aware of its surroundings, and any patient with reduced levels of consciousness should be assessed rapidly by the veterinarian.

Traumas such as road accidents can lead to head and brain injuries, which can cause rapid decompensation with changes in intracranial pressure. Spinal lesions or compressions may be progressive. Ongoing seizures can cause hypoxia and hyperthermia, both of which lead to a host of secondary issues, and should be treated as soon as possible (Silverstein & Hopper, 2015). It’s important to check with the owner whether neurological function has remained stable, or whether there has been deterioration since they first noticed signs.

Scoring the patient with the glasgow coma score or similar can give an indication of

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

prognosis, and allow clinicians to track whether neurological signs are deteriorating or improving over time.

Common neurological emergencies include: • Traumatic brain injury • Seizures or status epilepticus, commonly defined as seizure activity occurring for more than five minutes • Acute or progressive ataxia, paresis, or paralysis of one or more limbs • Hypoxic events Urogenital If the patient is conscious, able to ventilate adequately, and has sufficient cardiovascular function, the urogenital system should be assessed. The most common emergencies within this system include dystocia, and urethral obstruction. A bitch or queen in labour should be rapidly assessed if it has been more than 90 minutes of unproductive active labour, or if a foetus is obviously lodged (Lane, Cooper & Turner, 2009). Any male cats known to have a history of urinary tract issues, or who have been seen straining to urinate should be assessed quickly.

An extremely full bladder feels similar to a tennis ball in size and texture, and may be painful to palpate - care should be taken when handling, and only very gentle pressure should be used. Particularly if the cat is bradycardic or has arrhythmias present, potassium levels should be assessed. Urinary blockages frequently lead to elevated potassium levels, and this can be fatal if untreated (Silverstein & Hopper, 2015). These cats should be unblocked by catheterisation as soon as practicable. Occasionally, an animal may present for anuresis due to renal failure, and will often be dull or stuporous, extremely painful on abdominal palpation, and may have a history of renal disease or toxin ingestion, such as grapes or raisins for dogs, and lilies for cats (Peterson, Talcott & Peterson, 2012).

Secondary assessment – history Once the animal is deemed not to require emergency life-saving treatment, the triage nurse can proceed to a consult room for a more thorough examination and history. A distance exam may be performed to assess how the animal responds to the exam room, and whether their gait is normal or abnormal. This also allows more thorough assessment of mentation. The animal can also be weighed, and new client details can be gathered.

When taking a history, it is important to cover the basics that may not have been included on the initial phone call. Vaccination status, pre-existing issues, flea and worm control, and whether any other pets in the household are unwell will help gather a baseline. Duration of the current problem and progression in severity will also help you to judge whether it is an acute or chronic issue. Changes in demeanour, appetite, toileting or drinking are all commonly picked up by owners. For cats, knowing if they are indoor, outdoor, or both helps narrow down causes of trauma and access to toxins. Most other questions will revolve around the specific area that is abnormal (Lane, Cooper & Turner, 2009). I tend to try and have a semi-directed conversation with the owners and ask questions depending on where their mind is at the time, rather than sticking rigidly to a list that must be completed, as I feel this helps clients remember detail more effectively. During the consult, all pertinent information should be recorded on a triage sheet, and summarised. Triage sheets can be laid out to remind the user to ask or check certain things, e.g. TPR, and patient weight.

Secondary assessment – examination When performing the triage exam, a full nose-to-tail physical should be performed, with a focus on perfusion parameters and immediate issues. For example, it’s worthwhile recording that the dog has a lump on its left flank, but not as important as recording that its mucous membranes are extremely tacky, and its eyes appear sunken. If, during the physical exam, the animal deteriorates or you suspect it needs to be examined by the veterinarian faster, there is always the option to remove the animal to the treatment area, and complete the exam there. Again, erring on the side of caution is best here.

A good mnemonic to keep in mind when assessing a patient that has just arrived for triage is A CRASH PLAN. This stands for: A - AIRWAY C - CIRCULATION R - RESPIRATION A - ABDOMEN S - SPINE H - HEAD P - PELVIS L - LIMBS A - ARTERIES (AND VEINS) N - NERVES

Assessing each of these categories allows you to narrow down your target area and determine which parts of the animal are critically affected, if any. This will help you and your vet determine likely causes for your patient’s signs. It will also help you to triage cases when multiple animals show up together a patient without a patent airway is much more critical than one with a fractured limb, for example, but both of these patients are more critical than one with an ongoing skin disease.

Handover Once the exam has been completed, it is now time to excuse yourself and relay the information to the vet. Having comprehensive notes is important here, as it prevents errors in translation, and allows a rapid handover of the relevant information to the vet. If the vet is busy with another case, letting them know whether the patient is life-threateningly ill (see NOW ), critically ill (see within one hour), able to wait (see within two to four hours) or not urgent (reschedule or see when available) allows them to prioritise. Keeping clients updated about expected wait times is also beneficial, and helps reduce frustration.

Conclusion Triage can be an intimidating thing for nurses that are unfamiliar with it. It is a skill that improves with practice, but even a junior nurse may complete a triage exam competently if they remain calm, and follow the guidelines described above. Remember, there is almost always someone that can give you a second opinion if you aren’t sure on something. If in doubt, don’t be afraid to check in with a colleague. The client is likely to be grateful for the attention to detail, rather than judgemental over perceived lack of skill. Otherwise, it’s just a matter of having a chat with a client about what’s happened to Fluffy over the last few days, examining the animal to see what is wrong, and determining how severe the illness or injury is, then proceeding from there to diagnostics and treatment as needed.

References Lane, D., Cooper, B. & Turner, L. (2009).

BSAVA textbook of veterinary nursing (4th ed.). Gloucester, England: British Small Animal Veterinary Association.

Peterson, M., Talcott, P. & Peterson, M. (2012). Small animal toxicology (3rd ed.).

London, England: Elsevier.

Silverstein, D. & Hopper, K. (2015). Small animal critical care medicine. St. Louis, MO: Elsevier.

23

ADVERTORIAL

Canine Cough If your clinic switched to using Virbac’s Canigen® KC injectable vaccine for Canine Cough due to supply issues with intranasal vaccines, you will have noticed some key advantages.

As recently recommended in the WSAVA Dog and Cat Vaccination Guidelines (Day et al., 2016), Canigen® KC contains both Canine Parainfluenza Virus and Bordetella bronchiseptica. These

two organisms are important common causes of Canine Cough, also called Infectious Tracheobronchitis. Because these are inactivated cultures, the vaccine does not cause the dog to shed

contagious pathogens or experience symptoms of the disease, so there is no stand down period required before the dogs go into kennels or attend events, like agility meets.

Canigen® KC is given subcutaneously and can be given in the same syringe as the Canigen® DHA2PPi vaccine. It is less stressful for both dogs and veterinary staff to administer it this way. Canigen® KC offers the same level of protection as intranasal Canine Cough vaccines, and has the same annual booster schedule as its intranasal equivalents.

In intranasal vaccines, the live attenuated Canine Parainfluenza viruses can be shed by dogs for a few days after innoculation, and the live B. bronchiseptica can be shed for as long as six weeks. Intranasally vaccinated dogs should therefore be kept away from unvaccinated or immunocompromised dogs for six weeks.

While intranasal vaccines provide faster protection at the initial vaccination, as they are applied at the source of infection and stimulate production of antibodies in the upper respiratory tract, which prevents virulent pathogens entering the body, they are only faster for the first inoculation. For subsequent annual boosters, Canigen® KC acts just as quickly, and provides the same level of protection as the live formulation at each stage throughout the vaccination schedule.

Some dogs find an intranasal vaccination distressing. They can sneeze or shake their heads from the unpleasant sensation. For dogs which react fearfully or aggressively to an intranasal vaccination, it is advisable for veterinarians’ safety and pets’ comfort to use an injectable vaccine. Canigen® KC

is the best option as it provides minimal distress to the dog with much less sting than other injectable Canine Cough vaccines.

The vaccination schedule for Canigen® KC includes a primary vaccination for puppies from six weeks of age. Puppies should be inoculated subcutaneously with two doses, a month apart, then annual revaccinations are recommended.

For both subcutaneous and intranasal vaccines, following initial vaccination, the follow-up booster requirement is the same; one dose given annually.

Where vaccination with Canigen® KC is scheduled to coincide with the Canigen® DHA2PPi the two can be combined – using Canigen® KC as the diluent for Canigen DHA2PPi. There are many different agents that can contribute towards the development of Canine Cough, including Canine Adenovirus. A modified live version of this virus is included in Canigen® DHA2PPi which also protects against Canine Parvovirus, Canine Distemper Virus, and Infectious Canine Hepatitis.

The vaccine technology developed by Virbac, and used in Canigen® KC, has shown excellent efficacy and safety in dogs in numerous countries for decades.

Canigen® KC is part of the Virbac vaccine family and is very easy to incorporate into the daily routine within your practice.

Summary 1. It is important to use a Canine Cough vaccine that includes both

Canine Parainfluenza as well as B. bronchiseptica.

2. Once the initial puppy course is completed, subcutaneous Canine Cough vaccinations are immediately effective following each annual booster.

3. There is no stand down required after vaccination with killed Canine Cough vaccines, as the dog will not shed live organisms.

4. Some injectable Canine Cough vaccines can be quite painful to inject.

While no injection is pleasant to receive, Canigen® KC is the more comfortable option.

Reference Day, M. J., Horzinek, M. C., Schultz, R. D., & Squires, R. A. (2016). WSAVA Guidelines for the vaccination of dogs and cats. Journal of Small Animal Practice, 57(1).

In this article the syndrome Canine Infectious Tracheobronchitis has been referred to as Canine Cough, instead of Kennel Cough.

This change in language is part of an effort to emphasise to the public that Canine Cough is not only picked up in kennels, and that dogs who meet with other dogs in any situation should be vaccinated against this infectious disease. As more kennels are particular about the vaccination status of the dogs visiting, and fastidious about the disinfection of their facilities, the most common places for dogs to pick up Canine Cough is at the beach or the dog park.

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Photograph by Billie Fletcher

STUDENT CORNER

A Study of Dilated Cardiomyopathy in the Doberman By

Billie Fletcher BSc (Biology) DipVN student

Introduction Dilated Cardiomyopathy (DCM) is a disease of the myocardium that commonly affects both dogs and humans. Doberman Pinschers are one of the breeds most commonly affected by DCM, with between 45-63% of all Dobermans afflicted (Wess et al., 2015).

Doberman DCM is a progressive inherited disease that causes a decrease in ventricular contractility and dilation/enlargement of the left ventricle over a period of around two to three years in a preclinical (occult) stage. This eventually leads to the clinical (overt) stage of the disease with congestive heart failure (CHF) and/or sudden cardiac death (SCD).

Pathophysiology The primary functional defect in DCM is decreased ventricular contractility (systolic dysfunction), which leads to thinning of the ventricular walls and consequently leads to CHF and arrhythmias. Poor ventricular contractions fail to empty the heart fully and this leads to backflow, causing pulmonary oedema and CHF, as well as pleural fluid, ascites and oedema in other tissues. As the heart dilates and walls thin, the nerve sig26

nals that cause the heart to contract become more disrupted, as muscles are affected by scar tissue and fatty infiltrates. Tachycardia results as the body tries to compensate and decreases the ventricle relaxation time, which further damages heart muscle tissue by starving it of oxygen. This myocardial ischemia further impairs myocardial function and contributes to arrhythmias, especially premature ventricular contractions (PVCs) which can decrease cardiac output. As cardiac output decreases, the inadequate blood flow causes a neurohormonal response to increase vascular volume, leading to further oedema.

Alongside the risk of CHF is the common occurrence of ventricular tachyarrhythmias, which can cause SCD due to a cessation of cardiac output from atrial fibrillation (Sisson, O'Grady, & Calvert, 1999). It is unclear at this time whether there are two variants of DCM in the Doberman causing CHF and SCD respectively (Meurs, 2016).

At this stage there have been two genes identified as having an association with development of DCM in Dobermans: pyruvate dehydrogenase kinase 4 (PDK4) and DCM2.

PDK4 is an autosomal dominant trait with incomplete penetrance (Meurs et al., 2007) that plays an important regulatory role in cardiac energy metabolism. It causes production of a protein that leads to glucose oxidation, which acts as the primary metabolic pathway for the heart’s energy, instead of the preferred fatty acid oxidation, leading to an energy starved state. This energy starved state reduces mitochondrial electron transport activity, and is believed to cause structural abnormalities in the mitochondria (Meurs et al., 2012). DCM2 is in a gene that helps heart function, but little else is clear about its function at this stage. 50% of dogs with this mutation will develop DCM. Many dogs have both mutations, 60% of which will develop DCM, but it is unknown how many other genes contribute to DCM at this point in time (Meurs, 2016). PDK4 more commonly affects Doberman Pinschers from American pedigrees, and is uncommon in European pedigrees, while DCM2 is found more commonly in European pedigrees (O'Grady & O'Sullivan, 2012).

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Common signs Occult disease Dobermans in occult stage of DCM will commonly pass through this stage of the disease with no diagnosis, as they show no outward symptoms of the disease so appear normal to their owners. Diagnosis of disease in this stage can only be made with judicious health testing aimed at picking up early signs of DCM (Ware, 2003).

Overt disease Episodic weakness, syncope, reduced exercise tolerance, weakness, lethargy, cough (‘gagging’), anorexia, ascites, cachexia, sudden death (Ware, 2003).

Diagnostics Clinical findings Systolic murmur over left apex, a gallop rhythm on auscultation, a weak pulse quality/pulse deficit (arrhythmias and VPCs) (Ware, 2003).

Radiography Unlike DCM in other breeds, DCM in the Doberman does not readily show with cardiomegaly on radiograph. Some dogs have an asymmetrical or widespread distribution of pulmonary oedema infiltrates (Ware, 2003).

Electrocardiography (ECG) Electrocardiography is a diagnostic tool that records the depolarization and repolarization of the heart using sensors placed on the dog's skin. The gold standard for detecting DCM in the Doberman is a 24-hour ambulatory ECG (Holter monitor), where the dog wears an ECG monitor for a 24-hour period at home while engaging in regular activity.

Unfortunately this method can be expensive, time-consuming and not readily available, so five minute ECG performed in clinic is also an option. A five minute ECG is insensitive for detecting abnormal heart rhythms in Doberman DCM, however if any VPCs or atrial fibrillation are seen it strongly warrants further testing as this is highly suggestive of the occult stage of DCM (Wess, 2010).

Echocardiography Echocardiography is a non-invasive diagnostic procedure that utilizes an ultrasound machine and colour-Doppler to create images of and assess blood flow in the heart.

The preferred method of echocardiography for diagnosing DCM in Dobermans is the Simpson Method of Disc (SMOD) (Wess, 2011). SMOD measures the left ventricle area at end-diastole (corresponding to onset

of QRS) and end-systole, with the ultrasound machine automatically calculating the left ventricle volumes (Wess et al., 2010).

Values that indicate presence of Occult DCM based on echocardiography using SMOD are as follows: • End-Diastolic Volume Measurement/ Body Surface Area: >95ml/m2 • End-Systolic Volume Measurement/ Body Surface Area: >55ml/m2 (Wess et al., 2015).

The above indicate a larger than normal chamber through both systole and diastole.

Biomarkers Biomarkers are substances found in the blood that can identify particular disease processes. In the case of Doberman DCM there are two cardiac biomarkers that are clinically useful: N-terminal pro b-type Natriuretic Peptide (NT-proBNP) and Cardiac Troponin I (cTnI) (Wess et al., 2015). NT-proBNP is a neurohormone that increases when cardiomyocytes are stressed due to volume expansion or pressure overload (DeFrancesco, 2011). NT-proBNP testing is available in New Zealand through IDEXX Laboratories (Gribbles Veterinary, Personal Communication, November 08, 2016), and results over 500 pmol/l should raise concerns, especially to predict echocardiographic changes (Wess et al., 2015). cTnI is an intracellular cardiac muscle protein that is released when myocardial injury and cell death occurs (DeFrancesco, 2011). Testing for cTnI is available in Gribbles Laboratories in New Zealand (Gribbles Veterinary, Personal Communication, November 08, 2016) and levels over 0.22 are cause for concern (Wess et al., 2015). Azotaemia and mildly increased liver enzymes can also result from poor perfusion (Ware, 2003).

while improving quality of life and manage arrhythmias. Client education regarding the disease process, goals of therapy, medication and prognosis are important to manage expectations.

Stabilizing the DCM patient When presented with a patient in CHF it is important to avoid any further stress to the patient, while rapidly reducing pulmonary oedema using diuretics, optimizing cardiac output using inotropic drugs and improving oxygenation. Curtailing any physical activity, providing supplemental oxygen and minimizing handling during initial exam is important. Morphine may be used to reduce anxiety while also encouraging slower, deeper breathing (Ware, 2003).

Diuretics Diuretics are important in the management of DCM to decrease venous congestion and fluid accumulation. Furosemide is the most commonly used diuretic for DCM, and acts on the ascending loop of Henle in the kidney to inhibit Cl-, K+ and Na+ absorption, thereby causing an increase in urine output.

Diuresis begins within five minutes of IV administration, peaks in about 30 minutes and lasts approximately two hours. Adverse effects are usually related to excessive fluid loss and electrolyte imbalances (Ware, 2003).

Genetic tests Currently there are two genetic tests available for the disease: PDK4 and DCM2.

As we do not know how many genes are involved in this disease, the absence of these two genes does not guarantee the animal does not carry or will not develop the disease.

Likewise, due to the incomplete penetrance of the disease, a positive result for the genes does not guarantee that the animal will be affected (Meurs, 2016).

Inotropic Support Positive inotropic drugs are primarily used to improve cardiac output/function, but can also provide some neurohormonal modulating effects. Oral digitoxin is a commonly used inotrope for CHF, but must be used cautiously as toxicity is common in Dobermans at low doses. It is recommended that serum concentration levels of digitoxin are measured seven to ten days after initiation of therapy or change of dose. In cases of cardiogenic shock, stronger inotropic support is available in the form of IV dobutamine or dopamine administered for two to three days. Long term use is discouraged as it is thought to have harmful effects on the myocardium (Ware, 2003). Pimobendan is a positive inotrope that increases myocardial contractility and can cause peripheral vasodilation. It has shown marked clinical improvement in Dobermans with DCM and is recommended for treatment of CHF at first clinical signs (O'Grady et al., 2008).

Therapeutics The main goal of therapeutics for DCM are to control the signs of CHF, prolong survival

Vasodilators In most cases nitroglycerin or AngiotensinConverting Enzyme inhibitors (ACEIs) 27

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

such as enalapril are used to improve cardiac output by preventing vasoconstriction, and can improve survival, minimize clinical signs and increase exercise tolerance (Ware, 2003).

Beta-blockers Beta-blockers are antiarrhythmic drugs that can be used in an attempt to manage cardiac arrhythmias. They must be used with caution as they can worsen cardiac function (Ware, 2003).

Monitoring and owner education Periodic re-evaluation of the patient's serum biochemistry, pulmonary status, serum digoxin concentration, body weight and ECG are essential, and the frequency of reevaluation is dependent on the status of the patient (Sisson, O'Grady & Calvert, 1999).

Owner education about the patient's drugs is very important. Owners should be informed about the purpose of each drug, the dosages and the adverse effects of the drugs. Owners should also be trained how to monitor the respiratory rate and heart rate of their dog (Sisson, O'Grady & Calvert, 1999).

Prognosis Prognosis is poor; the disease is terminal.

Most do not survive longer than three months following clinical manifestation of symptoms (Sisson, O'Grady & Calvert, 1999).

Photograph by Billie Fletcher

Other therapies and management • Bronchodilators may be beneficial in patients with severe pulmonary oedema, but are not recommended for long term use (Ware, 2003).

• Sodium restriction to reduce water retention is rational in the case of CHF, but not at the expense of food palatability. Care must be taken when feeding a sodium restricted diet in conjunction with high doses of loop diuretics such as furosemide, as the potential for azotemia and hyponatremia is increased (Sisson, O'Grady & Calvert, 1999). There is some evidence to support oral supplementation with Omega 3 fatty acids and L-carnitine, but further research is needed to examine the

efficacy of this in the Doberman (Ware, 2003). Hill's® Prescription Diet® h/d® is a specially formulated diet to support heart function and contains low sodium and high levels of L-carnitine.

• Exercise restriction to prevent episodes of syncope and arrhythmia (Ware, 2003).

28

Summary DCM is a very serious heart condition that commonly affects the Doberman. The disease can be caught in early stages with preventative health testing, leading to the opportunity to extend the length and quality of life with therapy and careful monitoring.

Owner education is vital to ensure compliance with drug protocols and an awareness of the poor prognosis for this disease. Breeders of Doberman should be made aware of the DCM health testing measures available, and be encouraged to engage in the following recommended DCM health testing before undertaking any breeding: • DNA testing for NCSU PDK4 and NCSU DCM2. Dogs positive for both genes ideally should not be bred, and definitely should not be bred to a dog that is positive for either gene (Meurs, 2016).

• Annual evaluation with a cardiologist, with a Holter monitor and Echocardiogram (Meurs, 2016).

This health testing should be performed along with other kennel club recommended health testing for the breed. The goal of health testing is to decrease the prevalence of the genetic mutations over a few years, without greatly altering or decreasing the genetic diversity of the Doberman population (Meurs, 2016).

References Atkins, C., Bonagura, J., Ettinger, S., Fox, P., Gordon, S., Haggstrom, J., ... & Stepien, R. (2009). Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. Journal of veterinary internal medicine, 23(6), 1142-1150.

DeFrancesco, T. (2011). Cardiac Biomarkers.

Clinicians Brief. Retrieved from http:// www.cliniciansbrief.com/sites/default/ files/sites/cliniciansbrief.com/files/CardiacBiomarkers.pdf Meurs, K. M., Lahmers, S., Keene, B. W., White, S. N., Oyama, M. A., Mauceli, E., & Lindblad-Toh, K. (2012). A splice site mutation in a gene encoding for PDK4, a mitochondrial protein, is associated with the development of dilated cardiomyopathy in the Doberman pinscher. Human genetics, 131(8), 1319-1325.

Meurs, K. M. (Director). (2016). An update on Dilated Cardiomyopathy in the Doberman Pinscher [Video file].

Meurs, K. M., Fox, P. R., Norgard, M., Spier, A. W., Lamb, A., Koplitz, S. L., &

Photograph by Billie Fletcher

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Baumwart, R. D. (2007). A prospective genetic evaluation of familial dilated cardiomyopathy in the Doberman pinscher.

Journal of veterinary internal medicine, 21(5), 1016-1020.

O'Grady, M. R., Minors, S. L., O'Sullivan, M. L., & Horne, R. (2008). Effect of pimobendan on case fatality rate in Doberman Pinschers with congestive heart failure caused by dilated cardiomyopathy. Journal of veterinary internal

medicine, 22(4), 897-904.

O'Grady, M. R., & O'Sullivan, L. (2012).

Pathophysiology of dilated cardiomyopathy ACVIM 2012. Retrieved from http:// www.vin.com/doc/?id=5397136 Sisson, D., O'Grady, M. R., & Calvert, C. (1999). Myocardial Diseases of Dogs. In P. R. Fox, D. Sisson & N. S. MoĂŻse, Textbook of canine and feline cardiology (2nd ed., pp. 585-601). Philadelphia, PA: Saunders Elsevier.

Ware, W. A. (2003). Cardiovascular system disorders. In R. W. Nelson, & C. C. Guillermo, Small animal internal medicine (3rd ed., pp. 106-115). St. Louis, MO: Mosby Elsevier.

Wess, G., Schulze, A., Geraghty, N., & Hartmann, K. (2010). Ability of a 5-minute electrocardiography (ECG) for predicting arrhythmias in Doberman Pinschers with cardiomyopathy in comparison with a 24-hour ambulatory ECG. Journal of veterinary internal medicine, 24(2), 367-371.

Wess, G. (2011). Diagnosis & prevalence of dilated cardiomyopathy in Doberman Pinschers ACVIM 2011. Retrieved f rom htt p://www.vin.com/mem bers/cma/project/defaultadv1. aspx?id=4901770&pid=11333& Wess, G., Domenech, O., McEwan, J., Haggstrom, J., & Gordon, S. (2015).

ESVC task force committee report on DCM in the Doberman Pinscher 25th ECVIM-CA Congress. Retrieved from http://www.vin. com/doc/?id=6922037 Wess, G., Mäurer, J., Simak, J., & Hartmann, K. (2010). Use of Simpson's method of disc to detect early echocardiographic changes in Doberman Pinschers with dilated cardiomyopathy.

Journal of veterinary internal medicine, 24(5), 1069-1076.

Are you a student?

Have you worked on an interesting case study?

Would you like to see your article published?

If so, please send your article to: journal@nzvna.org.nz by November 1st SUBMISSION DETAILS The author must be a current VNA (L5) or VN (L6) student.

The case study must be no more than 2500 words, and must be referenced using APA style.

PHOTOS Images must be high resolution originals with owner's permission to publish granted.

All humans must be demonstrating best practice.

29

Peer-reviewed field studies have shown that Royal Canin Satiety veterinary diets: Induce a successful and safe weight loss1,2 Promote satiety, reducing voluntary energy intake and begging behaviour2,3 Maintain lean body mass during weight loss1 Maintain stable body weight after weight loss4,5 Help to improve quality of life6

References 1. German AJ et al. A high protein, high fibre diet improves weight loss in obese dogs. The Veterinary Journal 183 (2010) 294–297 2. Bissot T et al. Novel dietary strategies can improve the outcome of weight loss programmes in obese client-owned cats. Journal of Feline Medicine and Surgery (2010) 12, 104-112 3. Weber M, Bissot T, Servet E, Sergheraert R, Biourge V, and German AJ. A high protein, high fiber diet designed for weight loss improves satiety in dogs. J Vet Intern Med 2007;21:1203–1208 4. German AJ et al. Low-maintenance energy requirements of obese dogs after weight loss. British Journal of Nutrition (2011), 106, S93–S96 5. German AJ et al. Long term follow-up after weight management in obese dogs: The role of diet in preventing regain. The Veterinary Journal, May 2011.

6. German AJ, Holden SL, Wiseman-Orr ML, Reid J, Nolan AM, Biourge V, Morris PJ, Scott EM. Quality of life is reduced in obese dogs but improves after successful weight loss. The Veterinary Journal.2012 Jun;192 (3):428-34

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Ready or not, here we come:

The Veterinary Nurse Assistant role in practice By

Catherine Rice RVN (UK), GCTLT, Allied Veterinary Professional Regulatory Council

In 2016 the inaugural graduates emerged f rom the New Zealand Certificate in Animal Technology – Veterinary Nursing Assistant (VNA) qualification. Most VNAs will continue studying for a further year to complete the New Zealand Diploma of Veterinary Nursing (NZDVN), making themselves eligible to join the New Zealand Veterinary Nursing Association (NZVNA) Register of Veterinary Nurses. Some graduates of the certificate may choose to take leave from tertiary education at this juncture and seek employment in veterinary practice as an assistant to the Registered Veterinary Nurse (RVN). This follows a model of practice seen in the United Kingdom (UK) with the Animal Nursing Assistant (ANA), and more recently, the Veterinary Care Assistant (VCA) qualifications. Human health care organisations have a long established staircasing of roles in nursing care, where the Health Care Assistant (HCA) acts under the direction of the Registered Nurse (RN) in the provision of care across a wide range of settings.

fications Authority (NZQA) instigated this in 2014.

The review was run by the Primary Industry Training Organisation with the aim of ensuring that New Zealand qualifications are useful and relevant to current and future learners, employers and other stakeholders (NZQA, 2015). The analysis involved con-

sultation with stakeholders in the veterinary industry, including registered veterinarians via the Veterinary Council, and members of the New Zealand Veterinary Association (NZVA) and the NZVNA. From the feedback it was clear that there were different levels of utilisation of veterinary nurses already in veterinary practice, with roles

With the role in its infancy, it remains to be seen how the VNA will be utilised by the veterinary industry. As with all human resource structures there are benefits and drawbacks in adding a layer. The success of multi-tiered work structures depends on clarity around roles and responsibilities, which the veterinary nursing profession in New Zealand currently lacks. With regulation in sight this is set to change in the near future. Work is underway to produce a clear scope of practice for the veterinary nurse role.

How did we get here?

The VNA qualification was developed as part of the Targeted Review of Qualifications (TRoQ), a mandatory review of animal care sector qualifications, which included veterinary nursing. The New Zealand Quali-

TLC is an important part of the VNA’s role 31

CH

D

TE

VET

E R I N A RY

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

NU RS

LO

E

NO

LIS

A T E R I N RY T E

GIST

for both certificate level and diploma level graduates. This stakeholder feedback drove the qualifications NthatLVexist today. The qualiN RVT D EW W ZEALAND ZEALAN fication will be reviewed in late 2018.

TE

RI

NAR

Y NURS

IN

G

AS

IALIST

TA N T

EC

SIS

SP

VE

SE LISTED

R I N A RY N U R

R VNS

NE

W ZEALAND

LVNA

Image courtesy of NZVNA

W ZEALAND

Meanwhile…

As the review was taking place, the NZVNA formed the Allied Veterinary Professional Regulatory Council (AVPRC). This organisation is veterinary nurse led and is working towards imposing statutory regulation, making it unlawful for any non-registered veterinary nurse to practice as a veterinary nurse (NZVNA, 2015).

tion was introduced to replace the pre-VN qualification. More recently there has been a Veterinary Care Assistant (VCA) qualification available. Under the Veterinary Surgeons Act there are legal restraints applied to procedures that may be undertaken on animals by lay staff (UKGovernment, 1966). The ANA or VCA works under the direct supervision of an RVN or a Veterinary Surgeon.

The ANA programme is well regarded as a pre-requisite to veterinary nursing, it is accepted as an entry requirement for

the Royal College of Veterinary Surgeons (RCVS) veterinary nurse training scheme (a minimum of two years further study), in place of standard qualifications (GCSEs) provided the student meets the accepted standard in English and mathematics. In a 2005 survey of British Veterinary Nursing Association (BVNA) members, “98% of respondents felt that the ANA was a good foundation for VN training and qualification” (Ackerman, 2005, p.12). In line with this, the VCA role is also most often used

Voluntary registration was introduced in 2015 and received a positive response.

Approximately 200 veterinary nurses, technicians and allied professionals registered (diploma level), or joined the list (certificate level). In the second year of the voluntary initiative, the number of veterinary nurses and technicians supporting professionalisation doubled, with close to 400 NZVNA members signing up.

E

H

D

VET

E R I N A RY

NU E

Image courtesy N E W RVT A N D ZEAL of NZVNA

W ZEALAND

TE

RS

REG

A T E R I N RY T E C

GIST

E

RVN

VE

LO

RS

NE

D

LIS

Y

ER

TE D VE RINAR

REGIST

RE

Providing food and water to a hospital patient

NO

TE

NU

IS

Educational standards are an integral part of professional regulation, to this end, the AVPRC established an Educational Standards Committee (ESC). Along with the changes in qualification structure, the NZVA dissolved the ANTECH Board in 2016 and have formally handed over the reins to the ESC. Addressing the lack of consistency in educational standards across providers of veterinary nursing programmes has been identified as a priority by the AVPRC, with the aim of bringing New Zealand’s veterinary nursing education into line with international standards (NZVNA, 2015).

NE

LVN

W ZEALAND

VE

LISTED

D

RE

REGISTE

ED

LI ST

TA N T

VNS NE R W ZEALAND

SIS

IALIST

N

LRAT

W ZEALAND

EC

CIA

NE

SP

NI

32

AS

H

Y NURS L ANIMAL TE R I N A RY N U R IN NAR The UK Animal Nursing TE RA G SE C Assistant RI VE RU TE The Animal Nursing Assistant (ANA) has been part of the veterinary workforce Preparing surgical instruments for autoclaving in the UK since 2002 when the qualifica-

NE

LVNA

W ZEALAND

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

as a stepping-stone to much sought after employment in a training practice. Two years of fulltime employment as an enrolled student in a training practice is a stipulation of enrolment onto the work based RCVS veterinary nurse training programme.

Image courtesy of BVNA

Veterinary nursing practice in the UK is bound by Schedule 3 of the Veterinary Surgeons Act. This order makes provision for a veterinary surgeon to direct registered or student veterinary nurses, whom they employ, to carry out limited veterinary surgery (UKGovernment, 1966). The provision is currently under review by the RCVS as RVNs expressed confusion and concern over where the boundaries of veterinary nursing practice lie. Worldwide, there is increasing focus on the role of allied professionals and the veterinary team as a whole and how it might beneficial to strengthen the role of the veterinary nurse, particularly with regard to more ‘routine’ veterinary work (RCVS, 2017). The ANA or VCA’s role in veterinary practice is to assist with the husbandry and general care of veterinary patients. The guidelines are vague and there is no clear scope of practice available for the ANA and VCA. According to the BVNA, their role can include exercising and feeding animals, cleaning kennels and cages, helping with handling and giving lots of TLC (BVNA, 2015).

Although they do not require a specific qualification to carry out these tasks, most practices enrol their staff in recognised courses leading to the ANA or VCA qualification (BVNA, 2015) and the integration of the role into veterinary practice has not been straightforward. According to Ackerman’s 2005 survey less than half of veterinary practices were unclear on what an ANA can and cannot do regarding the regulated schedule 3 procedures, which includes administration of medications and monitoring anaesthesia.

There is certainly support in the UK for the role of an assistant to the veterinary nurse, most often as a pathway to future registration. In a practical sense, with veterinary nursing a relatively young profession, and full regulation still a work in progress, there

are details to be ironed out regarding where the boundaries lie regarding the legalities of the role. As the scope of practice of the veterinary nurse is reinforced by the review of schedule 3, the role of the ANA and VCA should become better defined.

The Human Health Care Assistant (HCA) In comparison, the Health Care Assistant role in human healthcare is unambiguous.

Human nursing has a long and proud history as a regulated profession. Nurses are “professionally accountable to the Nursing Council and accountable under legislation for their actions” (NCNZ, 2011, p.5). The role of the nurse is clearly defined, understood, and communicated in the Nursing Council of New Zealand (NCNZ) Registered Nurse Scope of Practice (NCNZ, 2012). It follows that the status of the HCA is clear-cut since “a person employed within a healthcare, residential or community context who undertakes a component of direct care and who is not regulated in law by a regulatory authority” (NCNZ, 2011, p.14).

Health practitioners in human medicine are familiar with different levels of responsibility and decision-making in the provision of nursing care, and HCAs are well-utilised.

The Royal College of Nursing advises that: “registered nurses make judgements and decisions according to the clinical context and the condition of the patient, rather than the task to be performed” (Hand, Evans, Jones, Peate, & Grainger, 2013, p.529) There are guidelines for delegation and according to NCNZ (2011) it is the responsibility of the RN to ensure the HCA has the appropriate knowledge and skills to carry out delegated task/s. The HCA is guided by protocols and is expected to act within them at all times and they “should not be required to make ‘standalone’ clinical judgements and plan the care of patients based on those judgements” (Hand et al., 2013, p.528).

The key to the successful multi-disciplinary care model used in human healthcare is the clarity around roles afforded by regulation.

In contrast to their human counterparts, veterinary nurses in New Zealand do not currently have scope of practice for the levels of nursing practice set by the qualification structure. The AVPRC Professional Standards Committee (PSC) is currently working to address this as they work to establish a framework for regulation.

The Veterinary Nurse Assistant Role in Practice With graduates of the NZCAT VNA already in veterinary clinics, consideration of how the role fits alongside the diploma trained veterinary nurse in practice is overdue. Based on the UK veterinary nursing practice model, and following the human healthcare example, an assistant to the RVN would perform many of the basic tasks involved in the provision of veterinary care, allowing time for the RVN to perform more advanced nursing tasks. The qualification overviews listed by NZQA (2015) state that: “Graduates of the veterinary nursing assistant strand will be able to provide assistance to veterinarians and veterinary nurses in a veterinary clinic and perform some tasks independently, whereas, the NZDVN graduate will have attained technical veterinary nursing skills in a clinical environment as well as the ability to manage patients and clients, and follow protocols in all aspects of clinical veterinary practice.”

NZQA Graduate Profile

New Zealand New Zealand Certificate in Diploma of Animal Veterinary Nursing Technology Veterinary Nursing Assistant Maintain animal health and husbandry of animals in a veterinary clinic

Manage veterinary nursing services

Assist with routine diagnostic procedures

Perform diagnostic sampling and medical imaging

Care for hospitalized patients

Provide medical veterinary nursing

Assist in surgery preparation and anaesthesia

Provide surgical veterinary nursing

(NZQA, 2015) To require an assistant in practice, a veterinary nurse would be working to a high 33

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

standard in terms of performing advanced nursing practice, however, veterinary nurses in NZ report that they are underutilised in this regard. In a 2015 survey of NZVNA members, almost half reported that they would like to use their skills more and 16% of respondents reported that they rarely use the skills they are trained for (NZVNA, 2015). Factors that contribute to poor veterinary nurse utilisation include inadequate training as well as a lack of trust in veterinary nurses (Crowhurst, 2017).

The role of the veterinary nurse in New Zealand is not well defined. There are currently 12 providers of veterinary nursing education that offer a range of national and local qualifications, which differ in content, length, and level. Consequently there is a lack of consistency within the education system. Whilst providers are required by the Tertiary Education Commission to ensure their graduates meet the NZQA Graduate Profile for the veterinary nursing qualifications, the interpretation and application differs across the board (Crowhurst, 2017).

With the historic lack of regulatory framework for the profession, and no protection of title, practitioners that identify as veterinary nurses range from those with no credentials, to holders of certificate and diploma level qualifications, as well as veterinary technicians and overseas graduates educated to degree level.

To address this problem the ESC is working to develop minimum standards for the veterinary nursing qualifications. The accreditation of providers has been identified as a priority. In the not too distant future, providers will require accreditation through ESC to ensure that their graduates are eligible for inclusion on the NZVNA Register (ESC, 2016).

Towards clarity The evolution of veterinary nursing as an unregulated profession in New Zealand has resulted in the development of multiple qualifications at different levels. This, combined with inconsistencies in educational standards has given rise to disparity in practicing standards. Regulated counterparts in human nursing, and the UK’s RCVS veterinary nursing system, have shown that clarity around the roles and responsibilities within the tiers of veterinary nursing practice are a key factor in the successful implementation of a nursing assistant role. As the AVPRC 34

develops a framework for regulation, the ambiguity regarding the role of the veterinary nurse in practice is being addressed as a priority. The Educational Standards Committee has begun work to bring New Zealand’s veterinary nursing education system into line with international standards, and the Professional Standards Committee is developing a scope of practice to standardise veterinary nursing practice.

There is no doubt the Veterinary Nursing Assistant will become an integral part of the companion animal veterinary team, however, it will take time for the boundaries between the role of the Registered Veterinary Nurse and the Veterinary Nurse Assistant to become clear. Veterinary nurses can look to international counterparts, and to the human health care system, for examples of practical application of the nursing assistant role. As veterinary nursing in New Zealand moves further towards becoming a fully regulated profession, the Allied Veterinary Professional Regulatory Council will provide the framework to guide the successful integration of the VNA into veterinary practice.

References Ackerman, N. (2005). What can an ANA do for you? Veterinary Nursing Journal, 20(8), 12-14.

BVNA. (2015). Who is caring for your pet: the veterinary nurse explained. Retrieved from British Veterinary Nursing Association: https://www.bvna.org.uk/publications/ bvna-leaflets-and-downloads Crowhurst, M. (2017). A valued member of the team. VetScript, 30(3), 36-43.

Education Standards Committee. (2016).

Provider Information. Retrieved from http://www.nzvna.org.nz/regulation/ Provider+Information.html Hand, T., Evans, J., Jones, M. L., Peate, I., & Grainger, A. (2013). The nursing team: common goals, different roles. British Journal of Healthcare Assistants, 7(11), 528-531.

New Zealand Qualifications Authority.

(2015). Qualif ication Overview New Zealand Certif icate in Animal Technology - Veterinary Nursing Assistant.

Retrieved from http://www.nzqa.govt. nz/nzqf/search/viewQ ualification. do?selectedItemKey=2490 New Zealand Qualifications Authority.

(2015). Qualif ication Overview New Zealand Diploma in Veterinary Nursing. Retrieved from http://www.nzqa.

govt.nz/nzqf/search/viewQualification. do?selectedItemKey=2491 New Zealand Qualifications Authori t y. ( 2 0 1 5 ) . Targeted Re vie w of Qualif ications. Retrieved from http:// w w w. n z q a . g o v t . n z / s t u d y i n g - i n new-zealand/understand-nz-quals/ targeted-review-of-qualifications/ New Zealand Veterinary Nurses Association.

(2015). Regulation. Retrieved from http:// www.nzvna.org.nz/regulation.html Nursing Council of New Zealand. (2011).

Guidelines for delegation of care by a registered nurse to a health care assistant.

Retrieved f rom http://www.nursingcouncil.org.nz/Publications/ Standards-and-guidelines-for-nurses Nursing Council of New Zealand.

(2012). Competencies for Registered Nurses. Retrieved f rom http://www. nursingcouncil.org.nz/Publications/ Standards-and-guidelines-for-nurses Royal College of Veterinary Surgeons.

(2017). Review of Schedule 3. Retrieved f rom http://www.rcvs.org.uk/aboutus/consultations/our-consultations/ review-of-schedule-3/ UKGovernment. (1966). The Veterinary Surgeons Act. Retrieved from http://www. legislation.gov.uk/ukpga/1966/36

Autoclaving the surgical kits

High-five to fresh breath.

Dual-action formula Cleans teeth Blocks plaque and tartar causing bacteria Easy-to-give daily chew

Boehringer Ingelheim Animal Health New Zealand. Trading name of Merial New Zealand Limited.

Level 3, 2 Osterley Way, Manukau, Auckland, New Zealand | OravetŽ is a registered trademark of Merial NZ Ltd. ŠCopyright 2017 Merial NZ Ltd. All rights reserved. NZ-17-ORA-176.

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Interview with

Miranda Samson (RVN) By

Antoinette Ratcliffe LVN, NZVNA Executive Committee member

Miranda Samson is the talented photographer behind this year’s NZVNA conference and 25th aniversary masked ball poster, as well as having produced many images for our journal over the past two years.

We talk to her about how she balances her veterinary nursing career with her career as a photographer, and find out about her new business Pawsome Dog Training.

Can you tell us a little about yourself?

I have been a veterinary nurse for six years, and boy, what a six years that has been! I started off my veterinary nursing career in Hamilton, which is where I am originally from, in a one nurse one vet clinic, which meant I had to develop skills in all areas pretty quickly. I was lucky enough to work along side the amazing veterinarian Chris

McCaughan who taught me a lot of skills which I still use every day. I also began working at an after hours practice as well for two shifts a week, before leaving my day job to pursue my passion for emergency and critical care. I have since moved to Gisborne and I am currently doing some locum work, and enjoying the beautiful beaches too! I have also recently started a dog training business called Pawsome Dog Training. It’s a positive and successful way of training and helping dogs and their owners create a stronger bond, socialise with other dogs in a safe environment and remind owners that training can be fun.

How long have you been a photographer for?

I am a self taught photographer and have developed my skills and techniques through trial and error (and taking photographs at every opportunity). I started photographing equestrian events and now I have my own business, enjoying many different areas of photography. I currently offer maternity, birth, newborn, cake smashes, wedding, and family photoshoots, along with landscapes, and, of course, pet portraits.

Do you find that having a photography career balances the stresses of veterinary nursing?

I think about photography as more of a hobby as I get to be creative and I can do it almost anywhere. Veterinary nursing sure has its stressful days but I also find it a very rewarding job, and can balance both careers well together as I also get to work with pets during my shoots. I guess for me photography and editing the images is my way to unwind and relax.

What do you enjoy the most about being a photographer?

Miranda with Napoleon and Duckie 36

I love being able to give the gift of memories, capturing images that bring happiness to my clients. When I look at photographs from special moments of my life, I am able to relive those moments and am so grateful to have them. It’s a really good feeling to create

images for owners of their pets, and parents’ images of their human babies. I enjoy being creative and also trying new techniques. I love noticing small details that others may be oblivious too, like a beautiful ray of sunshine coming through the clouds, or that eternal love that radiates from those big brown puppy dog eyes.

How do you get a pet to sit still?

I have a few tricks up my sleeve! I have an app on my phone that plays all sorts of animal noises, so when I am about to take a pet portrait I often play these sounds or, if that doesn't work, I may just have to make those sounds myself and yes, it can be rather embarrassing in front of owners. I also use squeaky toys or the pet’s favourite toy as a way to look my way and, of course, treats.

It’s all very positive and rewarding, and I give them lots of breaks in between photos so they don't get too frustrated with having to sit still.

Photography by Miranda Sampson

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Have you got any projects lined up in the future?

I have a few projects lined up for Pawsome Dog Training, and a few areas of photography that I also would like to develop in to grow my portfolio. I always have photos to supply to The New Zealand Veterinary Nurse journal too so that keeps me busy and allows those creative juices to keep flowing!

If you’d like to keep up to date with Miranda’s photography, follow her page ‘Miranda Samson Photography’ on facebook, and if you’d like some help or pointers with your own photography, please contact Miranda via her facebook page, she’s told us that she’s happy to answer any of your questions.

37

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Conference 2017 By

Luanne Corles BSc, LVN, Executive Committee Member NZVNA Photography by Antoinette Ratcliffe

This year the New Zealand Veterinary Nursing Conference was held at the Heritage Hotel in Auckland over the 4th-5th August 2017. The event was officially opened by the welcome drinks that were held at the Sky Tower café, and were sponsored by Royal Canin. Once inside we were greeted by Mark, Barney and Ian from Royal Canin, and the wait staff were at the ready to serve drinks. It was an amazing atmosphere, friendly and inviting with beautiful evening views of the city. It was good to see so many new and familiar faces. After mingling, everyone gathered around to hear the address

by Debra Green from Royal Canin, which was truly inspiring.

Once the welcome drinks wrapped up everyone went their own way, with some

delegates heading into town, while others headed back to the hotel they were staying in. After a nightcap at the casino with the crew from SVS, I headed to my hotel room quietly, so not to disturb my roomie for the weekend (Antoinette, NZVNA executive committee member), but found that she was still up editing photos taken earlier in the day. After chatting for a while we realized it was past 2 am and definitely time to try and get some sleep for the early start in the morning! Wow, what a great start to the next couple of days of the incredible learning experience everyone would receive.

It was an early start to get ready for registration for the morning’s attendees and after everyone had been given their lanyards and goodie bags, they were ushered to the confer-

ence room for the first speaker, Dr David Church, who gave an extremely informative talk on diabetes mellitus. David, who was also the the keynote speaker, was presenting a number of medical lectures this weekend on topics including hyperthyroidism, anaemia and renal disease in cats.

After the first couple of sessions, morning tea came and was an opportunity for delegates to investigate the sponsors’ stands and partake in the competitions there, while grazing on lollies and chocolate!

After the break, it was time for Jennifer Hamlin to give us an update on the regulation committee and the future for practicing NZ veterinary nurses. It was very interesting, and veterinary nursing certainly has come a long way in the last 25 years. Also included

NZVNA President Julie Hutt welcomes everyone to the dinner and masked ball at the Grand Tearoom 38

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

during this time were the CPD updates.

Then it was time for the NZVNA AGM, which you can read more about on page 12.

It was great to be able to welcome two new executive committee members to our NZVNA family and I look forward to catching up with you at our next meeting.

It was now lunchtime and the Heritage put on an amazing spread of different foods, including catering for special dietary needs. I am one of those people that needed to have a special meal made and they accommodated me every meal, the chefs finding no request too hard for them. Following lunch, Dr Mark Owen discussed radiography positions. Boy, were some of those radiographs terrible, especially the ones with human body parts in them. Very impressive lecture on what not to do!

Once again Dr David Church spoke to us, this time about considerations around managing anaemic patients from the veterinary nursing perspective. It was a fantastic build-up to Robyn Taylor’s talk on transfusion therapy, which was sponsored by SVS. Robyn is an amazing veterinary nurse and tutor, so it was a pleasure to hear her speak. Finally, it was the end of the day and we had happy hour.

Linda Sorensen presents her talk on fluid therapy

Dr Damien Chase presents on post-op management of orthopaedic conditions

Below: Nathan and Janine with their winning trophy

Amy Callan, Nicole White, Sammy James, Kezia McCabe, Kathy Reed and Kate Franchi enjoying the masked ball

Boehringer Ingelheim’s winning stand 39

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

for her article ‘Buddy: a case report’, which was published in December 2016. Once the formalities of the evening had finished, a fabulous dinner and dessert were served table by table, before the Mermaids entertained us by singing many of our favourite hits, old and new. After much grooving and shaking the evening was drawing to a close to afford us some rest before another early start. This time, I was happy to let the young ones go out and party up a storm in Auckland City.

Dr Mark Owen presents on radiography positioning

The final morning kicked off with the Hill’s sponsored breakfast, a seminar given by Dr Annabel Robertson, and an update in the management of renal patients. Next up was Dr Damien Chase, who was sponsored by Pet Doctors, and presented his lecture on post-op management of orthopaedic conditions: analgesia, recumbent animal, wound care, exercise and basic physiotherapy/rehab.

This was followed by Valerie Lee, who discussed the veterinary nurse’s role with the chemotherapy patient. For those of us that hadn’t participated in chemotherapy before it was very educational. Morning tea gave us another opportunity to check out the industry sponsors and network.

David Church was up again, this time discussing hyperthyroidism and its man-

An opportunity to visit the sponsors’ stands

This was extremely well deserved after the big day that everyone had had today. It was another chance for us all to mingle and relax after what had been an amazing and inspiring first day. Not long after, it was time for everyone attending the masked ball to dress up in their fabulous gowns and suits, of which there were many. The masked ball was held in the Grand Tearoom, a beautiful room affording spectacular evening views of Auckland harbour, with its lights shining bright against the night sky. NZVNA president Julie Hutt opened the evening by thanking the sponsors, past presidents, and NZVA CEO Mark Ward for their contributions over the past year. She went on to announce the winner of the Angela Payne award for the best article published in the NZVNA journal, presented during the past 12 months. It was awarded to Lauren Clark, who was presented with a bouquet of flowers 40

Below: Past presidents (from left to right) are Angela Payne, Steph MacPherson, Valerie Lee, Jan Bedford, Kathy Waugh and Julie Hutt (current)

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

agement from the veterinary nursing perspective. It was sponsored by Bayer, and was, again, another informative and interactive lecture. Linda Sorensen addressed us next, with her lecture on fluids, vaccinations, SDMA testing and wellness testing, again from a veterinary nurse’s perspective. It was proudly sponsored by IDEXX Laboratories and was very informative.

Next up Dr Mark Owen discussed advanced imaging (CT, MRI, ultrasound): what they are and when they should be used. It was a particularly pertinent lecture for those who haven’t had the opportunity to use these, and I found it extremely interesting. Afternoon tea followed, during which the award for the grandest stand (voted for by the delagates) was announced and the winners were Boehringer Ingelheim. Their stand was decked out with helium balloons, blue streamers, ornaments and 25th anniversary party items.

Congratulations to Janine, Susanne & Nathan for such a great stand.

Dr David Church delivered his final lecture on chronic kidney disease (CKD) and its management, along with an insight to hyperkalaemia, sponsored by Boehringer Ingelheim. I was really looking forward to this one since my lovely nine-year-old cat has just been diagnosed with CKD, and it didn’t disappoint. After writing a lot of notes, it was time for me to present the last speaker for the conference.

The NZVNA’s stand at the conference

Robyn Taylor presents on transfusion therapy

Mark Vette’s talk on Dog Behaviour enlightened us on keeping staff members safe, and providing educational material to clients around dog behaviour. He brought his dog Reggie in to tell us all about it via snapchat, so if you love snapchatting then look up ReggieDoesSnaps.

Amy Ross our vice president closed the conference and wished everyone a safe journey home.

I thoroughly enjoyed the conference and I hope you all learnt as much as I did. I would like to thank the NZVNA executive team for doing an amazing job and pulling this conference together. You are a great bunch of people and I am honoured to be serving on the committee with you all. On behalf of the NZVNA, I would like to thank all of the sponsors, speakers, guests and of course the delegates for making this one of the most successful conferences to date. I look forward to seeing you all next year!

Keynote speaker Dr David Church

Mark Vette and Reggie 41

T H E N E W Z E A L A N D V E T E R I N A RY N U R S E S E P T E M B E R 2 0 1 7

Increase your

word power

All definitions from Dictionary of Veterinary Nursing (4th ed), Lane, Guthrie & Griffith, except those in italics.

Azotemia Presence of excess nitrogen-containing compounds in the blood. (also known as uraemia) Cachexia Condition of weight loss, general bodily decline and weakness. Muscle loss is most noticeable on the temporal muscles of the skull and can be a sign of progressive diseases such as neoplasia.

Cardiomegaly Abnormal enlargement of the heart Cardiomyocyte Cardiac cells Inotrope Pharmaceutical agent that affects the strength of contraction of the heart muscle; drugs may be positive or negative inotropes.

Myocardium The muscle of the heart, the middle and strongest layer of the three that make up the heart wall.

Paradoxical movement Also known as paradoxical respiration, where a lung, or a portion of a lung, is deflated during inspiration and inflated during expiration.

Paresis Muscle weakness with neurological deficits, but the animal can still make coordinated walking movements if the bodyweight is supported.

Penetrance The frequency with which a heritable trait is manifested by individuals carrying the principal gene or genes conditioning it.

Pleural effusion Collection of fluid in the pleural space between the visceral and parietal layers of the pleura: the fluid maybe a transudate, exudate, blood, pus, chyle or associated with neoplasia. Clinical signs include progressive dyspnoea, with tachypnoea and unwillingness to remain in lateral recumbency.

Syncope Sudden collapse similar to human fainting. May be cardiac in origin with a temporary cerebral anaemia or the result of hypotensive drugs such as acetylpromazine.

42

Do your Elizabethan Collars reflect the Premium level of care you provide?

Choose BUSTER Premium for Premium Care Show your customers you care

Safe and comfortable design

BUSTER Premium Collars are an excellent way of showing customers you provide premium care.

Extra soft, flexible and breathable neoprene banding adjusted around the neck prevents skin irritation and friction for improved comfort.

Assembly and application in seconds, not minutes!

Simply insert the patient’s head and fasten the reinforced velcro in seconds.

Furniture-friendly and reduces noise

Ergonomic design for a perfect fit The close-fitting ergonomic cut is designed to follow the curvature of the dog’s neck, ensuring that the use of a collar or a fastening gauze strap is not required.

Rubber edged banding absorbs contact and therefore leaves no markings on furniture and reduces echo/noise inside the cone; better patient compliance.

Scan QR Code to see video

Contact your local Provet branch for more information or to order:

PROVET NEW ZEALAND PROVET AUCKLAND • PROVET CHRISTCHURCH • PROVET PALMERSTON NORTH P: 0800 776 838 F: 0800 776 839

www.provet.co.nz

KIDNEY

+

NEW MOBILITY

Let’s help more renal patients

do a happy dance SUPPORTS A LONGER AND BETTER QUALITY OF LIFE

SUPPORTS MOBILITY

NEW HILL’S PRESCRIPTION DIET™

k/d™+Mobility

Introducing the ONLY renal solution that also supports mobility with the full strength efficacy of k/d™ plus j/d™. + Supports the dog’s natural ability to rebuild lean muscle mass + Supports vitality and alertness in older dogs

For more information, talk to your Hill’s Representative.

TM’s owned by Hill’s Pet Nutrition, Inc. ©2017 Hill’s Pet Nutrition (NZ) Ltd. HIMA-HB-17116F08

hillsvet.co.nz