JOURNAL
VETERINARY NURSING IN ACTION
2016 CONVENTION ISSUE
COMPLIMENTS OF
IN THIS ISSUE‌
04
NAVTA Strategic Plan
12
Nutritional Considerations in Allergic Skin Disease
20
The Relationship Between Continuing Education and Job Satisfaction for Veterinary Technicians
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table of contents
11
4
20
On the cover
12
in this issue‌
04 NAVTA Strategic Plan 08 2016 Strategic Vision For the State Representative Committee
11 2016 Strategic Vision For
the SCNAVTA Committee
12 Veterinary Nursing Education Nutritional Considerations in Allergic Skin Disease
20 Professional Pulse
The Relationship Between Continuing Education and Job Satisfaction for Veterinary Technicians
Skin disorders are one of the common reasons owners bring their pets into the veterinary hospital. Harlingen Veterinary Clinic utilizes Julie Palmucci, CVT and her diagnostic skills to aid the veterinarian in obtaining an allergic skin disease diagnosis.
Photo courtesy of Nick Mistretta.
Veterinary Nursing in Action | 2016 convention issue
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JOURNAL NAVTA Executive Director: Julie Legred, CVT Communications Director: Kara Burns, MS, M.Ed., LVT, VTS (Nutrition) P.O. Box 1227 Albert Lea, MN 56007 Phone: 888-99-NAVTA | Fax: 507-489-4518 info@navta.net | www.navta.net 2016 NAVTA EXECUTIVE BOARD President: Rebecca Rose, CVT President Elect: Mary Berg, MS, RLATG, RVT, VTS (Dentistry) Secretary: Elizabeth Reed, BS, CVT, CCRA Treasurer: Beckie Mossor, RVT Member at Large: Ed Carslon, CVT, VTS (Nutrition Member at Large: Stephen Cital, RVT, SRA, RLAT Past President: Vicky Ograin, MBA, RVT, VTS (Nutrition) Committee Chairs NAVTA SCNAVTA Chairperson & Board Advisor: Lori Renda-Francis, PhD, LVT NAVTA CVTS Chairperson: Margi Sirois, EdD, MS, RVT, LAT NAVTA State Representative Chairperson: Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM) NAVTA AVA Chairperson: Dennis Lopez, M.Ed., LVT NAVTA Exhibiting Representative : Virginia Rud, CVT, RVT THE NAVTA JOURNAL Editor in Chief & Website Coordinator Heather Prendergast, RVT, CVPM Associate Editor in Chief Kara Burns, MS, M.Ed., LVT, VTS (Nutrition) Editorial Board Josh Clark, MS, RVT Katie Larsen, DVM Betsy Hensley, CVT Oreta M Samples, RVT, MPH, DHSc Jennifer Schori, MS, VMD Pat Telschow, BS, LVT Design Kalico Design | www.kalicodesign.com Printing and Fulfillment Boelte-Hall, LLC | www.boelte.com The NAVTA Journal Editorial Deadlines • Feb/Mar ‘16 edition: Dec 1(CE articles and case studies) and Dec 15 (all other content) • Apr/May ‘16 edition: Feb 1(CE articles and case studies) and Feb 15 (all other content) • June/July ‘16 edition: Apr 1(CE articles and case studies) and Apr 15 (all other content) • Aug/Sept ‘16 edition: July 1(CE articles and case studies) and July 15 (all other content)
NAVTA Strategic Plan
NAVTA, your professional organization, supporting you in your career, is movin’ and shakin’! NAVTA has seen extensive and exciting changes in the last couple of years, and this year has been no different! Our members wanted a credentialed technician in the seat of the Executive Director position, so at the end of 2012, we started transitioning to meet that request. During 2016, we will take the next step and become a fully self-managed organization, as we no longer need a management company to help guide our steps. The NAVTA 2016 Executive Board include: • President: Rebecca Rose, CVT • Past President: Vicky Ograin, MBA, RVT, VTS (Nutrition) • President Elect: Mary Berg, MS, RLATG, RVT, VTS (Dentistry) • Secretary: Elizabeth Reed, BS, CVT, CCRA • Treasurer: Becky Mossor, RVT • Member at Large: Ed Carlson, CVT, VTS (Nutrition) • Member at Large: Stephen Cital, RVT, SRA, RLAT We have made a lot of progress over the last few years. We can’t wait to see what 2016 brings! The following are some of the highlights since the reorganizing began:
Branding The new brand officially launched in January 2015, with a new NAVTA logo. VTSs, SCNAVTAs, AVAs, and State Reps now have a colored logo designated for each. In addition to the new logos, a new booth for veterinary conferences was designed. Stop by and see us at NAVC, WVC, or AVMA this year!
Sponsorships/Partnerships • Tier 1 Partner with Partners for Healthy Pets: A workbook was created specifically for Veterinary Technicians on how to take preventive initiatives and implement change within the practice. This 80 page step-by-step workbook is available free to members. To order, please visit www.navta.org and visit the store. • Abbott/LifeLearn Diabetes Advocate: An interactive course was developed courtesy of a grant from Abbott to help increase Diabetes awareness and education. Please visit the Education tab on the NAVTA website and click Diabetes Management. This course is free and comes with RACE credit! • NAVTA developed 7 new industry partnerships in 2015, that include present and upcoming CE opportunities.
Opinions and statements in The NAVTA Journal are those of the authors and not those of NAVTA, unless so stated. NAVTA assumes no responsibility for, and does not warrant the accuracy or appropriateness of, recommendations or opinions of the authors or of any product, service, or technique referred to in The NAVTA Journal.
SCNAVTA Chapters
Published advertisements in The NAVTA Journal are not an endorsement of any product or service.
A new co-chair of the SCNAVTA committee has been appointed and is creating an engagement strategy for the SCNAVTAs. Implementation for the initial items began in fall 2015.
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• The VetTeam Coach book published in 2015 with NAVTA branding for SCNAVTA students.
Navta News Veterinary Technician Specialties (VTS)
Website www.navta.net
here are now 12 recognized specialties (Dermatology was most T recently recognized in August 2015). There are 2 new petitions under review, with an additional 5-7 in the works. Currently, the Committee (CVTS) is reviewing guidelines and will propose changes in 2016.
The website has had impressive traffic since it’s new release in March of 2015. Members can log in and update their profile, obtain their member number, read industry and news updates, past editions of TNJ and review CE events that are unique to them.
Approved Veterinary Assistants (AVA) The Approved Veterinary Assistant committee reviews and approves curriculum for assistant programs, as well as mentoring assistant programs in the approval process. Currently, there are 25 AVA programs, and 7 programs currently being reviewed. Graduates of AVA programs are allowed to sit for an AVA credentialing test, in which there are currently over 900 AVAs in the United States. AVAs are required to submit CE for renewal.
Oct/Nov 2015
THE
NAVTA JOURNAL A Publication of the
National Association of Veterinary Technicians in America
in this edition… Golden Retriever Lifetime Study Dermatology 101 Killing Ourselves with Compassion
The NAVTA Journal How do you like the new look? 2016 is bringing about changes for you! TNJ will continue to feature 3 CE articles per month that will be topic specific. CE quizzes can be taken at www.vetmedteam.com to receive 1 RACE credit per article. In 2015, TNJ began including AVA specific articles; in 2016, TNJ will also include articles written by students in SCNAVTA chapters. Watch for more fun changes in 2016!
Anesthesia Nerds Corner
National Veterinary Technician Week National Veterinary Technician Week (NVTW) was held October 11th – 17th of this year. This year, TNJ included you, the members on our poster! Visit the website to download it if you have yet to do so. NAVTA had a large presence on social media during NVTW with over 940,000 total post reaches. In addition, NAVTA members created a video to help increase awareness with state and national associations, in addition to the proposed title change initiative. You can view this video on the website. Thank you to Hill’s for their continued support of National Veterinary Technician Week.
Membership
SCNAVTA Chapters
Social Media Have you liked us on Facebook? NAVTA has over 62,000 friends, with 1,393 new likes per week! Average posts reach 637,231 friends and post engagement averages 54,491. Visit us on LinkedIn, Instagram and Twitter!
NAVTA welcomes any questions, ideas, or comments of any type at any time. We are very excited about everything that has happened in 2015. Our goal is to move our profession forward and educate the veterinary industry and public on the importance of veterinary technicians/nurses in the health and wellbeing of pets and the integral role they play within the veterinary healthcare team.
E-newsletter Distribution
Veterinary Nursing in Action | 2016 convention issue
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Advancing Veterinary Technology and Veterinary Nursing
Navta News
Strengthen the Industry
Develop the model practice act. Be the credible resource. Lead and collaborate.
Advocate for Awareness
Public outreach and education. Comparative value of credentialed personnel. Global exchanges.
Support for Members
Benefits package and education. State and student chapters. Stature of membership.
Sustainability of NAVTA
Volunteer engagement. Governance. Finance and resources. Professional staffing and association management. Communication and technology.
The 2016 Strategic Plan In December 2015, NAVTA Leadership met to develop a strategic plan that will guide successive boards, committees and staff.
The Mission of NAVTA is to Advance Veterinary Technology and Veterinary Nursing. Four goals were set with action steps to carry out each. NAVTA will Strengthen the Industry by developing a standardized and protected credential. In order to carry this out, a model practice act will be developed, and NAVTA will serve as the credible resource for veterinary technology. In addition, NAVTA will collaborate with state, national and global organizations. NAVTA will Advocate for Awareness by differentiating the unique roles of the veterinary healthcare team. This will be
achieved through public outreach, education campaigns, promoting the benefits of credentialed technicians and nurses, and global networking. NAVTA will Support Members by providing relevance and value through benefits packages, collaborating with state associations and student chapters, and work to continuously improve member communications. In addition, NAVTA will provide educational opportunities and advancement pathways. The Sustainability of NAVTA will be carried out by developing future leaders to guide the association and profession. In addition, NAVTA will maintain financial stability, quality industry relationships, transparency, and institute accountability. Performance measures will be implemented to monitor the progress.
The Executive Board adopted the goals and action plan on December 16, 2015, with the next step being to notify members and create community awareness. The alignment and assignment of committees will now occur, with the review occurring at each monthly board meeting. An annual review will occur annually during new board member orientation, with full review occurring in December of 2018. NAVTA is looking for volunteers that would be interested in joining the following committees to help carry out the above goals. • SCNAVTA • CVTS • State Reps • AVA
• • • •
Legal Membership PR Continuing Education
Your Participation on the NAVTA committee will benefit your professional growth through networking, engaging, and volunteering. Contact Julie Legred NAVTA Executive Director, to learn more about committees and volunteering. – The NAVTA Executive Board
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Navta News
2016 Strategic Vision
for the
State Representative Committee Ken Yagi, BS, RVT, VTS (ECC, SAIM) – Committee Chair
of direction gained will guide NAVTA activity and support for the state associations.
Pictured: 2015 NAVTA Leadership Workshop attendees, representing various state associations and VTS academies.
2016 marks an exciting era for veterinary technicians all throughout the nation. Over the past couple of years, the National Association of Veterinary Technicians in America (NAVTA) has been a catalyst to bringing state associations together to develop leadership and association organization,
Veterinary technician advocacy associations vary in organizational structure depending on the state, and have differing needs. NAVTA aims to gather resources to aid their growth. The veterinary technician credential can be mandatory of voluntary in the state to practice, and can be governed by the state government or by private organizations. Veterinary technician associations vary in size from several dozen members to thousands, mostly staffed by volunteers though some have established themselves enough to sustain employed staff. Motivated groups of veterinary technicians in some states are aiming to form a veterinary technician association to pursue long term goals for the profession, and some states have opted to advocate through the state’s veterinary medical associations. Depending on the approach each state has taken to advocate for the veterinary
Pursuing a nationally standardized credential for our profession is a large goal, yet only one of many profession-wide goals veterinary technicians in every state are major stakeholders in, and need to work in a coordinated manner to achieve. exchange practical solutions and experiences in common challenges, and discussing national and local visions and goals to bring cohesiveness to the veterinary technician profession. Pursuing a nationally standardized credential for our profession is a large goal, yet only one of many profession-wide goals veterinary technicians in every state are major stakeholders in, and need to work in a coordinated manner to achieve. The NAVTA State Representative Committee kicks 2016 off with an all-state leadership summit in partnership with the American Veterinary Medical Association (AVMA), inviting veterinary technician leaders throughout the nation to discuss issues at hand. The collective sense 8
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technician profession and the state of growth associations are in, their needs are varied. Despite the varying needs, veterinary technician associations face common challenges; public and professional awareness, membership engagement, leadership and governance, organizational sustainability, and legislative action. The NAVTA Leadership Summit in January includes a workshop allowing associations to assess their progress through an association assessment checklist, essential policies for governance of an association, and creating practical sponsorship packages. The summit was also arranged to be in conjunction with the AVMA
Navta News
The Goals of the State Representative Committee include: • Pursing a nationally standardized credential •G ather resources to aid the building of a strong foundation and create organizational strength in state associations •H elp each association grow it’s member database
Pictured: NAVTA and state leaders worked through an all day workshop to develop national and state goals and plans. Veterinary Leadership Conference where personal leadership, association board responsibilities, and membership growth and engagement are major workshop topics. Just as important, is the ability for veterinary technicians to attend a national veterinary leadership conference to forge new relationships with veterinary leaders throughout the nation. A similar meeting and workshop is planned to be held in August in conjunction with the AVMA Convention to provide further guidance and follow up meetings.
The committee communicates with veterinary technician associations through digital and faceto-face meetings throughout the year, publishing state updates to the national audience. The committee will continue to improve communication and dissemination of NAVTA resources to strengthen the profession as a whole. The State Representative Committee intends on continuing its major role in serving as an avenue for communication between state associations and NAVTA to bring cohesiveness to the profession in order to pursue large scale goals.
Veterinary Nursing in Action | 2016 convention issue
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NOW ACCEPTING
STUDENT ArTIClES
The NAVTA Journal is a bi-monthly, peer-reviewed publication providing information pertinent to the veterinary healthcare team. We welcome articles on a variety of topics pertaining to veterinary technology. Please contact studentarticles@navta.net, before submitting articles to ensure that there is not another author working on the same topic. All articles are submitted with the understanding that The NAVTA Journal staff, CE editors and editorial board will edit as deemed necessary and appropriate. The staff reserves the right to edit and print articles in the edition of their choice, based on editorial focus. GUIDELINES FOR STUDENT ARTICLES: • From 1,000 to 1,500 words (not including cutlines, breakout boxes, footnotes and so on).
Photos, images and illustration guidelines:
• Minimum of two references.
• For print, photos/images must be 300+ dpi.
• Include drug footnotes.
• Digital photos only.
• Authors must complete a short biography to be published in The Journal
• We encourage authors to submit images and illustrations to supplement their article.
• Include a statement of purpose/objective for the CE article with specific information, concepts and/or skills that participants are expected to obtain when they complete the offering. • Authors are asked to cite all quotations and references at the end of the article. Citations should be numbered in the order of their citation with superscript numbers. Follow the AMA Manual of Style format.
• Tables, figures, photos and other images should be submitted as an individual high-resolution (>300 dpi) JPG or TIFF (do not embed within the article). • Captions/descriptions should be provided for each photo at the end of your document, not on the photo itself.
JOURNAL Veterinary Nursing in Action
• The author must obtain permission from individuals in the photos. • Identify individuals in the photos.
*See the NAVTA Editorial Guidelines for examples http://www.navta.net/?page=editorial_guidelines
Navta News
2016 Strategic Vision for the
SCNAVTA Committee Beckie Mossor, RVT – Committee Chair
2016 welcomes a new SCNAVTA chair, Ms. Beckie Mossor. Many thanks to Lori Renda-Francis, PhD, LVT for her many years of service. We are looking forward to her role as committee advisor to ensure a smooth transition. Beckie is very excited to be taking on this role and working closely with all the advisors and programs across the country. The updated database will bring many opportunities for students and advisors alike. It will allow each advisor to interact with their student accounts and help their students participate to a higher degree. A new ‘group’ will be launched for all advisors to interact through the website. Additionally, we will be launching a group for the students to interact together and share ideas. Throughout January, Beckie will be reaching out to all current advisors and relaying instructions and information about logging into their own accounts, as well helping students log in.
include a Tech Tutor Corner, an events calendar to help notify students of events that may be nearby them, and interactive webinars/work sessions for students to talk with current technicians. In addition, NAVTA is seeking opportunities for SCNAVTA driven events at major conferences to give the advisors and students an opportunity to meet with the NAVTA Leadership. The SCNAVTA Committee welcomes your ideas and is always seeking advisors to join. Please reach out to Beckie Mossor at SCNAVTA@NAVTA.net with any comments, questions, or concerns!
New Items for SCNAVTA this year Student article in The Navta Journal: NAVTA has launched a student article section in the NAVTA Journal and the first article has already been received! All students are encouraged to submit articles to studentarticles@navta.net. Dr. Oreta Samples will help guide students to build articles to perfection! SCNAVTA e-newsletter for advisors: The Committees goal is to help keep communication and interaction alive. NAVTA wants to be able to provide support to these chapters, help integrate ideas and bring new ideas into our field. Other new ideas! The committee continues to brainstorm ideas for student activities within the website area for SCNAVTA. Ideas
The Goals of the SCNAVTA Committee for 2016 include: • Recruiting advisor members to the SCNAVTA Committee • Creating a contact point for advisors to share ideas
• Encouraging participation from advisors in yearly awards (Chapter of the Year and Advisor of the Year) • I ncreasing participation and communication throughout the SCNAVTA Chapters
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Veterinary Nursing Education
Nutritional Considerations
in Allergic Skin Disease Vicky L. Ograin, MBA, RVT, VTS (Nutrition) Kara M. Burns, MS, MEd, LVT, VTS (Nutrition)
Learning Objective: After reading this article, readers will be able to describe inflammatory skin diseases in dogs and cats, the application of nutritional therapy in managing these disorders, and the important role veterinary technician’s play in improving patient care through client communication and enhanced compliance.
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Veterinary Nursing Education Skin disorders are a common reason owners bring their pets to the veterinary hospital. Allergic skin disease is one of the most common types of skin disorders. Allergies in dogs and can affect quality of life for the pet as well as the pet parents; thus impacting the human-animal bond. Pruritic pets are often uncomfortable; leaving owners to ascertain the reason for the itching and what can be done to stop the itch. Common skin allergies diagnosed in dogs and cats are fleas, atopy, and food. It is estimated that 15 to 25% of hospital visits involve treating and diagnosing skin and coat problems.1-3 Nutrition plays a primary role in the management and treatment of skin disorders. The use of dietary fatty acids, antioxidants, and novel and hydrolyzed proteins can be beneficial in managing skin disorders.1,4 This article discusses how to provide the health care team with an understanding of inflammatory skin diseases in dogs and cats, the application of nutritional therapy in managing these disorders, and the important role veterinary technicians play in improving patient care through client communication and enhanced compliance. The skin is the largest organ of the body and protects the animal against water loss and physical, chemical, and microbiologic injury. It also serves as a sensory organ with the ability to perceive temperature, pain, touch, pruritus, and pressure.4
Flea Allergies Flea allergy dermatitis (FAD) is the development of hypersensitivity reaction(s) and ensuing skin lesions accompanied by variable pruritus in response to exposure to flea salivary antigens. Pet owners often refer to this as flea bite allergy. It is reasonable to assume there is high vari-
low-exposure area to an area where fleas are widespread. Flea allergies typically present as a pruritic papular dermatitis, concentrated on the rump, dorsal thorax, flanks, tail, and perineal area.3,5 Pruritus occurs on the caudal areas and tail, although generalized pruritus may be seen. Papules in the umbilical area
Allergic dermatitis might be the cause if the pet has seasonal pruritus, lichenification (thickening of the skin which indicates chronic inflammation), hyperpigmentation. ability within individual patients as to the amount of flea salivary antigen required to induce clinical flea allergic dermatitis. Flea allergies are the most common type of allergic skin diagnosed in dogs. It is also one of the most commonly diagnosed skin disorders in cats.1,3 Specific breed of gender predilection has not been seen in patients with fleabite hypersensitivity. Dogs that are predisposed to flea allergy and live in a flea-endemic area typically show clinical signs by 5 years of age.3 However, clinical signs can develop at any age, especially if animals move from a
is also very suggestive of flea hypersensitivity. Front limb “corn cobbing� is another characteristic behavior seen in flea-allergic dogs. Cats are more prone to miliary dermatitis lesions on the back, neck, and face; although lesions may be found anywhere. It is important to obtain a history, including clinical signs and diet history. When diagnosing flea allergies, look for the presence of live fleas or flea dirt. Diagnosis may start simply with a thorough combing of the patient’s coat with a flea comb. However, further diagnostics including intradermal testing, may be warranted.3
Allergic Dermatitis Dogs and cats may be sensitive to allergens in the environment. These allergens are proteins which cause an allergen-specific IG-E production leading to allergy symptoms, such as inflammation when inhaled or absorbed through the skin, respiratory tract, or GI tract.3,6-9 Canine research suggests dermal barrier defects contribute to environmental allergens and microbes penetrating the skin,
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Veterinary Nursing Education Atopic dermatitis is one of the top claims submitted by Veterinary Pet Insurance (VPI) policyholders year after year.
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Veterinary Nursing Education thus stimulating the epidermal immune system. The immunologic response results in release of inflammatory mediators.6,7 As cats have increased in popularity, the recognition of atopy in this species has increased. Atopic dermatitis is one of the top claims submitted by Veterinary Pet Insurance (VPI) policyholders year after year. In 2012 alone, policyholders submitted over 68,000 claims for skin allergies in dogs, accounting for more than $5.6 million in medical claim amounts. This resulted in atopic dermatitis being the second highest claim submitted for dogs. Skin allergies also fall within the top 10 claims for cats (2012 data – VPI).10 The most commonly diagnosed breeds are: golden retriever, West Highland white terrier, Chinese Shar pei, bull terrier, Bichon frisÊ, and the Tibetan terrier.6,9 In cats any breed can be at risk; however, the Devon
rex, purebred cats in general, and orange cats or cats with orange color in their coats seem to be more predisposed than other breeds and colors.11 Most dogs are diagnosed with atopy from 6 months to 3 years of age.6 Cats diverge from dogs and the range is 6 months to 14 years.11
Adverse Reaction to Food Adverse reactions to food are not easy to diagnose as they frequently imitate allergic diseases. Additionally, adverse food reactions often mimic a variety of canine skin disorders (e.e., pyoderma, pruritic seborrheic dermatoses, folliculitis, ecto-
Adverse food reactions typically occur as nonseasonal pruritic dermatitis, occasionally accompanied by gastrointestinal signs.4,12,13 In dogs, adverse reactions to food are ~10% as common as atopic dermatitis and conceivably as common as atopic dermatitis in cats. Allergic dermatitis might be the cause if the pet has seasonal pruritus, lichenification (thickening of the skin which indicates chronic inflammation), hyperpigmentation. The feet, face, ears, flexural surfaces of the front legs, axilla and abdomen are most affected. Lesions can develop due to self-trauma. Also otitis, pyoderma or Malassezia dermatitis are seen secondary to atopy.9 Diagnosis for atopy involves eliminating other conditions with similar symptoms.6,9 Thus, diagnosis includes appropriate control for external parasites, and potentially elimination food trials. Intradermal skin testing or serologic testing can also be performed to identify possible antigens, but they are not a definitive diagnosis of atopy. Skin testing or serological testing is only used to guide immunological therapy after a diagnosis of atopy is made.
parasitism).12 An adverse reaction to food is an abnormal response to an ingested food or food additive. Adverse food reactions typically occur as nonseasonal pruritic dermatitis, occasionally accompanied by gastrointestinal signs.4,12,13 In dogs, adverse reactions to food are ~10% as common as atopic dermatitis and conceivably as common as atopic dermatitis in cats.14 Concurrent allergic disease, such as flea-allergic dermatitis and atopic dermatitis, may be present in 20% to 30% or more of dogs with suspected adverse food reactions.4 The severity of the pruritus is extremely variable. Lesion distribution is often indistinguishable from that seen with atopic dermatitis; feet, face, axillae, perineal region, inguinal region, rump, and ears are often affected. 25% of dogs with adverse food reactions have lesions in the ear area.4 Therefore, adverse food reactions should always be suspected in dogs with pruritic, unilateral or bilateral otitis externa, even if accompanied by secondary bacterial or Malassezia infections.
Patient History The first step in evaluating patients with potential skin disorders is to obtain a patient history. A complete history should include signalment (i.e., species, breed, age, gender, reproductive status, hair color), presenting complaint, weight and body condition score, nutrition regimen, medical history, and home environment.
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Veterinary Nursing Education
The patient’s nutritional history should be reviewed carefully for allergens or ingredients believed to be commonly associated with or at risk of exacerbating skin disorders. A complete nutritional history should determine the quality and adequacy of the food being fed to the pet, the feeding protocol (e.g., meal fed, free choice, amount, family member responsible for the feeding), and a thorough history of the types of foods fed, including access to treats, supplements, and/or other foods. All members of the health care team should be familiar with taking a nutritional history and should ask open ended questions to stimulate conversation with the owner. A proper nutritional history will result in uncovering the following: • Specific foods pet ingests • Commercial snacks or treats • Supplements • Chewable medications • Chew toys • Human foods • Access to other sources of food It is prudent to have the pet parent maintain a diary for several weeks prior to the visit and document the types of food and other items the pet ingests daily. The patient’s nutritional history 16
The navta journal | navta.net
should be reviewed carefully for allergens or ingredients believed to be commonly associated with or at risk of exacerbating skin disorders.
Nutritional Management The nutritional status of the animal affects the health of the metabolically active organ known as the skin. Inflammatory skin disorders result in inflammation and infection and require additional nutritional support. It is important to ensure that essential nutrients to support normal skin and hair as well as reparative functions are available to the pet suffering with a skin disorder. If the patient is believed to have an adverse food reaction, the offending ingredient(s) must be eliminated. Key nutritional factors that help maintain healthy skin and aid in the management of skin disorders are protein, energy, essential fatty acids (EFAs), minerals (copper and zinc), and vitamins (A, E, and B-complex). The pet’s food should include ideal levels of these nutrients and the nutrients should be highly digestible and available to the pet.15 Protein and energy are crucial for new hair and skin synthesis. The pet’s food
should provide optimal protein quality with appropriate levels of essential amino acids, adequate protein quantity, and digestibility. Growth, gestation, lactation, and illness require increased protein and energy. Subsequently if nutritionally inadequate foods are fed during these specific life stages, abnormal skin and hair may be noticed. Inadequate intake of protein and energy may result in depigmentation, dry, dull haircoat, and hair loss. Changes in the epidermis’ lipid content may affect the protective barrier function of the skin. This predisposes the pet to secondary bacterial or yeast infection. Inadequate protein and energy are also associated with impaired wound healing. Pets with severe seborrhea have amplified epidermal cell turnover which may result in an increase in protein and other nutrient requirements.4 The protein in the pets’ food is the nutrient of most concern in suspected adverse food reaction. This is due to the belief that most food allergens are thought to be glycoproteins. Consequently, the healthcare team should be cognizant of the following:5
• Types and numbers of proteins in the food • Protein sources • Amount of protein • Digestibility of the protein • Previous exposure to the protein Pet parents should be educated that pet food additives, such as antimicrobial preservatives, colorants, antioxidant preservatives, and emulsifying agents, rarely cause either food intolerance or food allergy. Essential Fatty Acids (EFAs) are polyunsaturated fatty acids found in phospholipids. EFAs are key in the structural function of the lipoproteins of cell membranes and allow for conformational responses during temperature fluctuations. They also provide a barrier function to prevent the loss of water and other nutrients.1,4 EFAs provide a source of energy to the skin and are precursors to assorted important molecules involved in the inflammatory response. EFA deficiencies may result in scaly skin, matting of hair, loss of skin elasticity, alopecia, dry and dull haircoat, erythroderma, hyperkeratosis, interdigital exudation, otitis externa, and poor hair regrowth. These changes affect trans-epidermal water loss, epidermal cell turnover, poor wound healing, and increased vulnerability to infection. EFAs also act as antipruritic agents. The inflammation and dermatitis associated with allergic skin disease may be partially caused by abnormal EFA metabolism. The presence of EFA in the cellular membranes is believed to decrease inflammation through competition with arachidonic acid for metabolic enzymes or by anti-inflammatory properties.4,16 The effect of EFAs on pruritus have been studied and on average, it has been found that 50% of dogs and cats with allergic pruritus improve with modification in EFA intake providing secondary bacterial and yeast infections are also controlled.16,17 Skin lesions are often the result of mineral and vitamin imbalances. Deficiencies
Veterinary Nursing Education in copper can lead to loss of normal hair coloration, lack of hair, and a dull or rough coat. Zinc is an important enzyme cofactor and modulator of many biologic functions. Zinc deficiency can lead to a dull, rough coat, skin ulcerations, hyperkeratosis, and other dermatoses. Vitamin A, E, and B-complex imbalances are associated with a variety of skin disorders.4 Given this, it is suggested that foods be evaluated for appropriate quantity and balance of these vitamins and minerals. Overall, most commercial pet foods contain excessive vitamins; consequently, skin disorders caused by vitamin deficiencies are rare. However, vitamin deficiency should be considered in animals being fed homemade, noncommercial, or species generic foods.
Nutritional Plan The key nutritional factors are important to managing skin disorders, but the healthcare team must also be working with the pet parent on an overall nutritional plan for the patient. This plan includes insuring the key nutritional factors are part of the patient’s diet, as well as discussing the feeding method, and insuring compliance. The feeding route, amount fed, how the food is offered, access to other food, and who is responsible for feeding the pet all make up the feeding method. This
ascertain the patient’s access to treats, table scraps, and flavored medicines. For generalized nutritional skin disorders, the diet should be transitioned to a highly digestible food with increased levels of protein and EFAs and an appropriate balance of minerals and vitamins. Nutritional management which aids in dietary-related skin problems in dogs and cats may also be of benefit in inflammatory skin disorders and dermatologic signs associated with metabolic diseases. Studies show the use of novel-protein foods with enhanced levels of omega-3 fatty acids and antioxidants aids in the management of pets with chronic, nonseasonal pruritic dermatitis caused by suspected atopic dermatitis and/or adverse food reaction. Pet owners noted improvements in itchy skin, otitis externa, skin redness, and hair loss. Veterinarians recognized the overall improvement in skin and coat condition in the majority of dogs. Novel protein foods with enhanced levels of omega-3 fatty acids and antioxidants should be considered in managing dogs with suspected allergic dermatitis.18 Patient’s with skin disorders caused by nutrient deficiencies respond positively when their diet is changed to a high-quality, highly digestible food. Improvement is relatively fast - a few days to a couple
The key nutritional factors are important to managing skin disorders, but the healthcare team must also be working with the pet parent on an overall nutritional plan for the patient. information is collected with the nutritional history. Although it is important to carefully evaluate the feeding method, it may not indicate change is needed in the nutritional protocol.4 Appropriate food selection is an important consideration when managing patients with inflammatory skin disorders. There are a number of influences which must be considered when treating skin conditions. The healthcare team should
of weeks. The healthcare team should closely monitor and document any food and supplement changes. The patient should be examined on a weekly to monthly basis, depending on the diagnosis and severity of the lesions. An adverse food reaction diagnosis involves a series of elimination trials with novel protein foods or protein hydrolysate foods. Dietary elimination trials are the main diagnostic method used in
Veterinary Nursing in Action | 2016 convention issue
17
Veterinary Nursing Education dogs and cats with suspected adverse food reactions. An ideal elimination food should provide a limited number of highly digestible protein sources, preferably a protein hydrolysate or one to two different types of intact protein to which the animal has not been previously exposed. Again, a complete nutritional history is imperative to the success of an elimination trial. A protein hydrolysate food works well in managing adverse food reactions. Protein hydrolysates have molecular weights below levels that commonly elicit an allergic response.4,19 Patients should also be evaluated for concurrent allergic skin diseases, particularly atopy and flea allergy hypersensitivity as these patients may only partially respond to an elimination trial. The healthcare team must remember that client compliance is crucial to a successful outcome. Proper management of skin disorders is a long-term investment by the veterinary health care team and the client. Management involves symptomatic treatment until a definitive diagnosis and appropriate treatment protocol are determined. The technician has a great opportunity to provide vital client support by reinforcing the veterinarian’s diagnosis and treatment protocol, educating the client about the importance of and proper application of nutritional protocols, and monitoring patient care through follow-up communications with the pet parent. Skin disorders can be extremely frustrating for owners, healthcare team members, and the pets themselves. Skin disorders can affect quality of life for the pet as well as the pet parents; thus impacting the human-animal bond. Pruritic pets are often uncomfortable; leaving owners to ascertain the reason for the itching and what can be done to stop the itch. Veterinary nursing and execution of the nutritional plan allows for effective patient care, owner satisfaction, and improved quality of life for the pet.
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REFERENCES
1. Roudebush P, Schoenherr WD. Skin and Hair Disorders. In: Hand, Thatcher, Remillard, Roudebush, Novotny, eds. Small Animal Clinical Nutrition, 5th edition, Mark Morris Institute, Topeka, KS. 2010: 637- 665 2. Scott DW, Miller WH, Griffin CE: Small Animal Dermatology, ed 6. Philadelphia, WB Saunders, 2001. 3. Miller WH, Griffin CE, Campbell K: Muller and Kirk’s Small Animal Dermatology, ed 7. Philadelphia, WB Saunders, 2012. 4. Wortinger A, Burns KM. Dermatology. In Nutrition and Disease Management for Veterinary Technicians and Nurses, 2nd ed. 2015. Wiley-Blackwell. Ames, IA. 5. Burns, KM. Nutritional Management of Inflammatory Skin Disorders. Veterinary Technician, November, 2005. Pp. 794-800. 6. Olivry T, Deboer D, Et All., Treatment of Canine Atopic Dermatitis: 2010 Clinical Practice Guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol. 2010: 21:233-248.
15. Roudebush PR, Guilford WG, Jackson HA: Adverse Reactions to Food, in Hand MS, Thatcher CD, Remillard RL, et al (eds): Small Animal Clinical Nutrition, ed 5, Topeka, KS, 2010, 609 – 633. 16. Miller WH, Scott DW, Wellington JR: Investigation on the antipruritic effects of ascorbic acid given alone or in combination with a fatty acid supplement to dogs with allergic skin disease. Canine Pract 17:11–13, 1992. 17. Harvey RG: Management of feline miliary dermatitis by supplementing the diet with essential fatty acids. Vet Rec 128:326–329, 1991. 18. .Allen TA, Fritsch D. A multi-center clinical study of therapeutic foods in dogs with chronic, non-seasonal pruritic dermatitis due to atopy and/or adverse reaction to food. Data on File. Hill’s Pet Nutrition Center, Topeka, Kansas, 2005. 19. Loeffler A, Lloyd DH, Bond R, et al: Dietary trials with a commercial chicken hydrolysate diet in sixty-three pruritic dogs. Vet Rec 154(17):519– 522, 2004.
7. Inman, AO, Olivry, T, Dunston, SM, et al.: Electron microscopic observations of stratum corneum intercellular lipids in normal and atopic dogs. Vet Pathol. 38(6), 2001, 720–723. 8. Bizikova P, Pucheu-Haston CM, Eisenschenk MNC, Marsella R, et al. Review: Role of genetics and the environment in the pathogenesis of canine atopic dermatitis. Veterinary Dermatology. 2015; 26: 95–e26 9. Moriello, KA. Atopic Dermatitis. The Merck Veterinary Manual. July, 2013. Accessed online http://www. merckvetmanual.com/mvm/integumentary_system/ atopic_dermatitis/overview_of_atopic_dermatitis.html, November 2015. 10. http://press.petinsurance.com/pressroom/ 381.aspx). 11. Jeromin AM. Feline atopy—are you seeing more cases in your veterinary clinic lately? DVM360. June 2012. Accessed November 2015. 12. MacDonald JM: Food allergy, in Griffin CE, Kwochka KW, MacDonald JM (eds): Current Veterinary Dermatology. St Louis, Mosby, 1993, pp 121–132. 13. Roudebush P, Schick RO: Evaluation of a commercial canned lamb and rice diet for the management of adverse reactions to food in dogs. Vet Dermatology 5:63–67, 1994. 14. White, SD. Food Allergy. The Merck Veterinary Manual. May, 2013. Accessed online http://www. merckvetmanual.com/mvm/integumentary_system/ food_allergy, November 2015.
CONTINUING EDUCATION
QUIZ ONLINE visit VetMedTeam.com and log in with your Vet Med Team Profile.
®
Veterinary Nursing Education Vicky Ograin, MBA, RVT, VTS (Nutrition) Vicky received her technician degree in 1983. She served in private practice for 18 years in California, and then 14 years ago began a new career with Hill’s Pet Nutrition. In 2007, she completed a Bachelor of Science and in 2008, she completed a Masters in Business Administration. Vicky obtained her Veterinary Technician Specialty (VTS) in nutrition in June 2013 and serves as secretary for the Academy of Veterinary Nutrition Technicians. She is also the Secretary/Treasurer for the Kansas Veterinary Technician Association. She is a life member of the National Association of Veterinary Technicians in America (NAVTA), and was the 2014 president of NAVTA. Vicky is currently the past president of NAVTA. Vicky speaks national and internationally and is a published author.
Kara M. Burns, MS, MEd, LVT, VTS (Nutrition) VTS-H (Internal Medicine, Dentistry) Kara Burns is a licensed veterinary technician originally from New England, now living in Kansas. She holds a master’s degree in physiology and a master’s degree in counseling psychology. Kara is the Founder and President of the Academy of Veterinary Nutrition Technicians, the tenth recognized specialty for veterinary technicians and has attained her VTS (Nutrition). She teaches nutrition courses around the world on the VIN/Veterinary Support Personnel Network and on VetMedTeam. Kara is a consultant for the Lafeber company and Emeraid. Kara is the Director of Nursing for Brief Media as well as the Editor of Veterinary Team Brief. She also works as an independent nutritional consultant. She is a member of many national, international, and state associations and holds positions on many boards in the profession: AAVN executive board technician liaison; Society for Veterinary Medical Ethics Board Member; Western Veterinary Conference Technician Education manager; LGVMA; International Society for Sports Nutrition; and the Pet Nutrition Alliance, to name a few. She has authored many articles, textbooks, and textbook chapters and is an internationally invited speaker, focusing on topics of nutrition, leadership, and technician utilization. Ms. Burns has been featured on the cover of the Veterinary Technician Journal and the NAVTA Journal. She was named the 2013 North American Veterinary Conference Technician Speaker of the Year. She was granted an honorary VTS (Internal Medicine) in 2011. She was also granted an honorary VTS (Dentistry) in 2012. She is the 2010 NAVTA Veterinary Technician of the Year, as well as the 2011 Dr. Franklin Loew Lecturer.
Veterinary Nursing in Action | 2016 convention issue
19
Professional Pulse
The relationship between
continuing education job satisfaction
&
By Cynthia A. Dittmar, LVT
Veterinary technicians are key players in the veterinary healthcare team. Unfortunately, the turnover rate for veterinary technicians is 35%1, with the average veterinary technician only remaining in the profession for just over 12 years.2 With the employment outlook expected to grow by 52% from 2010 to and 20203 and the number of positions available expected to outpace the number of new graduate veterinary technicians3, it is important to identify ways to keep current veterinary technicians actively working in the profession longer. Veterinary technicians who are satisfied in their current position are more likely to remain in the profession4, therefore identifying strategies for increasing job satisfaction among veterinary technicians can help to increase the professional longevity of veterinary technicians and decrease the turnout rate.
20
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for veterinary technicians
Literature Review Data on whether or not Continuing Education (CE) has an effect on the job satisfaction of veterinary technicians is scarce if it exists at all. However, many studies can be found that show a relationship between CE and job satisfaction in the human medical field and there is also evidence from studies involving veterinarians. One study looking at primary care physicians found that a perceived lack of opportunity for CE was “significantly associated, albeit modestly with job stress, burnout and job dissatisfaction�5. In a study which looked in part at the motivations of veterinarians in seeking out continuing education, participants reported that they attended CE to rejuvenate their enthusiasm for practice and prevent practice burnout6. In that same study, veterinarians also reported using CE to maintain the enthusiasm of hospital staff. Several studies related to the nursing profession, which the veterinary technology profession is often described in terms of, have also found a link between continuing education and job satisfaction. In 2011 a study found that continuing education “has the potential to
Professional Pulse improve job satisfaction and retention of clinical nurses”.7 Another study found increased scores on the job satisfaction scale from nurses who participated in more continuing education activities.8 From these studies, it is possible to assume that continuing education activities are also likely to improve the job satisfaction of veterinary technicians. When looking at the types of continuing education that veterinary technicians engage in, social interaction, or the lack thereof, may also play a role in whether or not the CE affects job satisfaction or to what extent it affects job satisfaction. Moore et. al.6 noted that the chance for social interaction with peers was the most reported benefit of veterinary continuing education. Social support and interaction has a favorable impact on workers9, however for veterinary technicians this support may not be available in their clinical setting due to a lack of other technicians in the practice or an “us vs. them” mentality that is often seen in practices between veterinary staff in different roles.10 For this reason, the attendance of continuing education events where social interaction with others of their profession may be of more benefit in relation to job satisfaction than other types of continuing education. While these other studies point towards the likelihood that continuing education affects the overall job satisfaction of veterinary technicians, having evidence related specifically to the veterinary technology profession can be beneficial to veterinary technicians and their employers in making choices about the types and amounts of continuing education in which to invest. The assurance that there is more benefit to continuing education than simply the acquisition of knowledge may also be sufficient to tip the scales in favor of veterinary technicians and their employers in investing both time and money on continuing education when they would may not have previously supported such expenditures.
Research Objectives & Background This study was performed as part of the coursework for a B.A.S. in Veterinary Technology from Tarleton State University in the spring of 2014. The purpose of this study was to investigate the possibility of a relationship between the job satisfaction of veterinary technicians and the amounts and types of continuing education experiences had by veterinary technicians, thereby helping both the veterinary technicians and their employers to take steps to extend the time veterinary technicians remain active in their profession.
Method & Sample A survey of 90 veterinary technicians, 77 still active in the profession and 13 who had left the profession, was performed with data collected on their CE activities and the length of time that they were active in the profession. Participants ranged in their time in practice from 1-3 years to more than 16 years and were both credentialed technicians and “on-thejob” trained. Invitation to participate in the digital survey was posted to both open, public forums and a private veterinary hospital staff community forum. The self-administered survey consisted of either 6 or 12 questions, depending on whether or not the respondents attended continuing education. Survey questions included how long the participant has or had been involved in the veterinary technology profession, how many hours or units of continuing education were accrued each year, the types of continuing education formats utilized, rating of overall job satisfaction and of the different types of continuing education available. The data was evaluated both statistically and through comparison of the quantitative data to the qualitative data for evidence of a relationship between the number of years participants remained active in the veterinary technology profession, the number of hours/units of continuing education they accrued and their professed level of job satisfaction.
When looking at the types of continuing education that veterinary technicians engage in, social interaction, or the lack thereof, may also play a role in whether or not the CE affects job satisfaction or to what extent it affects job satisfaction. Responses
Rank 1
Rank 2
Rank 3
Rank 4
Rank 5
Weighted Rank
Major Conferences
36
8
2
7
20
1 (252)
Local
8
26
17
16
6
2 (233)
Interactive
9
18
16
23
7
3 (218)
In-House
5
15
29
10
14
4 (206)
Correspondence
15
5
9
17
27
5 (183)
Total Responses
73
Table 2 Ratings given to each type of continuing education presentation by participants based on the effect each had on job satisfaction
Veterinary Nursing in Action | 2016 convention issue
21
Definitions Correspondence CE reading of articles or watching online presentations followed by submission of answers to a series of questions Major conferences multi-day continuing education events which typically include social events and travel to vacation type destinations Interactive CE – online events where participants interacted via message forums but which did not involve face-to-face social interactions Local CE – single day continuing education events held locally In-House CE – is a short continuing education event held within the participants own practice. The social interaction at these events is generally limited by time and to only those people that the veterinary technician works with every day.
Summary and Discussion The study did not show evidence of a relationship between the amount of continuing education accrued yearly and the length of time that veterinary technicians remain active in their profession. However, it did show a correlation between the type of CE events experienced and the job satisfaction experience by participants. Out of all 90 participants, 81 (90%) acquired CE and 9 (10%) did not. Of those 81 participants who attended CE, 73 participants (90%) felt that CE improved job satisfaction while 8 (10%) participants felt that it did not. This effect on job satisfaction occurred regardless of the number of years spent in practice. The ability to interact socially with others in the same profession was also a common reason listed for CE being valuable both to improve job satisfaction and to keep participants active in the profession. In fact, major CE events which allow the most opportunities for more new social interactions and more prolonged social interactions was ranked as the type of CE event that had the most impact on job satisfaction, with local events ranked second. One participant stated “I find it motivating and encouraging. I love networking with other techs and vets and gathering new ideas to take back to my work. I feel the people that leave the profession aren’t involved enough.” The findings from this study would indicate that continuing education that involves social interaction with others veterinary technicians outside of the workplace are the most beneficial for building excitement about the profession and increasing job satisfaction. This is based upon the top two ranked CE types, Major CE and Local CE, both of which allow for new social interactions as compared to the other 3 types of CE which allow for little or no new social interaction. These finds are consistent with research related to other professions that studied the effects of social interaction and/or “social isolation” on job satisfaction. Based upon the perception of participants concerning the effects of the different types of CE presentations on job satisfaction, in those instances where money and time allow, attending CE events that allow for new social interactions (local or major conferences) should be given priority. These types of CE events were ranked higher in value related to
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participant job satisfaction and longevity in the profession by the majority of participants in this study. Participants also consistently commented on the importance of face-to-face social interaction with others in their profession as important to improving job satisfaction and excitement about their profession. As one participant stated, “Being around others who are passionate about the field helps me to continue to be inspired and uplifted.”
References
1. American Animal Hospital Association. AAHA Compensation and Benefits report. Lakewood, CO: AAHA Press; 2008. 2. National Association of Veterinary Technicians in America. NAVTA Survey. NAVTA Journal. 2012; Dec.-Oct.: 44-47. 3. Bureau of Labor and Statistics. Occupational Outlook Handbook: Veterinary Technologists and Technicians. http://www.bls.gov/ooh/ Healthcare/Veterinary-technologists-and-technicians.htm#tab-6. Updated March 29, 2012. Accessed January 21, 2013. 4. Larkin M. The veterinary technology profession continues to push for greater recognition. Journal of the American Veterinary Medical Association. https://www.avma.org/news/javmanews/ pages/default_toc.aspx. Updated October 15, 2013. Accessed January 21, 2013. 5. Kushnir T, Cohen A, & Katai E. Continuing medical education and primary physicians’ job stress, burnout and dissatisfaction. Medical Education. 2000: 430-436. 6. Moore D, Klingborg D, Brenner J, & Gotz A). Moivations for and barriers to engaging in continuing veterinary medical education. Journal of the American Veterinary Medical Association. 2000; October:11001-1006. 7. Cleary M, Horstfall J, O’Hara-Aarons M, Jackson D, & Hunt G. The views of mental health nurses on continuing professional development. Journal of Clinical Nursing. 2011: 3561-3566. 8. Roberston E, Higgins L, Rozmus C, & Robinson J. Association between continuing education and job satisfaction in nurses employed in long-term care facilities. Journal of Continuing Education in Nursing. 1999; 30(3): 108-113. 9. Seers A, McGee G, Serey T, & Graen G. The interaction of job stress and social support: a strong inference investigation. Academy Of Management Journal. 1983: 273-284. 10. Gair DA. Forget “us vs. them”. Firstline. 2009; October: 12-13.
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