Facilitating stress reduction of patients within the veterinary practice - Veterinary Practice
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Facilitating stress reduction of patients within the veterinary practice

Reducing the stress levels of patients and creating positive learning experiences in the veterinary practice requires a holistic and collaborative approach between veterinary professionals, paraprofessionals and caregivers

The veterinary practice can be a stressful environment for patients. Often, pets encounter this environment when they are unwell and already in a negative emotional state. Even for patients in good health, the environment can still provide a number of potentially stress-inducing stimuli, including a range of unfamiliar or alarming sounds, sights and smells. In addition to this, pets are secured and handled, limiting their behavioural repertoire and reducing their choice of coping strategies.

Stressful experiences may cause a negative emotional state, which pets learn to associate with the veterinary practice environment. Consequently, this can lead to future visits being an unpleasant and challenging experience for pet, caregiver and veterinary professional. The veterinary practice team are in a great position to implement stress reduction methods, educate caregivers on their pet’s stress and collaborate with paraprofessionals to provide a holistic approach to stress reduction.

Barriers to stress reduction

Time is a precious commodity in veterinary practice and as such can be a barrier to implementing stress reduction methods (Blaxter, 2022). This is especially true for consultations, where discussion of certain topics with caregivers may be avoided to prioritise other topics in the limited time slot (Belshaw et al., 2018). Unless the caregiver specifically approaches the topic of stress or behaviour, this may not be at the forefront of conversations.

Time is a precious commodity in veterinary practice and as such can be a barrier to implementing stress reduction methods

Additionally, veterinary professionals may be concerned about customer dissatisfaction should they approach sensitive topics which the caregiver has not brought up themselves (Aldewereld et al., 2021). Nevertheless, like many other health challenges, addressing emotional health requires sufficient caregiver understanding and compliance. As such, opening up a conversation about stress reduction with the patient’s caregiver is the fundamental starting point.

Identifying stress and educating clients

The first point of client contact is often the veterinary receptionist. This is a great opportunity to introduce the topic of stress reduction. Standard patient history-taking questions can be incorporated into the appointment booking process. Open questions such as, “How does your pet normally cope coming to the vets/having this procedure?” and “What can we do/prepare to help them have a pleasant experience?” can be used as standard by reception staff. This may help clients feel more comfortable talking about their pet’s behaviour at the appointment (Belshaw et al., 2018), or they may even provide useful information in advance of the appointment during the discussion with a receptionist (Roshier and McBride, 2013). Relevant notes can be added to the pet’s record prior to the appointment, which can save time later on and facilitate a better focus of conversation during the appointment.

While history taking at appointment booking can be a great technique for opening a conversation, it should not be assumed that all caregivers are able to recognise signs of stress in their pet (Tami and Gallagher, 2009). Therefore, continuous body language assessment on arrival of the pet and during the consultation should also be carried out.

Verbally acknowledging important body language signals and explaining their likely meaning to caregivers can help educate them on their pet’s stress

Veterinary professionals are generally well experienced in body language assessment and practise the skill throughout the day. Verbally acknowledging important body language signals and explaining their likely meaning to caregivers can help educate them on their pet’s stress. Trained and experienced reception staff may also be appropriately placed to do this. Additionally, providing clients with body language handouts such as Lili Chin’s Doggie Language while they wait for their appointment can help them identify their pet’s stress signals in real time.

Even once a patient’s stress has been identified, a caregiver may not acknowledge the importance of this within the context of the veterinary practice. They may perceive it to be “normal” or may not be aware that help is available. Caregiver compliance is key in the implementation of stress reduction. It is imperative that conversations with such clients are steered to help them understand how their pet’s stress and subsequent behaviour can be exacerbated with each visit, as well as its impact on their general emotional health. Such a conversation may be time limited during a consultation, so may need to be scheduled as a follow-up or referred to another member of the team.

Collaborative approach

Once a patient has been identified as being stressed in the veterinary environment, and the caregiver is on board with supporting their pet, a stress reduction plan can be formulated. The plan is likely to involve colleagues within the veterinary team working together; however, it may also involve reaching out to external paraprofessionals such as trainers, behaviourists, groomers and dog walkers.

By addressing pre-visit triggers, we are setting up the pet to be in a positive emotional state on arrival and as such, in-practice stress reduction methods should be more effective

The plan should be designed around the individual pet’s needs and triggers, which should be identified during earlier conversation. One key area to discuss is what happens prior to the pet visiting the veterinary practice. For example, it may be that the pet has an aversion to their harness, their carrier or car travel. Pets who experience triggers before even arriving at the veterinary practice arrive in a high state of emotional arousal, and are likely in a negative emotional state. This will significantly hinder learning from any stress reduction efforts that are made in practice.

It is useful to know where to direct these clients for support. For behaviourists and trainers, the Animal Behaviour and Training Council (ABTC) is a good starting point. Additionally, reaching out to the local paraprofessionals and getting to know them will facilitate this collaborative approach. By addressing pre-visit triggers, we are setting up the pet to be in a positive emotional state on arrival and as such, in-practice stress reduction methods should be more effective.

Adapting the environment

There are many general adaptations that can be made to the veterinary environment which are likely to help reduce overall stress for most pets. These may include separate species waiting areas and wards or separate species consult times, use of pheromones, visual barriers, gentle handling and the use of treats (Williams et al., 2019).

There is likely to be scope to implement small adaptations… These might include arranging for the pet to come in at a particular time or through a different entrance, greeting them in the car park…

In addition to these, there is likely to be scope to implement small adaptations which are specific to the individual patient. These might include arranging for the pet to come in at a particular time or through a different entrance, greeting them in the car park, using or avoiding a specific food and using positive learned verbal or visual “cooperative care” cues to aid the examination.

The initial goal is to reduce patient stress by reducing triggers where possible, and providing coping strategies, choice and a better sense of control over their situation. The ultimate goal is to provide opportunity for positive learning experiences, whereby veterinary practices may offer behaviour-specific services within their practice.

In-practice behaviour services include:

  • Puppy “parties”/preschool: an educational and practical puppy class (not free-for-all playtime), run by members of the team or external trainers/behaviourists
  • Confidence clinics: clinic appointments which focus on helping the pet build confidence in the veterinary environment and with handling. By taking it at the pet’s pace while assessing their behaviour, confidence clinics provide opportunities for pets to form positive associations
  • Cooperative care training: the pet is taught how they can opt in and out of a procedure or situation. Training can be started by an external trainer or experienced members of the veterinary team, and then practised by caregivers at home
  • Practice tours: allowing caregivers to bring their pet in for a tour of the practice and to have a pleasant experience in doing so. These can be incorporated into confidence clinics or run separately and can be useful in preparing the pet for routine hospital stays such as neutering
  • Educational talks for clients: topics such as dog law and safety, body language, toilet training, handling and socialising are all often of interest to caregivers; however, they cannot be sufficiently covered during a routine appointment. Trainers and behaviourists are appropriately placed to provide such talks and are often happy to do so
  • Behavioural triage: having a designated “behavioural first aider” within the veterinary team who can respond to behaviour- or stress-related enquiries should help facilitate implementation of stress reduction and highlight pets who may require the support of a clinical or veterinary behaviourist. In-clinic ABTC-registered animal behaviour technicians are perfect for this

Summary

Veterinary practices are well placed to provide many behaviour-focused services and implement many stress reduction methods. The practical application of this will very much depend on each practice’s availability of time, staffing, knowledge and resources. Ultimately, the experience a patient has in the veterinary practice and how they perceive it is multifactorial and as such, so should our approach be. At the very least, opening up a conversation with clients to acknowledge their pet’s stress gets the ball rolling for facilitating any stress reduction methods that can then be implemented.

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