Positive Veterinary Care

What is a positive veterinary experience?

The term “POSITIVE” refers to methods of veterinary practice that promote calm emotions for patients of all species and their caregivers by encouraging awareness of the patient’s experience throughout the visit. Every team member should play a role.

Positive veterinary care strives to prevent stress, anxiety and fear.

Why worry about stress in animals receiving veterinary care?

Physiologically there is both good and bad stress. Negative stress can lead to emotional distress, which should be avoided as much as possible. An unpleasant experience at the vet may trigger the “fight, flight, freeze” response. A pet may become aggressive (fight), attempt to get away (flight), or “shut down” (freeze). Patients exhibiting any of these responses are experiencing fear, even those that appear passive. It only takes one experience to trigger these responses, and lead to generalized fear affecting all future visits.

What is the physical effect of anxiety and fear?

Anxiety and fear lead to increased cortisol and blood glucose levels, pupil dilation, and muscle tension. Heart rate, respiratory rate, blood pressure, and temperature may all increase. These effects can hinder accurate diagnosis and lead to increased anesthetic and sedation risk.

DEFINITIONS

  • Stress – a physical, chemical, or emotional response to a situation which can cause either physical or emotional distress.
  • Anxiety – The anticipation of a threatening event.
  • Fear – An unpleasant emotion caused by the threat of danger, pain, or harm.
  • Aggression – A behavioral response to a perceived threat consisting of displays such as growling, barking, snarling, hissing and biting. Aggression is almost always caused by fear.
  • Classical Counter-conditioning – Pairing something the animal likes (usually food) with a fear inducing stimulus to create a positive emotional response.

What do clients think of their pets’ negative experience?

Nearly 40% of all cat owners report they “get stressed” thinking about a veterinary appointment because of their cats’ stress at the vet. More than a third of dog owners and over half of cat caregivers (38% of dog owners and 58% of cat caregivers) say their animals “hate” going to vets; they are less likely to visit their veterinarian.

When animals are stressed, the people who love them also become stressed. The signs of anxiety often begin at home. Cats may hide or struggle when a carrier appears, resulting in bites or scratches. During travel they may vocalize, vomit, defecate, and even become dyspneic. Dogs may yawn, pant, or vocalize during the car ride. Horses may begin to pace in their stall or refuse to enter the trailer. These anxiety-related behaviors contribute to a decline in veterinary visits resulting in a rise in preventable illness and behaviors.

Veterinarians can encourage owners to accept recommendations for anxiety- reducing medications or products, and to learn how to counter-condition their pets. The veterinary team should teach clients at-home care (such as medication administration or ear cleanings) using counter-conditioning and positive training techniques. This will not only reduce stress, but it will also decrease the risk of caregiver injury.

The entire veterinary team should be empowered to create the positive experience

  • The veterinarian must lead the handling plan, triaging the patient’s immediate needs.
  • Staff should be taught to obtain a weight and guide the patient to the exam room without force.
  • Technicians should be trained to use minimally stressful handling techniques for procedures such as blood draws or catheter placement.
  • If a patient is exhibiting signs of stress, consider breaking care into multiple visits, and use redirection with treats and toys.
  • Clients should be educated on the signs of anxiety and basic training techniques. They should be encouraged to bring the patient to the clinic for “Happy Visits” consisting of counter-conditioning to create a positive association.

Every aspect of every visit should focus on preventing and reducing stress

  • Knowledge of species-specific body language of fear and anxiety is essential to providing a positive visit
  • Training every team member to identify signs of anxiety is essential.
  • Minimal restraint should be used whenever possible.
  • Procedures that trigger fear should be postponed, reduced, or performed after positive counter-conditioning.
  • Pre-medicating with anti-anxiety medications or injectable chemical restraint may be needed and should be used as necessary.
  • Causes of anxiety should be identified and eliminated.
  • The use of things the animal finds pleasant (usually food) paired with non-aversive tools, such as towel wraps, blindfold, and basket muzzles help create a positive experience.
  • Moving people and equipment instead of animals for care helps reduce stress.
  • Keeping owners in the exam area (not involved in restraint or handling) prevents the patient from having to acclimate to a new environment, thus reducing stress.
  • The goal is to avoid force and allow the patient to cooperate in care.

Careful management of sensory input is also important.

  • All exam areas should be cleaned using odorless cleaners.
  • All stool, urine, and blood should be completely removed.
  • Noise should be minimized by using silent clippers, low voices, soothing music, and management of barking dogs.
  • Tables and floors should be non-slip or covered to reduce noise and cold sensation.
  • Bright lights and other stimulating colors or artwork should be limited, especially for cats and horses.

The positive veterinary experience is focused on recognizing signs of fear and anxiety, and responding to them in a way that reduces patient stress.

Download a PDF here:  Positive Veterinary Care

REFERENCES

Books

  1. Horwitz, D. Ciribassi, J. Dale,S (2014) Decoding Your Dog: The Ultimate Experts Explain Common Dog Behaviors and Reveal How to Prevent or Change Unwanted Ones. Houghton Mifflin Harcourt.
  2. Landsburg, G., Hunthausen, W., Ackerman,L., (2012 3rd edition) Handbook of Behavior Problems of the Dog and Cat. Elsevier Heath Services.
  3. Overall, K. (2013 2nd edition) Manual of Clinical Behavioral Medicine for Dogs and Cats. Elsevier Health Services.
  4. Shaw, J, Martin, D., (2014) Canine and Feline Behavior for Veterinary Technicians and Nurses. Wiley - Blackwell.
  5. Yin, S. (2009) Low Stress Handling, Restraint and Behavior Modification of Dogs and Cats: Techniques for Developing Patients Who Love Their Visits. Davis, Ca., Cattledog Publishing.

Websites for further reading and reference

Staff training and educational programs