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Veterinary nursing is considered to be a relatively young profession, having been established for the last fifty years. The role encompasses a wide range of responsibilities including first aid, dealing with clients and the creation of nursing plans. Nonetheless, the pinnacle of their work is concerning animal welfare. When working, every Veterinary nurse (VN), Animal care assistant (ACA) and Veterinary Surgeon (VS) must be aware of the legal and professional regulatory frameworks which govern the veterinary profession.
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A VN’s prime responsibility is providing care to patients while focusing on the welfare of the animal. They must keep within areas they are competent at while demonstrating professional accountability by referring cases responsibly. In regards to the legal framework that has caught up to the standards the profession has long upheld, one of the more well-known pieces of legislation is The Animal Welfare Act (2006). The creation of the act was a significant step towards holding people accountable for the care of their animals through the five needs- not to be confused with the five freedoms which are considered to be aspirational, instead of legally binding. Relating the act to the treatment of animals in a veterinary practice can often seem contradictory as there is often a conflict of interest. For example, an animal that is about to go into surgery must have food withheld for a period of time beforehand. Yet the act states a need for a suitable diet. However, it is generally agreed that some harm may be necessary for the overall increased welfare of an animal (Yeates, 2013)
Another responsibility of VN’s is first aid, which is the immediate treatment of an animal that is injured or suffering from an illness. This may be needed in regards to an animal that has been brought in but is unable to receive veterinary attention straight away. Although the animal will be able to receive better care by someone more knowledgeable and trained to respond to the situation, there is also a limiting factor. This is due to schedule 3 of the Veterinary Surgeon act (1966) which states unless directed by a vet a VN can do no more than a member of the public. This can pose a dilemma for VN’s, who may know what medication needs to be administered, yet are legally unable to do so unless directed by the VS who will need to have assessed the animal. If a VN were to arguably decide to act in the best interest of the animal and for example, administer diazepam to a dog that was fitting, they would be breaching two Acts. The first being VSA (1966) and second being the Medicines Act (1968), which states that a POM-V may only be prescribed by a VS following a clinical assessment of the animal which is under their care. Depending upon whether any action that is taken is seen as an interim measure or not, would be the subsequent argument about whether it went beyond first aid and could be brought up in court. However, so far, no nurse has been struck off the register for inappropriate first aid. Furthermore, a report by the RCVS last year showed a very high 92 percent of VN’s and 71 percent of VS’s agreed that VN’s should be able to undertake areas of work that are not currently allowed under Schedule 3 (Institute for employment studies,2017). This suggests that in the future, the law may catch up to the desires of the profession and enable VN’s to take on more roles.
Yet another large responsibility of a VN which can take up a significant portion of their role, is communicating effectively with clients and client care. Client care can include booking appointments, receiving complaints or gaining informed consent. By improving communication, client compliance and customer experience will be directly affected. This would lead to improved animal welfare (Hedberg, 2016). Ultimately VN’s are often the ‘face’ of the practice and deal with sensitive and personal information. With this comes the requirement of abiding by the professional code of conduct and the Data Protection Act (2018). As a veterinary/client relationship is based on trust, a VN or VS should not disclose any information about a client or an animal. However there are exemptions to this, for example, if disclosure can be justified by animal welfare concerns, the client has given consent or where disclosure is justified by law (RCVS, 2018: Section 14.2). This legislation is by no means limiting but encourages a relationship whereby the client knows that by a requirement of law their data will stay under the protection of the veterinary practice.
In regards to informed consent, this is another responsibility which often falls upon the VN to gain. Obtaining consent is a legal obligation for the practice (Wild, 2017). Those obtaining consent must first ensure the person accompanying the animal is the owner and is the legal age to possess an animal. However in England, only those who are 18 years of age or over can be held accountable for financial contracts, so practices may only accept consent from those that are 18 or over (Macdonald and Gray, 2014). Furthermore, the RCVS Code of Professional Conduct (COPC) for Veterinary Surgeons and Nurses, states that informed consent may only be given by a client who has had the opportunity to consider a range of reasonable treatment options with (RCVS, 2018: Section 11.1). They also must have been given the fee estimates and have had the main risks explained to them. Given the stressful situations owners may find themselves in, this can prove challenging for the VN. However, informed consent procedures play a vital role in legal protection, enabling defense against patient accusations of assault or malpractice.
A questionnaire done by the Queen Mother Hospital for Animals concluded that despite efforts of staff, although the majority recalled signing the form – (51 percent) did not feel in control and (53%) did not feel reassured. Furthermore, the results displayed limited understanding, with (31 percent) believing that the veterinarian could do something different from the agreed procedure without first consulting them (Whitning et al.,2016). So perhaps those in the veterinary field reflecting a paternalistic role and communicating in a manner that has minimal eliciting of client control while dominating the discussion (Bard et al., 2017), should focus on relationship building and encourage client participation. As a result, the clients will be more likely to put into place the veterinary recommendations, and animal welfare will be overall improved.
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According to the Code of Professional Conduct for Veterinary Nurses (COPCVN), VN’s must make animal health and welfare their first consideration when attending to animals as well as being responsible for their actions (RCVS, 2018: Section 1.1). A key step that VN’s should do, but maybe underutilised is the creation of Nursing care plans (NCP) (Ballantyne, 2014). NCP’s are extremely important to improving an animal’s welfare, although you must keep into consideration to avoid anthropomorphism and anthropocentrism. Instead, the situation should be viewed from the animal’s perspective (Cooper, Mullineaux and Turner 2011). Although an NCP enables a systematic approach to care, the key to professional and functional patient care is by using a nursing model or framework (Lindley, 2015). The Ability Model (AM) is the only model designed specifically for veterinary patients. It is an adaptation of both the Orem and Roper and Logan and Tierney (Jeffery & Ford-Fennah, 2011). When a patient has been admitted, a process of assessment, planning, having those actions carried out and evaluating will occur. The assessment should start out by interviewing the client. This is an important step that enables the VN to understand what the animals normal routine is, and how they can best replicate that for their stay in the practice. Although appointments are traditionally between a VS and the client, nurses are now becoming more involved in admitting, discharging and changing bandages for patients. Continuing on from that is identifying the initial nursing requirements, and what veterinary interventions may be needed. Then planning takes into consideration when these need to be done. For example, would this species benefit from being house separately in order to minimise stress, and do they need to be moved now? Then carrying out solutions to those problems that have been previously identified, ensures action takes place. When considering the care that must be provided, it is important to remember that they may rely on the owner’s co-operation as well as direct patient care. So if their participation is not a feasible factor then the care will need to be reassessed and adapted. Furthermore, by evaluating the results of the intervention you can be directed as to whether more could be done. Clear and structured reflection combined with accurate record keeping make evaluative practice highly beneficial (Ballantyne, 2014). Carrying out NCP’s is not the responsibility of one nurse, but requires a proactive approach from all members of the team. Although a VN is not legally allowed to make a diagnosis, the aim of a veterinary nursing diagnosis and intervention is to prevent or provide relief for any of the identified health issues within the allowed parameters (Matthews et al., 2018). However, overall when considering the care of the patient, ensuring it is done holistically is an important measure.
Holistic care (HC), as defined by Mosby (2013) is a comprehensive system of patient care that includes the physical, social, economic, spiritual and emotional needs of the patient. Though clearly explained in a definition more suitable for the medical world, the veterinary application can be extrapolated and applied to veterinary nursing (Ballantyne, 2014). HC is important in nursing an animal as an individual, and not just considering its needs based on species, gender or age although these are still relevant. Considered to be the gold standard for nursing in veterinary hospitals, this is where correctly done care plans come into practice to ensure every welfare need of the animal is met (Orpet, 2011).
Overall, a Veterinary Nurses position encompasses more responsibilities and is affected by more laws that may be immediately obvious. From the Animal Welfare Act (2006) to the RCVS (COPC), laws and regulations provide an important guiding framework for VN’s to work within. Veterinary nursing as a whole is still considered a young profession. Therefore it also limited by the same regulations that they rely upon but could also expand the profession. For example, despite the overwhelming statistic of 92% of VN’s believing they should be able to undertake more work than is currently allowed under Schedule 3, their role can be considered to be quite restricted in certain areas, such as having no more ability than a member of the general public in administering first aid. However, it is also important to take into consideration that this statistic comes from those that did reply to the request toward the survey, and so does not reflect the desire of the veterinary community as a whole. It will remain to be seen in the future, whether their role remains the same or evolves.
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