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Veterinarian Technician May 2009 (Vol 30, No 5)

Nursing Process Helps Guide Critical Care Essentials

by Paul Basilio

    PHILADELPHIA — Because the critical care arena can be fast-paced, it is important for technicians to become proactive instead of reactive members of the critical care team.

    One way to get a handle on critical care is to adapt the human medicine concept of the "nursing process," said Harold Davis, BA, RVT, VTS (ECC, Anesthesia), manager of the Emergency and Critical Care Service at the Veterinary Medical Teaching Hospital, University of California, Davis.

    "I discovered the nursing process a couple of years ago," Davis said here at the 109th Penn Annual Conference. "It's a clinical decision-making tool that nurses in human medicine use when they care for their patients. It helps you think about what you're seeing and can help you act on an event of concern with your patients. It's the way I approach nursing care, but I was surprised there was already a name for it."

    The nursing process can provide a good foundation for technicians in emergency settings to gather information about a patient and interpret that information in such a way that can help the patient, the veterinarian and the rest of the health care team.

    "The assessment phase [of the nursing process] is the detective phase," said Davis, who is a member of the Veterinary Technician Editorial Board. "You gather as much information about the patient, put those clues together and hopefully arrive at what I call a nursing conclusion. In human medicine, it's called a nursing diagnosis, but in veterinary medicine, technicians can't make a diagnosis. However, we can try to make sense of the clues."

    Ideal ways of gathering information about a patient include an extensive patient history, diagnostic tests and a physical examination.

    "The physical examination is important," Davis explained. "Occas­ionally technicians will tell me that it's not part of their job, but I disagree. Technicians typically spend more time with patients and are charged with the responsibility of monitoring an animal's condition. You need to be able to alert the veterinarian if anything changes, and one way to do that is with the physical exam."

    When obtaining a patient history, technicians can group pieces of information that fit together, thereby leading to a nursing conclusion. It can be beneficial to develop a list of problems to help identify what's wrong with the animal and a list of things for which the animal may be at risk. "Think ahead about problems that can occur and what's likely to occur," he said. "Anticipate. Be proactive rather than reactive."

    The veterinarian will lead the treatment plan and its implementation, but a majority of the monitoring will be carried out by technicians. Davis said that during shift changes at his hospital, technicians go on rounds and discuss each patient's condition, what has been done, what needs to be done and any tips that can make the next shift go smoothly.

    "If you've been trying for 10 hours to get a cat to eat, for example, and you finally hit on something that the cat likes, then share that with the person coming on duty after you," Davis said. "Don't make [your colleagues] blindly reinvent the wheel."

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