There is no “one way” to make a visit a Fear Free℠ experience. Individual animals and clients will have individual preferences. While performing procedures we often have to touch our patients in sensitive areas. Creating a plan of action for each patient can be a quick process that saves time and creates a more pleasant experience for the veterinary healthcare team, the patient, and the client.
Considerate Approach, Gentle Control, and Touch Gradient
The following are definitions from the Fear Free℠ Certification Program. Considerate approach encompasses the interaction between the veterinary team and the patients and inputs from the environment while veterinary care is being administered. Gentle control is how the veterinary team comfortably and safely positions the patient to allow the administration of veterinary care. The goal of considerate approach and gentle control is to alleviate fear, anxiety, and stress (FAS) in your patients.
Some key concepts with gentle control include: restraint is frightening and creates FAS; use the least amount of restraint as needed. In general, it is beneficial to use treats before, during, and after procedures. Constant communication between team members is critical.
Touch gradient is a term used to describe how to touch our canine and feline patients to minimize fear, anxiety, and stress (FAS) during veterinary procedures. Touch gradient encompasses both gentle control and considerate approach.
Touch gradient has two components:
- It begins by maintaining continual physical hands on contact throughout the entire procedure or examination whenever possible.
- It includes acclimating a patient to an increasing level of touch intensity, while continuously measuring the patient’s acceptance and comfort.
Plan of Action
There are multiple components to creating a plan of action for a procedure.
1. Assess the patient.
a. Observe and notate body language and behavioral indictors of fear, anxiety, and stress.
b. Notate the current level of FAS based on the FAS scale.
c. Continuously reassess throughout the procedure.
2. Assess yourself.
a. Are you utilizing a considerate approach?
b. Ask for help if you are feeling uncomfortable.
3. Assess the environment.
a. Remove stressors in the environment.
b. Set up a calming environment.
4. Create a veterinary plan for care.
When creating the veterinary plan for care, first determine a reinforcement hierarchy/reward ladder for the patient today. You may refer to the emotional record of the patient but reassess the patient’s response today. Next, rank procedures as most to least important procedure. The veterinarian will be responsible for determining the importance of procedures. Now, rank the most important procedures as least to most aversive. Determine if there are stopping points for breaks in the procedure and what behavioral indicators for this patient will be considered a stopping point.
Once you have a high-level reinforcer for the patient, a plan for which order you will perform the procedures, and stop points, now consider the 3 Ws;
- Where will you perform the procedure? The exam room, treatment area, housing area?
- Who will be present? If possible, it is usually best for the owner to be present.
- What do you need to make the environment as pleasant as possible? What items do you need for the procedure? Get everything ready before the patient is brought to the area.
Always be willing to ask for assistance from other team members as needed for re-evaluation of the plan.
Want Versus Need
Wants are things that you would like to perform today. Needs are procedures that must be performed today because they are treatments that are vital to the health of the animal right now and waiting any length of time to perform them would be severely detrimental to the patient’s health.
For wants that are producing FAS in the patient, it does not mean the procedure will never be performed but instead we need to consider other options such as, being willing to reschedule. Perhaps the patient has reached his/her tolerance for today. Another day may be better. In the meantime, schedule some fun/victory visits for the patient to have a pleasant experience at the hospital. The veterinarian may consider dispensing previsit pharmaceuticals (PVPs). If rescheduling is not an option, sedation to minimize the potentially emotionally damaging experience should be considered by the veterinarian.
Case Examples and Discussion
Case examples will be reviewed and through audience participation options for a Fear Free℠ plan of action will be determined.
Through early recognition of behavioral signs of fear, anxiety, and/or stress and intervention on our end, we can prevent the escalation of fear in our patients. Thus, we can facilitate pleasant associations with the veterinary hospital and the procedures we want to perform. Creating a veterinary plan for care for each patient, will help facilitate a Fear Free℠ experience for all team members.
For more information on the Fear Free℠ certification program and resources visit: www.fearfreepets.com.