What was your route into the profession, and how did you get involved in palliative and end-of-life care?
When I left school in 2002, I was too young to start veterinary training at college, so I worked as an auxiliary nurse. I did that for a year before starting my NVQ veterinary nursing qualifications via day release.
Since qualifying in 2005, I’ve had a varied nursing career, taking up posts in referral and first opinion clinics, working night shifts and working for charities.
I’ve always been drawn to older pets and wanted to work more closely with them as my career progressed. When I discovered Dignipets (a team of mobile vets and nurses in the midlands specialising in compassionate visits for pain assessments, hospice and palliative care, and dignified home euthanasia) was looking for a district palliative and hospice care district RVN, I just had to go for it.
I love my job as it enables me to spend time with families and, in doing so, identify the best way to support their pet at whatever life stage it is at.
What attracted you to work in the palliative/end-of-life sector – why is it important?
Owners can become quite overwhelmed when their pet is diagnosed with a chronic or life-limiting condition, and I think it is vitally important all parties receive as much comfort and expertise as possible.
For me, being able to support the whole family during this period of their pet’s life is an honour.
What does your role entail?
As a palliative care and hospice nurse, I conduct a lot of house visits to support my palliative and hospice cases. I can do blood pressure readings, change dressings and provide support for specific conditions, such as renal disease. A lot of my time is spent contacting the owners of our hospice patients to make sure everyone is doing okay, and if not, how we can best help support them.
I also suggest adaptations owners could make around the house to enhance their pet’s quality of life. Sometimes, though, it is all about the small actions – listening when an owner needs someone to confide in. Just being there can make a huge difference to their lives and that of their pet.
I help with disease education, as well as implement complex care plans, and conduct quality of life and pain assessments to inform my veterinary team. When all my appointments are done, I write reports for practices and owners. I also have additional responsibilities within Dignipets, such as supporting our receptionist and being involved in events such as our pet memorial walks.
Once upon a time, discussing euthanasia was taboo. How have attitudes changed over the years? Is it more acceptable/easier to approach with clients now?
Euthanasia will always be a difficult subject to broach. However, owners today seem open to considering all options when it comes to their animal’s well-being, with many opting for euthanasia at home on that basis.
Although it can be difficult to talk about, allowing owners to discuss their options ahead of time can help them make decisions and put plans in place – something they may find too difficult to do when the time comes.
Owners and pets tend to feel more comfortable at home in their own environment. Being part of a larger multidisciplinary team that includes local bereavement support counsellors, local pet crematoria and our own 24-hour emergency end-of-life veterinary team means I am able to spend a lot of time with the pets and their families, and refer if the need arises.
How have people’s attitudes changed to palliative/end-of-life care/home euthanasia over the years, and are these options more accepted now?
Owners certainly have more options now when it comes to helping their pet, regardless of its condition or stage. While it is difficult, I think owners are now making decisions based on what is best for their pet and not them, necessarily. So, they may take the decision to euthanise their animal because it will stop it suffering, even though they will miss it terribly.
Even though human medicine has a strong and well-known hospice and palliative care presence, pet palliative and hospice care is still relatively unknown. At Dignipets, we try to reach out to our local practices and communities to inform people of the services available – from local events to CPD talks. Subsequently, owners have become more aware different options are available – from practice and at-home euthanasia to the aftercare offered.
Having more choice is great, but it can also be more confusing for clients and they may need further support, which we, as community nurses, can give.
How do you approach home euthanasia conversations with owners, and why are these sometimes preferable to doing this in practice?
Owners can sometimes find it difficult to talk about such an emotional and personal subject in public. Many practices are excellent at having special rooms where they can conduct these conversations. Even so, some people just do not feel comfortable unless they are in their own home – which is where our mobile service comes into its own.
Everyone is different and it is important for owners to have all the options – either with their existing practice or with a mobile practice. When I am talking to a client who is about to have his or her pet euthanised, I always spend a lot of time just listening. Sometimes people just need to talk things through and feel heard. With their permission, I can help gently guide them through the euthanasia process and discuss the aftercare options.
How do you conduct a sympathetic home euthanasia?
We always take time to ensure clients are as comfortable as they can be, every step of the way. We discuss quality of life first, and if owners decide to say goodbye, we always give sedation prior to the final injection.
This allows owners time to say goodbye. We go at the clients’ pace and never rush.
What skills do you need to work in palliative and end-of-life care?
You need to be a good listener, have a good all-round knowledge of senior pet conditions and pain management, and be able to think on your feet. Empathy is extremely important, as is being able to appreciate clients’ needs and those of the patient.
What is are most rewarding and the most challenging parts of your job?
The most rewarding is when you see an improvement in the quality of life for a palliative or hospice patient, as a result of our help and support. For example, sometimes owners think euthanasia will be the only option for their elderly dog, but with the right pain relief and support, they sometimes “bounce back”.
Another highlight is being able to use my nursing knowledge on a daily basis. I feel extremely lucky to work with a dedicated team of vets that values my input in cases. The biggest challenge is when one of your long-standing hospice cases has come to the end of its life. Although I know we have done everything we can, it is always sad to say goodbye.
What has been the most memorable/rewarding case you have been involved in so far?
A case of a little dog with pancreatitis and inflammatory bowel disease. It had terrible painful episodes, which were distressing for the dog and the owner. The Dignipets team was able to work with, and support, this pet with a palliative care plan, and now she is completely different.
It has been months since the dog’s last painful episode and it is running around happy when we see it. Just seeing the dog so bright brings a smile to your face. This was such a lovely case as we were able to work closely together to support the client and the little dog.
Any advice for nurses wanting to work in this sector?
Get as much experience as you can in first opinion and referral practices first, as this will be invaluable when you are working alone. Disease education is an important part of the role, so you must have knowledge and experience of treating a large variety of conditions.
I would check out the International Association for Animal Hospice and Palliative Care website (www.iaahpc.org) and look into bereavement support CPD, such as the Blue Cross course. The district VN movement has started to gain momentum, too, so I would encourage VNs to check this out on Facebook.