ABSTRACT: Visual impairment in dogs can arise through a variety of acute and progressive diseases, trauma and illnesses. This can be distressing for both the patient and owner because significant adjustments are needed to maintain quality of life. Veterinary nurses can help owners to understand the aids that can be implemented to support their pet and how to monitor developments and progress in its condition. As well as supporting owners at home, veterinary nurses must also implement specific holistic care for these patients in the hospital to maintain quality of life and reduce concern for both the owner and dog.
Visual impairment in pet dogs can be distressing for both the patient and owner and it is often just diagnosed, with little advice given to the client. However, support from veterinary nurses can provide vital guidance to owners on beneficial and suitable care at home, whilst remembering that specifically tailored care is also necessary for the patient when in the hospital environment.1
Owing to all the extra care and support needed for these patients, owners often feel that euthanasia is the best option because they are unsure how to cope with the needs of the patient. Blindness alone is insufficient justification for euthanasia; and in these cases veterinary nurse support is paramount for guiding concerned and apprehensive owners, bearing in mind that one of the most important aspects of the nurses’ role is to help support owners in challenging situations.2’3
Development monitoring
There are many adjustments that can be suggested to owners which are often initially overlooked as potential areas of concern for these pets. As veterinary nurses we continually use care plans to monitor our patients’ progress and to provide holistic care.4
The use of these care plans may also be continued at home to identify and facilitate the interventions needed to aid optimum well-being. This idea is taken from human medicine and the development aids supplied to visually impaired children and parents/guardians as well as incorporating the care plan ideas.5’6
Development monitoring for visually impaired patients is a similar concept to routine care plans – in that the owner is provided with initial assessments and a plan of interventions for their dog in order to aid positive adjustment and development. A. home monitoring chart is provided for the required interventions, and evaluation checks are made by the assisting veterinary nurse to ensure that the individual is coping well (Figure 1).
Home guidance
Veterinary nurses must be aware of the advice and aids required to support these patients in order to enable confidence in the development monitoring scheme for owners.
Home
Advise owners that the layout of the rooms in the home must stay the same to enable the animal to familiarise itself and move around confidently.2’7 Keeping feeding bowls, beds and toys in the same place is also important to enable daily living activities, such as eating, drinking and rest, to be maintained.8 Measurement of water and food intakes are also important to assess that the dog’s needs are being met.
The garden must also be made secure, if necessary, as these patients may become disorientated and will stray if doors or garden gates are left ajar.
Mobility and exercise
Research has shown that the use of a harness often makes visually impaired animals feel more secure as the owner is able more effectively to guide them. This helps to build confidence and a positive demeanour.7
As with visually impaired people, companions have been found to provide guidance and support to dogs with vision difficulties. Literature shows that visually impaired people often feel isolated and have a fear of leaving the home.8 However, guide dogs significantly enhance their mobility and, therefore, increase confidence in their ability to go out and about, which aids socialisation.9-10
Visually impaired dogs may benefit significantly from a companion dog to aid and guide them, but this is dependant on the compatibility of the dogs and the relationship between them.2'10&7 Veterinary nurses, therefore, need to take care if suggesting implementation of this aid to an owner. However, if a companion pet is already living with the visually impaired dog, this may provide a great benefit and support.
It is also worth discussing with owners that communication between their pet and other dogs may be compromised during exercise, because signs of submission or aggression through body language will not be noticed by their pet. It has been shown, however, that hearing signals, visual signals and smell are all indicators of aggressive behaviour, so visually impaired pets will learn to make use of other senses for interaction.
Potential problems arising from interaction with unfamiliar dogs should be discussed with owners, even if they have not experienced these issues with their pet in the past.11
Stimulation
Toys to provide stimulation – such as noisy items or food – may prevent boredom and encourage use of the dogs other senses, which can be a method of adjusting to the impairment and aid in accommodating to daily activities. 12.2,13&6 Owners should be encouraged to promote, where possible, the use of hearing, smell, taste and touch because their pet will then gradually begin to utilise these senses to replace the loss of sight (Figure 2).
Figure 2: Toys provide stimulation and may encourage the use of other senses
In the hospital
In the hospital environment, a nursing care plan is very important, to ensure individualised care whilst maintaining a degree of normality.4 It is important to be aware of the additional support required for a visually impaired patient over and above that required for its general care.
The assessment stages of any nursing care plan allow information to be obtained with regard to the patients normal routine, which enables daily activities to remain as normal as possible, whilst allowing any potential or actual problems to be managed.4 The owner is key to this process – owner involvement in the patients nursing care and information as to general daily needs is, therefore, of great importance.
Blind patients will have learned to accommodate to the constraints of their disability at home with routine tasks such as where to find their water and food and how to access the outdoors for elimination.8 However they will need to re-learn this if they are hospitalised, and the degree of assistance required from veterinary nurses in the hospital is significant in
order to respond to – and promptly act upon – the patients needs for optimal care.
Veterinary nurses should also remember key simple tips that can be initially overlooked – such as not overfilling bowls so as to prevent spillage and reduce distress and problems of hygiene. As with all patients, introducing familiar comforts and learning their usual commands will maintain normality and reduce stress.
Reduction of stress and anxiety is a major factor in the hospital care of these patients, owing to the unpredictable environment and unfamiliarity. Stressed animals can develop a compromised immune system, resulting in worsening of a condition or the manifestation of other conditions.14-15
Veterinary nurses should be accomplished at noticing signs of stress to enable the implementation of appropriate mechanisms to reduce this. These signs may include lip smacking, out-of-context yawing, panting and nose licking.16 Assessment of stress – either potential or actual – should be included in patient assessment, and suitable interventions planned as necessary. The type of intervention will depend on individual cases.
A specific consideration for visually impaired patients in the hospital will include padded kennels to prevent accident or injury.12 This could mean that a specially designed kennel is always kept padded for this purpose, or that items are available on demand when needed to prepare a kennel of this nature. It is also worth considering spending some time guiding the patient around the kennel environment until they are settled within their surroundings.17
Previously designed and implemented monitoring plans that have been made for the owner to use in the home environment must be maintained whilst the patient is staying in the hospital, to enable continuation of the patients development and skills.5-17 This may also mean that if the patient has a canine companion, it may need to accompany the patient into the hospital, depending of course on the type of health issue and welfare of both the canine companion and patient.
Veterinary nurses must remember to promote the use of the patients’ other senses whilst they are in the hospital as startling them may result in unwanted behaviour. Speaking to the patient whilst approaching and making your movements heard will help to prevent alarm and negative or aggressive behaviour towards staff.17
Conclusion
Overall, the needs of visually impaired canine patients and their owners are significant and support from the veterinary nurse is vital to enable the owner to cope. Veterinary nurses need to assess all aspects of patient care, just as they would with sighted patients. However, additional areas must be considered, including additional aid for daily routines.
There is a need for further study into the most beneficial aids for our visually impaired patients; yet by supporting owners, assessing needs and implementing the available proven positive aids and care for these patients, we are a step closer to ensuring a higher quality of professional care for these animals.
Author
Laura Sheldon RVN MBVNA DipAVN(Small Animal)
Laura began work in veterinary practice in 2006, subsequently qualifying as a Veterinary Nurse in 2008. She then went on to study for the Advanced Diploma (Small Animal), which she has recently completed. Laura is employed at Derbyshire Veterinary Service Ltd and has been there for six years.
To cite this article use either
DOI: 10.1111/j.2045-0648.2012.00233.x or Veterinary Nursing Journal Vol 27 pp 418-421
References
1. HINDLEY, P. [2005] Development of deaf and blind children'. Psychiatry, 4|7|: 45-48.
2. Mitchell, N. (2010) Cats Living with blindness Part 2' Veterinary Nursing Journal. 225(6): 20-23.
3. YEATES, J. W. and MAIN, D. C. J. [2011] Veterinary Opinions on refusing euthanasia: justifications and philosophical frameworks', Veterinary Record (online) Available from: http://veterinaryrecord.bmj.com (Accessed on September 25th 2011)
4 ORPET, H. A. I2008I Advances in the delivery of practical nursing care – Practical examples', Proceedings of the 33rd World Small Animal Veterinary Congress (online) Available from: http://www.ivis.org lAccessed on August 22nd 2011)
5. SALT, A., DALE, N . OSBORNE, J. and TADIC, V. (2005) Development of a national monitoring protocol (development guide for children with visual impairment 0-36 months'. International Congress Series, 1282: 293-297.
6. WRIGHT, B. (20081 Development in deal and blind children', Psychiatry, 7(7|: 286-289.
7. MOORE. D. 12011) Cataracts and cataract surgery in the dog'. Veterinary Nursing Journal. 26: 273-275.
8. BHAGOTRA, S., SHARMA, A. K. and RAINA, B. (2008) Psycho-social adjustments and rehabilitation of the blind'. Journal of Medical Education and research, 10(1): 48-51.
9. BROOKS, A.. MOXON, R. and ENGLAND. G. C. W (2010) Incidence and impact of dog attacks on guide dogs in the UK', Veterinary Record, 166: 778-781.
10. MIZUKOSHI. M„ KONDO, M. and NAKAMURA. T. (2008) Evaluation of the potential suitability of guide dog candidates by continuous observation during training'. Journal of Veterinary Behavior, 3(5): 193-198.
11. FATJO, J.. AMAT. M„ MARIOTTI. V. and MANTECA X. (2008) The importance of Communication in Understanding Canine Aggression', Proceedings of the Southern European Veterinary Conference (online! Available from: http://www.ivis.org [Accessed on October 24th 2011]
12. BUSSE. C. [2011] The canine lens- cataract surgery and lens removal'. Veterinary Nursing Journal. 26(2): 59-61.
13. WILD, K. (2011) All stressed out and nowhere to go'. Veterinary Nursing Journal, 26:186.
14. SIRACUSA. C.. MANTECA. X., CVENCA. R.. ALCALA, M D M.. ALBA A.. LAVIN, S. and PASTOR J. (2010) Effect of a synthetic appeasing pheromone on behavioural, neuro-endocrine, immune and acute- phase perioperative stress responses in dogs', Journal of the American Veterinary Medical Association, 237(6): 673-681.
15. SLATER. H. (20111 Sleeping and sniffing-a world of difference'. Veterinary Nursing Journal, 26: 187.
16. RICCOMINI, F. (2010) Understanding desensitisation – making it work in practice', Veterinary Nursing Journal, 25(3): 23-26.
17. WATKINSON. S. and SCOTT, E. (2004) Managing the care of patients who have visual impairment', Nursing Times, 100(1):40.
Veterinary Nursing Journal • VOL 27 • November 2012 •