No amount of study can teach you some things. Case in point: earlier today I was working with some students to anaesthetise a patient and when I asked her to check the patient's heart rate, the student in charge of checking vital signs raced to place a pulse oximeter. I decided not to say anything, carefully watching the big dog's chest wall rise and fall, and the heart thumping away visibly against the chest wall so that I could easily count the rate. The pulse oximeter placement was a struggle for the student and a minute passed as she attempted to get a consistent reading, trying different locations, and fiddling with the wires. I quickly and silently used my stethoscope to listen to the heart and chest sounds, and digitally compared bilateral femoral pulse rates, then I visually checked mucous membrane colour and digitally assessed capillary refill time to assure myself that cardiac output was normal and that the patient was ok with normal heart rate and respiratory rate and pattern. I watched silently as the student looked quizzically at the monitor. ‘The heart rate is 45,’ she said. ‘Isn't that a bit low?’
I replied to the student, asking her what the normal heart range is for a large dog, she verified she knew the normal range and then asked. ‘So, I should tell the vet if the heart rate is so low?’ Her face looked concerned, and uncertain. Her usually strong academic performance was doing nothing for her in this situation where a patient's life was at stake and a problem needed to be solved. I proceeded to explain to her the limitations of relying on equipment and we worked together to assess the patient's vital signs again. Once we determined the patient was safe, and we had attached all of the necessary monitoring equipment, we talked about why it is important to assess multiple vital signs to make sure there is an accurate picture of the patient's wellbeing. Is the heart beating regularly but the mucous membranes are pale? Is there a pulse mismatch? Does the character of the breathing correspond to the oxygen saturation?
Even with all of the monitors hooked up properly, beeping, buzzing and whirring away, it never takes away the importance of verifying what you see right in front of you. In fact, the values we collected manually didn't even align perfectly with what the monitors were displaying and we discussed whether this was operator error, subjective measurement, or machine failure — all could be true and with careful assessment we could rule out unlikely options to come up with the most plausible answer. This is the human art of nursing.
The student learned a valuable lesson that day; about how even after an hour with monitors working away it still pays to check the patient using your own senses. We are only as good as our ability to critically reflect on our practices and in cases like this, relying heavily on equipment can lead to mistakes at best and at worst can lead to catastrophic failure.
Veterinary nursing is an activity of continual learning and evolution, an art as much as a science. As we gain tools to help us in our jobs, we also are faced with the reality that the physical body is unique for each individual and what works well for one patient might not work at all for another. We must use all of our senses to provide unique and holistic care to each patient and never stop striving to improve.
We hope you enjoy this issue.