Atkinson T, Devaney J, Girling S. Animal handling, restraint and transport. In: Cooper B, Mullineaux E, Turner L (eds). Gloucester: British Small Animal Veterinary Association; 2018

Balakrishnan A, Benasutti E. Pain assessment in dogs and cats. Todays Vet Pract. 2012; 2:(2)68-749

Bamberger M, Houpt KA. Signalment factors, comorbidity, and trends in behavior diagnoses in dogs: 1,644 cases (1991–2001). J Am Vet Med Assoc. 2006; 229:(10)1591-1601

Beerda B, Schilder MBH, Van Hooff JARAM, De Vries HW, Mol JA. Chronic stress in dogs subjected to social and spatial restriction. I. Behavioral responses. Physiol Behav. 1999; 66:(2)233-242

Bleuer-Elsner S, Medam T, Masson S. Effects of a single oral dose of gabapentin on storm phobia in dogs: A double-blind, placebo-controlled crossover trial. Vet Rec. 2021; 189:(7)

Bloor C, Allan L. Pain scoring systems in the canine and feline patient. Vet Nurs. 2017; 8:(5)252-258

Burhans LM, Alligood MR. Quality nursing care in the words of nurses. J Adv Nurs. 2010; 66:(8)1689-1697

Burn CC. Bestial boredom: a biological perspective on animal boredom and suggestions for its scientific investigation. Anim Behav. 2017; 130:141-151

Casey RA, Loftus B, Bolster C, Richards GJ, Blackwell EJ. Human directed aggression in domestic dogs (Canis familiaris): occurrence in different contexts and risk factors. Appl Anim Behav Sci. 2014; 152:52-63

Camps T, Amat M, Mariotti VM, Le Brech S, Manteca X. Pain-related aggression in dogs: 12 clinical cases. J Vet Behav. 2012; 7:(2)99-102

Emerson RW. Convenience sampling, random sampling, and snowball sampling: how does sampling affect the validity of research?. J Vis Impair Blind. 2015; 109:(2)164-168

Fatjo J, Amat M, Mariotti VM, de la Torre JLR, Manteca X. Analysis of 1040 cases of canine aggression in a referral practice in Spain. J Vet Behav. 2007; 2:(5)158-165

Gajanayake I, Lumbis R, Greet G, Girling S. Nutrition and feeding. In: Cooper B, Mullineaux E, Turner L (eds). Gloucester: British Small Animal Veterinary Association; 2018

Goddard L, Irving L. Essential patient care. In: Cooper B, Mullineaux E, Turner L (eds). Gloucester: British Small Animal Veterinary Association; 2018

Goddard L, Phillips C. Observation and assessment of the patient. In: Cooper B, Mullineaux E, Turner L (eds). Gloucester: British Small Animal Veterinary Association; 2018

Gupta S, Frank BL, Masand PS. Gabapentin in the treatment of aggression associated with conduct disorder. Prim Care Companion J Clin Psychiatry. 2000; 2:(2)60-61

Hubrecht RC. Comfortable quarters for dogs in research institutions, 9th edn. In: Reinhardt V, Reinhardt A (eds). Washington, DC: Animal Welfare Institute; 2002

Jager J, Putnick DL, Bornstein MH. More than just convenient: the scientific merits of homogeneous convenience samples. Monogr Soc Res Child Dev. 2017; 82:(2)13-30

Jeffery A, Ford-Fennah S. The nursing process, nursing models and care plans. In: Cooper B, Mullineaux E, Turner L (eds). Gloucester: British Small Animal Veterinary Association; 2018

Johnson MR, Polak K, von Gontard C. Humane canine handling, capture, and transportation. Field Manual for Small Animal Medicine.: Wiley-Blackwell; 2018

Joiner T. An holistic approach to nursing. Veterinary Nursing Journal. 2000; 15:(4)142-148

Kanika K, Prasad S. Effect of massage on pain perception after administration of intramuscular injection among adult patients. Nursing and Midwifery Research Journal. 2011; 7:(3)

Leask E. Efficacy of EMLA cream for reducing pain associated with venepuncture in felines. Veterinary Evidence. 2021; 6:(3)

Levine ED, Ramos D, Mills DS. A prospective study of two self-help CD based desensitization and counter-conditioning programmes with the use of dog appeasing pheromone for the treatment of firework fears in dogs (Canis familiaris). Appl Anim Behav Sci. 2007; 105:(4)311-329

Lind AK, Hydbring-Sandberg E, Forkman B, Keeling LJ. Assessing stress in dogs during a visit to the veterinary clinic: correlations between dog behavior in standardized tests and assessments by veterinary staff and owners. J Vet Behav. 2017; 17:24-31

Mikkola S, Salonen M, Puurunen J Aggressive behaviour is affected by demographic, environmental and behavioural factors in purebred dogs. Sci Rep. 2021; 11:(1)

Moffat K. Addressing canine and feline aggression in the veterinary clinic. Vet Clin North Am Small Anim Pract. 2008; 38:(5)983-1003

Monsey L, Devaney J. Maintaining animal accommodation. In: Cooper B, Mullineaux E, Turner L (eds). Gloucester: British Small Animal Veterinary Association; 2018

Nogueira LB, Palme R, Mendonça-Furtado O. Give them a toy or increase time out of kennel at lawn areas: what is the influence of these interventions on police dogs' welfare?. Animals (Basel). 2021; 11:(8)

Norkus CL. Veterinary technician's manual for small animal emergency and critical care.: John Wiley & Sons; 2018

Odore R, Rendini D, Badino P Behavioral therapy and fluoxetine treatment in aggressive dogs: a case study. Animals (Basel). 2020; 10:(5)

Opperman E. The recumbent patient. Veterinary Nursing Journal. 2004; 19:(5)164-166

Orpet H, Welsh P. Handbook of Veterinary Nursing, 2nd edn. Chichester: Blackwell Science; 2011

Overall KL. Can we treat and manage animals in our care and not scare them?. J Vet Behav. 2020; 39:A4-A5

Peate I, Lane J. Bed bathing: how good cleaning turns into great care. Br J Healthc Assist. 2015; 9:(4)174-178

Royal College of Veterinary Surgeons. Code of professional conduct for veterinary nurses – professionals. 2017. (accessed 5 May 2023)

Sarrau S, Jourdan J, Dupuis-Soyris F, Verwaerde P. Effects of postoperative ketamine infusion on pain control and feeding behaviour in bitches undergoing mastectomy. J Small Anim Pract. 2007; 48:(12)670-676

Sharma G. Pros and cons of different sampling techniques. International Journal of Applied Research. 2017; 3:(7)749-752

Shaw J, Martin D. Canine and feline behavior for veterinary technicians and nurses.: John Wiley & Sons; 2014

Thompson-Hughes J. Burnout and compassion fatigue within veterinary nursing: a literature review. Veterinary Nursing Journal. 2019; 34:(10)266-268

Wake AAF, Stafford KJ, Minot EO. The experience of dog bites: A survey of veterinary science and veterinary nursing students. N Z Vet J. 2006; 54:(3)141-146

Yelland T, Whelan F. An introduction to handling aggressive patients. Vet Nurs. 2011; 2:(10)568-576

Do ‘CARE’ labelled canine patients get a lower standard of nursing care?

02 May 2023
17 mins read
Volume 14 · Issue 4
Figure 1. Diagram showing the layout of the questionnaire.


Aggressive patients are labelled as ‘CARE’ within their clinical history and the quality of nursing care they receive may be compromised because of concerns for staff safety. The aim of this study was to investigate if a difference in the quality of nursing care exists between aggressive patients labelled as CARE and other patients not labelled as CARE, hoping to identify whether this suggested a breach of patient welfare. This study used a cross-sectional, observational survey distributed online via social media veterinary nursing community pages. Open invitations were also emailed to the first author's own practice, and the RVC's Queen Mother Hospital for Animals. UK-based registered veterinary nurses who had been in practice within the last 12 months participated. Likert response categories of 1-5 were used to question registered veterinary nurses about how likely they were to undertake certain nursing activities for both CARE and non-CARE canine patients. In total, 390 registered veterinary nurses completed the questionnaire. Pearson's chi-squared test was used to statistically analyse the data. An association was discovered between level of nursing care and CARE or non-CARE labelled patients. Statistically significant differences (P=0.05) in nursing care were found under every nursing category for CARE patients. The key categories identified were patient hygiene, feeding, pain scoring, exercise and restraint. The current study provides evidence that aggressive canine patients do get a lower standard of nursing care compared to other canine patients. Areas of concern are highlighted when these differences are discussed in the context of animal welfare. The authors hope these findings serve as a prompt for practices to examine their performance towards aggressive patients to ensure adequate standards of nursing care and patient welfare are sustained.

Aggressive canine patients are not rarely encountered in practice, as current surveys show that 7% of UK owners' dogs demonstrate aggressive behaviour towards strangers (Casey et al, 2014), with human-directed aggression the main presentation of canine aggression reported to veterinary behaviourists (Bamberger and Houpt, 2006). Veterinary staff come into close contact with canine patients and so are more likely targets of aggression (Fatjo, 2007). However, despite the risk aggressive behaviour brings to veterinary personnel, the registered veterinary nurse must ensure the patient receives adequate care. The Animal Welfare Act 2006 ensures animal needs are met by the person responsible for their care, therefore this responsibility extends to registered veterinary nurses during their hospitalisation. Under the Royal College of Veterinary Surgeons (2017) code of professional conduct, the duty of registered veterinary nurses is to make animal health and welfare their first consideration by providing appropriate and adequate nursing care. However, the Royal College of Veterinary Surgeons code also states ‘Veterinary surgeons are not expected to tolerate threatening, aggressive, or violent behaviour or to compromise their personal safety when attending to animals’. This opens up an interesting discussion as canine human-directed aggression is a significant welfare consideration, as it can subsequently make clinical treatment of patients difficult (Odore et al, 2020). This queries if a balance between patient welfare and personal safety is possible if there is a considerable compromise to personal health and safety.

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