The Royal College of Veterinary Surgeon's Code of Professional Conduct for Veterinary Nurses (2017) requires both the health and welfare of veterinary patients to be maintained and the legal and ethical definition of welfare includes an animal's emotional and behavioural needs as well as its physical needs (Hedges, 2017). Although veterinary nursing courses are increasingly emphasising to students the importance of understanding the natural behavioural and environmental needs and the emotional complexity of patient species, practising nurses often find it difficult to source the necessary support, or sufficient time, to meet their patient's emotional and behavioural needs. A previous article introduced an argument for the introduction of first aid behavioural support for patients into practice routine. This article is intended to provide some practical solutions that will enable veterinary staff to offer preventative welfare and behavioural first aid advice to the owners of canine patients.
Offering a consistent message and a consistent level of behavioural support
It is not the intention of this article to explain the ethology of the dog, but some good books are available (Horwitz and Mills, 2009; Hedges, 2014), and these will assist staff in developing an underlying competence in canine ethology and the dog's natural behaviour and needs. An understanding of the dog's natural behaviour is essential in supporting owners of dogs with behaviour problems, as many of the canine behaviours that owners struggle to cope with are actually natural responses to their environment (e.g. territorial barking; distress on finding themselves socially isolated; startling, barking, lunging or growling at novel stimuli and stimuli that are presented suddenly).
One study (O'Neil, 2013) suggested that behaviour problems resulted in the euthanasia of more dogs than any other medical factor, so it is imperative that clients see the veterinary practice as the ‘go to’ source of information on all aspects of canine behavioural care. It is also essential that the advice given within the practice is evidence-based, accurate and consistent — no matter which member of staff a client speaks to.
Due to differing staff interests, competencies and time restraints, offering a full behaviour service can be beyond the capacity of many veterinary practices. But the minimum responsibility of behavioural veterinary care should include offering basic behavioural support and this should be integral to the daily routine of the practice (Hedges, 2014), recognising that behaviours that owners find unusual or problematic are often indicators that a dog's welfare or medical needs are not being fully met (Zulch, 2019). This means that all members of staff should have a basic and accurate understanding of the welfare needs of the species represented in their patient base and, when client queries exceed their level of knowledge, that they can instantly refer a client to an alternative member of practice staff or an appropriately qualified clinical animal behaviourist (using the registers provided by ABTC, APBC or ASAB — see below). Clients with concerns about the emotional welfare or behaviour of their pet should always be given the impression that help and support is available.
The reception desk — the eyes and ears of the practice
Reception staff can fulfil a pivotal role in identifying dogs that require behavioural support. Simply by observing the responses of dogs within the waiting area, they can recognise dogs whose owners may benefit from a quiet, behavioural welfare-related chat with a veterinary surgeon or nurse. Consequently, whether reception staff are qualified nursing staff or not, they should be included in discussions of practice policy on behaviour-related issues. The websites of the major pet charities and the Association of Pet Behaviour Counsellors (APBC) provide excellent, free to download behavioural advice (see below) and reception staff should be encouraged to make themselves familiar with this material and how to guide clients towards it.
In addition, time spent in the waiting room can be an opportunity for parents and children to read through a resource such as Sophia Yin's ‘Dog Bite Prevention Activity Sheet’ (see below for a free, downloadable copy). Importantly, such time can offer an opportunity for reception staff to introduce information to owners on how the dog expresses distress within an environment (e.g. using a copy of the Kendal Shepherd's ‘Ladder of Aggression’ Figure 1).
The first opportunity to identifying problems may be in the consulting room
Whether a behaviour problem has been recognised by the owner or by a member of practice staff, the first step in resolution should always be a thorough physical examination to determine whether the behaviour change may be related to physical discomfort, sensory deficit or metabolic changes (Zulch, 2019). During such an examination, further information can be solicited from the owner regarding the progression of the behaviour change, both regarding the time-scale and the nature of its presentation. If a more ‘in-depth’ discussion would be of benefit, a separate time can be arranged for this to occur, allowing practice staff a little time for research. However, the next move should be to decide whether the problem can be best dealt with by:
- Offering ‘in-practice’ behavioural advice
- Offering ‘first-aid’ advice and then following up progress, or
- Offering first-aid advice while arrangements are made for a referral to a more qualified practitioner?
When making the above decisions, it is always important to also consider whether the client will be able to afford options that involve extra visits or referrals and how they will access such appointments. However, whatever the decision regarding the next option, the primary concern has to be reducing potential harm to the family, members of the public, the patient and any other animals within the home (Zulch, 2019).
An important practice consideration should be the implementation of regular health checks for canine patients, occurring between annual vaccinations. Not only will this help with recognition of developing health conditions, but it also assists in identifying behavioural changes associated with sensitive emotional developmental periods as well as those less likely to have an obvious initiating factor; this enables veterinary staff to provide early intervention in behaviour problems before an excess of learning and generalisation of trigger factors has occurred. This early spotting of problems and client education can prove crucial to ensuring that dogs remain with their families.
Behavioural first aid for common problems
In general, behavioural first aid should concentrate on:
- Reducing risk to the dog, family, other household pets, strangers and other animals met outside the home (Table 1)
- Management strategies to reduce the worsening of the problem (Table 2)
- Strategies that can do no harm and that should improve the situation (Table 3).
Table 1. Emergency strategies to reduce risk to others or the dog
| Purpose | Implementation |
|---|---|
| Safety of all parties | If a dog is aggressive, ensure that the dog is not exposed to the target of its aggression or placed in the environment in which it becomes aggressive.Ensure that the family is familiar with the signals that the dog is likely to use if it is becoming distressed (Figure 1) and explain that the dog should be immediately removed from a distress-inducing situation |
| Reducing escalation of an aggressive incident | Never use positive punishment (direct or indirect, physical or verbal). On recognising any behaviours from Figure 1, the family should remove the dog from the environment or, if this is not possible or safe, the person should move away from the dog |
| If the family are considering euthanasia, cannot cope with the dog in the house but want time to consider the situation | Keep a list of local kennels that have the competency and kennel design suitable to support dogs displaying difficult behaviours. Help the family to get a break from the dog while encouraging them to spend time visiting the dog in safe, open spaces |
| If the dog is showing any form of aggression | Explain to the family how they can introduce a Baskerville style muzzle (see Blue Cross below). This should be initiated by a family member who has a good relationship with the dog and in an open space. The muzzle should be used for ‘fun’ as well as in potential conflict situations. Teach the family to recognise signs of ‘distress’ in their dog (Figure 1) and to distance the dog from triggers whenever any signals of distress are shown |
| If the dog is targeting a family member in the home | Introduce a muzzle (as above) and a light-weight house line (see APBC advice sheet) so that the dog can be gently guided away from rooms without anyone inadvertently threatening the dog. Consider using baby-gates in the home. If a person is threatened, they should stop what they are doing, keep their arms down and stay quiet; they should lean slightly away from and look slightly downwards and away from the dog (maintaining a peripheral view of the dog). If they are unable to move away from the dog, they should pick up an item that could be used as a barrier, but they must not use this to threaten the dog. Provide a hiding place (den) that is always available to the dog but that is away from family activity |
| If the dog is likely to bark, growl, snap or bite when being touched or moved | Use a house-line (see APBC advice hand-outs) and food lures to move the dog while people remain at a safe distance. Do not confront or force the dog |
| If the dog is likely to attack another dog in the home | Separate the dogs into different areas of the home and do not try to reintroduce them without professional advice. Keep thick gardening gloves, blankets and cushions in every room, in case someone accidentally releases a dog — separate the dogs as soon as possible and with the minimum of fuss. Placing a visual barrier between the dogs may help (e.g. a blanket) — but the earlier this is applied the less likely it is that it will result in frustration-related arousal |
| If the dog is likely to attack another dog while outside the home | Do not take the dog out at ‘sociable’ times of the day or to ‘sociable’ environments — instead use e.g. large car parks and introduce games to increase interest. The dog should be muzzled and on a lead when outdoors. If the dog is generally distressed outdoors (use Figure 1 to discuss this with owners) exercise the dog in the owner's garden |
| If there is a risk to property (e.g. if the dog is damaging door frames or window frames in response to territorial triggers) | Keep the dog in a safe environment at trigger times, ensuring that this environment is as far from the trigger as possible. Only leave a dog in a crate if ‘crate trained’ and able to relax in a crate |
| If an animal is anxious or fearful about approaching a stimulus or entering an environment | Never force or cajole a dog to approach a stimulus or enter an environment that initiated anxiety or fear — this will only result in further emotional arousal and enhance the dog's need to use aggression |
Table 2. Basic advice that is helpful to virtually every behavioural scenario — for short-term use until a behavioural modification programme can be implemented
| Aspect of dog's life | General advice |
|---|---|
| Owner understanding of the problem | Many problem behaviours may be natural behaviours, e.g. digging, jumping up to greet visitors, licking people or barking at stimuli — explain this. Ensure that the owner understands that the dog is not being ‘bad’ or trying to ‘dominate’ them |
| If the dog is exhibiting inhibited (shaking, hiding, avoiding) or aggressive (barking, growling, lunging, snapping) behaviour | Explain that the dog is misinterpreting situations as threatening and hence it is failing to cope. Ensure that the dog is not exposed to environments that initiate the behaviour |
| Owner's general behaviour | Avoid all triggers to the problem behaviour — do not expose the dog to people, animals or situations that trigger the problem |
| Owner response to unwanted behaviour | STOP all punishment — physical or verbal — no stern or raised voices, no pointing fingers, physical contact or use of ‘correctional’ aids, e.g. rattle cans, water sprays, citronella collars, choke collars or slip leads. Also ensure that no other response is made that may inadvertently reinforce the behaviour — owners should remain neutral and move away |
| Owner response to desired behaviour | Any behaviour that is desirable should be reinforced by giving the dog something that it likes — food, vocal praise, a short game BUT if the desirable behaviour is ‘resting/calm’, ensure the reward does not excite the dog |
| Different family members respond differently to the behaviour | Gather the family, explain the implications of not resolving the behaviour (often re-homing or euthanasia) and develop an agreed series of first aid strategies that everyone can follow. The dog needs a consistent and predictable environment |
| Owner's response to the dog in any environment | If safe, use small, tasty rewards to teach the dog a small array of co-operative behaviours, e.g. ‘look at me’, sit, lie, calm and re-call. Practice these throughout the day and in a variety of environments. Use these to give the dog guidance in situations, rather than leaving the dog to come up with a solution! |
Table 3. Helpful first aid strategies for specific types of problem — to help until a behavioural modification programme can be designed
| Nature of problem | General advice |
|---|---|
| Food or resource guarding | Only allow the dog to have access to ‘sensitive’ resources in places and at times when no one needs to disturb the dog. If a resource must be taken away from the dog, either offer an acceptable ‘swap’ for a more valuable resource (e.g. a very tasty treat) or, if this is not likely to be safe, lure the dog to another environment, give the dog a tasty reward, shut the door/barrier and remove the problem resource |
| Attention seeking, e.g. when the owner is on the phone, talking to people, trying to relax | Initially, ignore the behaviour but try to ensure that the dog is given an alternative but appropriate form of mental stimulation (e.g. puzzle feeding or food searching activity). Whenever possible, pre-empt the need for attention with suitable mental stimulation |
| Jumping up at visitors to the home | Do not allow the dog to be part of the greeting party — place it in another room (possibly with two doors between them) and give the dog an appropriate activity to keep it busy until the guest is settled. Teach the dog to sit/lie in many different areas of the home and with increasing activity around it. Once ‘settled’ ask confident visitors to request a sit/lie for a reward |
| Jumping up at people met on walks | Do not stop to talk to people until the dog has learned to sit/lie in increasingly stimulating situations outdoors |
| Problems during owner absence | Arrange a dog-sitter for the dog or someone who the dog can visit. Then seek professional help |
| Indoor toileting problems | Initially, medical issues must have been ruled out or treated. Ask questions about the time and location — particularly whether family members are present in the room — this should help determine whether this may be a ‘home alone’ issue or a fear associated with a particular stimulus. Give advice on the appropriate cleaning routine for soiled areas and the need for the family to remain calm at all times. If not associated with separation or fear, re-start toilet training using the same routines as for puppies to create a substrate and location connection. Gradually extend the period between opportunities to be allowed access to the latrine to produce bladder control |
| Specific anxiety, fear or phobia | Protect the dog from exposure to the trigger stimulus — keep the dog out of rooms that are exposed and close doors/windows/curtains/blinds to form visual and auditory barriers. Mask sounds with noise from radio/TV. Create a darkened, sound-proofed den that is constantly available (also see next point) |
| Repetitive behaviours, e.g. tail-chasing, limb licking, shadow-chasing | Get family to keep a diary of preceding events — no matter how trivial or how occasional — avoid exposure to such events and, if unavoidable, mask or pre-empt such events with an activity that the dog enjoys. If an episode is ongoing, appear to ignore it, create a none-startling distraction and get the dog involved in an alternative activity |
| Territorial responses to stimuli passing home or to visitors entering home | Do not allow the dog to have access to areas of the home where it can hear or see passing stimuli. Try to ignore territorial barking and, once quiet, try to offer an alternative activity in a quiet area, as a distraction (Figure 2). Do not allow the dog to be part of the ‘greeting party’ — ensure that the dog is in another area of the home when someone answers the door |
| Aggression to people or animals outside the home | Do not take the dog to environments where it may meet the target. If getting to a safe exercise environment means passing a trigger, either use a different route, drive there or do not go there. If there is a chance that the dog may accidentally meet a target, it should wear a muzzle and remain on the lead |
| Aggression to people inside the home | Never leave the trigger target in a room with the dog — never allow the dog to enter a room with the target without allowing the target the option to move out of the room. Always ensure that the dog wears a lead and muzzle when in an environment where it may meet the trigger target. Use barriers to prevent accidental meetings with target |
| Aggression to another household dog | If aggression occurs on sight, separate the dogs into different areas of the house — don't ‘swap’ the areas. If aggression is associated with triggers, identify all triggers and separate prior to exposure to triggers. Use a neutral room between areas, so that accidental escape does not lead directly to the other dog. If obviously distressed or the family are unable to manage, consider kennelling one dog. If the dogs can cope when in open spaces outdoors, continue social encounters on walks |
Many of the strategies that you suggest may sound like common sense and hence pointless, however, in the heat of a distressing situation, many owners fail to think of the obvious — so simple practical solutions that will be easy to implement are always worth mentioning (Zulch, 2019). In addition, advice that is simple will be the most likely strategies that a family will try to implement (e.g. placing the dog that jumps up on visitors in another room while the front door is opened). It is also important that you ask families what they have already tried, as you may have to explain why some advice that they may have heard or read (e.g. ‘never let your dog get away with bad behaviour — always make sure that he knows he's done ‘wrong’’) is never appropriate and is incompatible with enabling the dog to relax and learn an appropriate response. Also, by getting a detailed description of how appropriate strategies have been implemented, you may spot obvious and easy to correct flaws in technique.
Overall, when offering first aid advice for behaviour issues, the most universally appropriate advice is to separate the dog from the trigger for the behaviour; the more often the behaviour is practised, the more likely it is that the dog will learn that the behaviour helps it to cope — hence the behaviour becomes more entrenched, is used in a wider set of circumstances and in response to a lower level of exposure to the trigger stimulus (Hargrave, 2017). Therefore, if the dog is not coping when left alone in the home, then arrangements should be made for someone to visit the dog or for the dog to visit a ‘sitter’; if a dog is barking at visitors to a home, ensuring that the dog is kept in the garden or another room will at least keep visitors safe; if a dog is starting to guard the area under a table during meal times, ensuring that the dog is in another room at such times separates the dog from the family; if a particular member of family is being targeted by the dog, getting another family member to remove the dog if the target needs to enter the room, can prevent further accidents. Of course, simply placing a physical barrier between the dog and the target of the dog's behaviour may result in the dog's behaviour worsening if it becomes frustrated due to failure to gain access to its target — this is best managed by a family member engaging the dog in an interesting, possibly food-related, activity in an alternative area of the home. If the activity can be offered away from the target and prior to the target approaching, the strategy is likely to be far more effective, as the dog will not have already experienced the emotional motivation that initiates the undesirable behaviour (Hargrave, 2017).
Avoiding triggers to aggression that are met outside the home during walks, can be particularly difficult for owners to deal with. Dog owners are so used to being told that their dog must have at least two walks per day, that they can find it impossible to consider keeping their dog in the home and garden. However, if it is the outdoor environment that causes the dog to fail to cope then it is a welfare problem when the dog is exposed to this environment. Giving dog owners permission to not walk their dogs until the dog is capable of coping outdoors, can be tremendously helpful to both dog and owner — allowing both to relax (Zulch, 2019).
Before giving any of the advice below, it is absolutely essential that you are sure that there is no underlying or initiating medical problem associated with the dog's behaviour problem. It is also essential that any behaviour that may result in harm to a person or another animal, be referred to a suitably qualified clinical behaviourist, either within or outside the practice team.
Do not overlook the advantages of environmental enrichment
Whether a dog's behaviour is becoming difficult for a family to cope with due to social or environmental sensitivities, restricted exercise tolerance following medical treatment or due to old age, a need to restrict the dog's access to specific environments or situations or if the dog would simply benefit from increased mental stimulation during owner absence, enhanced environmental enrichment should not be overlooked as a supportive adjunct to treatment (Figure 3) (Ryan, 2014). Puzzle solving feeding games and food search activities will not only enable dogs with specific sensitivities to focus on alternative sensory input within a safer environment, but, when used correctly, they can enhance gentle exercise while encouraging problem solving and lowering expectations of immediate satiation of needs yet engaging positive emotional systems. Consequently, practice staff can help dog owners to support dogs with many minor challenging canine behaviours, by keeping a wide range of simple environmental enrichment items in the reception area, the use of which can then be demonstrated and explained to owners.
Should chemical support be considered?
Chemical support for the behaviour patient may be intended to alleviate a predisposing or maintaining health condition, to provide neurochemical support to enable behavioural change to occur or to provide support during environmental or behavioural modification that will enhance the patient's capacity to ‘cope’ and hence alter its behaviour:
- Supporting ongoing acute or chronic health problems — it is essential that a dog, whose owner reports behavioural change, undergoes a thorough medical examination. If a behaviour problem is of sudden onset in an adult dog or cannot be linked to predisposing problems during a developmental stage of the dog's life, it is highly likely to have a medical origin (Zulch, 2019). Much overlooked is the discomfort of muscular and skeletal conditions, e.g. a 1997 study showed radiographic evidence of osteoarthritis to be present in 20% of dogs older than 1 year and 80% of dogs of more than 8 years of age (Johnston, 1997). If chronic pain is suspected to have a role to play in a behaviour problem, then it is useful to remember that not every analgesic will suite every dog and that if treatment is intended to resolve chronic pain, then a multi-modal approach, for at least 4–6 weeks is likely to be more successful than trialing individual analgesics. If behavioural change is achieved, then individual products can be removed from the mix to identify efficacy (Penturn, 2019) within the individual dog.
- There is a small range of products licensed for the psychotropic support of dogs experiencing emotional problems. It may be obvious that an individual dog's welfare is so severely depleted, or that euthanasia of the dog is a serious alternative to therapy, that it is essential to immediately embark on psychotropic medication. If the practice does not have a veterinary surgeon familiar with the use of psychotropics in modifying behaviour, it would be wise to contact a veterinary clinical animal behaviourist (via access to the ASAB, ABTC or APBC registers — see below) as anecdotal evidence suggests that once used or if used ineffectively, specific psychotropic pharmaceuticals may not be as effective on a future occasion (Penturn, 2019).
- There are now a wide range of nutraceutical and herbal products available for use as adjuncts to treatment programmes to support behavioural change in dogs. However, it should be noted that research on the efficacy of specific products is still unavailable. In contrast, both CEVA Animal Health's Adaptil products and Zoetis' Sileo have been researched to show beneficial behavioural support in specific circumstances.
When to refer
An important part of the veterinary nurse's role is to ’keep within their own area of competence’ and ‘not hold out themselves or others as having expertise they cannot substantiate’ (RCVS Code, 2017). In addition, particularly when giving advice to owners of aggressive dogs, should clients, family members, members of the public or other animals be injured while a client is implementing advice given by a member of practice staff, there can be legal liabilities. Hence, as soon as a patient's needs exceed a practice's level of expertise or exceed the amount of time that staff have available for the provision of behavioural support, a referral should be made to a clinical animal behaviourist or veterinary clinical animal behaviourist (who, as a veterinary surgeon may also prescribe medication to support both ongoing medical and emotional health) (Heath, 2018) — contact details for whom can be found on the ABTC, APBC and ASAB registers (see below).
Specialising in behaviour
To enable the provision of basic behavioural support within a veterinary practice, there should be no need for nurses to specialise in behaviour — the basic nursing requirement to maintain an animal's emotional homeostasis and to minimise an animal's emotional distress during handling, restraint and the provision of nursing care equips nurses with a considerable degree of behavioural knowledge (Hedges, 2017). However, for those wishing to gain a greater level of competency within veterinary behaviour, there are increasing opportunities to gain access to part-time learning via online courses that are accredited to Level 5 and satisfy the requirements of the ABTC for registration as an Animal Behaviour Technician (ABT). An ABT provides preventative and first aid behavioural advice, as well as supporting clients working through behavioural modification plans that follow on from a diagnostic consultation. An ABT also undertakes audits to reduce patient distress associated with visits to the practice and offers veterinary behavioural advice and support to colleagues. There are also full, part-time and online Level 6 and 7 courses for those aspiring to become clinical animal behaviourists, enabling recognition of behaviour problems and creating behaviour modification programmes to overcome them while liaising with veterinary professionals in supporting animals whose behaviour is linked to pathologies. More details can be found on the ABTC website (see below).
Conclusion
Without realising it, the majority of veterinary nurses and veterinary surgeons are delivering behavioural first aid advice on a daily basis. However, the nature and quality of advice given within a clinic is often inconsistent and dependent on the individual member of staff that a client sees. This situation can be easily rectified and clarified, so that every client and their dog receive evidence-based behavioural support throughout their dog's life. The ultimate aim of any veterinary professional is to enhance the welfare of their patient — by providing adequate behavioural support the practice's patients benefit from enhanced welfare and the practice finances benefit from a retained and growing client base.
KEY POINTS
- Sudden behavioural change is an indication that something within a dog's external or internal environment has changed — this requires investigation and identification.
- A thorough medical examination is a pre-requisite of behavioural investigations.
- Pain is often a major factor in both sudden onset and ongoing behaviour problems. This needs to be overcome before behavioural change can occur.
- In offering behavioural first aid, safety has to be a prime concern — safety of the dog, the family, the public and other animals — so a risk assessment is essential to every case.
- Once first aid advice has been offered, serious consideration should be given to referring the case to a registered clinical animal behaviourist.
- Provision of consistent and evidence-based behavioural support bonds clients to the practice and maintains patient longevity within homes
Useful information and resources
- Association of Pet Behaviour Counsellors www.apbc.org.uk (including free to download advice sheets for clients)
- The Association for the Study of Animal Behaviour register of certified clinical animal behaviourists www.asab.org/ccab-register
- The Animal Behaviour and Training Council register of trainers and behaviourists can be found at http://www.abtcouncil.org.uk/index/abtc-members-by-region.html
- Advisory Council on the Welfare Issues of Dog Breeding http://www.dogadvisorycouncil.com/puppy/index2.html
- Blue Cross — Dog https://www.bluecross.org.uk/pet-advice/choosing-right-dog
- Blue Cross — Muzzle training https://www.bluecross.org.uk/pet-advice/dogs-and-muzzle-training
- Blue Dog Bite Prevention www.thebluedog.org/en/professionals/vet-practices-and-the-blue-dog
- British Veterinary Behaviour Association — Dog Friendly Practice www.dogfriendlypractice.com
- Dogs Trust — Buying a Dog or a Puppy https://www.dogstrust.org.uk/help-advice/advice-for-owners/buying-a-dog/buying-a-dog
- RSPCA Buying a puppy https://www.rspca.org.uk/adviceandwelfare/pets/dogs/puppy
- Sophia Yin's Bite Prevention Activity Sheet http://info.drsophiayin.com/dog-bite-prevention-activity-sheet-for-kids
- Sound Sensitivity Survey https://www.surveygizmo.com/s3/1038942/CEVAssl
- Sound Therapy for Pets www.dogstrust.org.uk/help-advice/dog-behaviour-health/sound-therapy-for-pets