Journal of Feline Medicine and Surgery

http://jfm.sagepub.com/

AAFP and ISFM Feline-Friendly Nursing Care Guidelines

Hazel C Carney, Susan Little, Dawn Brownlee-Tomasso, Andrea M Harvey, Erica Mattox, Sheilah Robertson, Renee
Rucinsky and Donna Stephens Manley
Journal of Feline Medicine and Surgery 2012 14: 337
DOI: 10.1177/1098612X12445002
The online version of this article can be found at:
http://jfm.sagepub.com/content/14/5/337

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>> Version of Record - Apr 17, 2012

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Journal of Feline Medicine and Surgery (2012) 14, 337–349

SPECIAL ARTICLE

AAFP and ISFM Feline-Friendly

Nursing Care Guidelines

Nursing care: The term nursing care means different things to different people. The authors
of these AAFP and ISFM Feline-Friendly Nursing Care Guidelines define nursing care as
any interaction between the cat and the veterinary team (veterinarian, technician or nurse,
receptionist or other support staff) in the clinic, or between the cat and its owner at home, Hazel C Carney
that promotes wellness or recovery from illness or injury and addresses the patient’s physical DVM MS DABVP (Canine and Feline)
Guidelines Co-Chair
and emotional wellbeing. Nursing care also helps the sick or convalescing cat engage in activities
that it would be unable to perform without help. Susan Little
Guidelines rationale: The purpose of the Guidelines is to help all members of the veterinary team DVM DABVP (Feline)
Guidelines Co-Chair
understand the basic concepts of nursing care, both in the clinic and at home. This includes methods
for keeping the patient warm, comfortable, well nourished, clean and groomed. The Guidelines provide Dawn Brownlee-Tomasso
numerous practical tips gleaned from the authors’ many years of clinical experience and encourage RVT
veterinary team members to look at feline nursing care in ways they previously may not have considered. Andrea M Harvey
Overarching goal: The primary goal of feline-friendly nursing care is to make the cat feel safe and secure BVSc DSAM (Feline) DEVCIM-CA
MRCVS
throughout its medical experience.
Erica Mattox
CVT VTS (ECC)
Principal goals of nursing care
Sheilah Robertson
The art of nursing care of the feline patient BVMS (Hons) PhD DACVA DECVAA
✜ Make the cat feel safe and secure in CVA MRCVS
Veterinary medicine is a combination of science the clinical setting and at home following
Renee Rucinsky
and art. Science uses research evidence and discharge DVM DABVP (Feline)
data to guide it, while the art of healing relies ✜ Minimize stress to the patient during
Donna Stephens Manley
on clinical experience, observation, patient- in-clinic and at-home treatment DVM
or client-directed feedback and the ability to ✜ Contribute to successful recovery from
interpret the patient’s state of mind. The illness, surgery or other treatment, and injury
patient’s behavioral response to treatment is
the central focus in the art of nursing care.
To provide optimal support to a well, sick,
injured or recovering cat, the art of nursing essential primary information regarding the
care is as important as medical science. importance of reducing the stress that cats
Most cat owners can readily detect which experience before, during and after the vet-
members of the veterinary team truly connect erinary visit.1 These Feline-Friendly Nursing
and exhibit empathy with their cats. Vet- Care Guidelines supplement the recommen-
erinary team members who apply both the art dations of the predecessor Feline-Friendly
and science of veterinary nursing care will not Handling Guidelines by placing greater
only deliver optimal healthcare to the cat but emphasis on the art of veterinary medicine
earn the confidence and appreciation of the delivered by the veterinary team in the clinic
practice’s clients. Involving the cat owner is a and by the cat owner at home. The primary
key aspect of successful feline nursing care goal of these Guidelines is to make the cat feel The AAFP and ISFM welcome
and requires client education, guidance and safe and secure throughout its medical experi- endorsement of these guide-
support from the veterinary team. ence. By making the cat feel safe and secure, lines by the American Animal
The previously published AAFP and ISFM many challenges of handling the feline patient Hospital Association
(AAHA).
Feline-Friendly Handling Guidelines provide subside or disappear altogether (Figure 1).

DOI: 10.1177/1098612X12445002
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S P E C I A L A R T I C L E / AAFP/ISFM guidelines on feline-friendly nursing care

Understanding fear and stress from the cat’s perspective

Upon entering the clinic and throughout their visit, cats perceive a gauntlet of predators
(reception area, exam room, treatment/surgery, hospitalization)

Without a sense of security Figure 1 Ensuring

and wellbeing a sense of safety and
security is the ultimate
Frozen fear Aggressive ‘bad cat’ goal for managing feline
patients in the veterinary
clinic. When cats do not
With appropriate nursing feel safe and secure,
care and handling they display behaviors
associated with fear or
aggression. Both fear-
induced withdrawal
✜ Does not move ✜ Vocalizes (left-hand arrow) and
✜ Does not eat Content patient ✜ Bites/scratches aggression (right-hand
✜ Does not drink Cat feels like it has arrow) make treatment
no other options difficult or impossible. In
Cat looks like it does not
addition, the physiologic
need care, but it does effects of stress impair
recovery from illness or
injury. ‘Frozen fear’ and
‘Content patient’ images
courtesy of Hazel Carney.
‘Aggressive “bad cat”’
Goal: To make our feline patients feel safe and secure ©iStockphoto.com/
Anna Sematkina

While most veterinary medical guidelines Making the cat feel safe
address the veterinarian, these Guidelines and secure
contain nursing care concepts and methods
that will also benefit other members of the Veterinary team Understanding fear and stress
veterinary team, especially the veterinary from the cat’s perspective
technician/nurse. An appreciable number of members who Anticipating stressful situations
veterinarians are not comfortable working apply both the Cats are notoriously sensitive to their sur-
with cats or do not consider the feline patient roundings and have a well developed fight-or-
to be their first preference. An important goal art and science flight response. These self-protective respons-
of these Guidelines is to provide practical es, normally essential for survival, may be
recommendations for veterinarians and other of veterinary detrimental in a veterinary clinic or domestic
members of the veterinary team who find nursing care setting or when they persist for a prolonged
working with cats challenging. Many feline period of time. Unfamiliar circumstances (see
practitioners will find that the Guidelines will not only box below) that cats encounter in veterinary
cover familiar territory. However, the authors clinics may lead to the adverse effects of anxi-
hope to provide insights that even experi- deliver optimal ety and fear. These adverse effects suppress
enced clinicians may find helpful. healthcare to normal behaviors (such as rest and feeding),
Clinical improvement in the hospital is only and increase vigilance, hiding and dysfunc-
one aspect of treatment success. The ability of the cat but earn tional signs such as anorexia, vomiting and
the cat owner to provide a continuum of care diarrhea or even lack of elimination.2,3
at home will contribute substantially to a
the confidence Undesirable physiologic responses to stress
successful case outcome. Thus a key focus of of clients. include hyperglycemia, decreased serum
these Guidelines is how to involve the owner potassium concentrations, elevated serum
in the proper handling of the cat, both in the creatinine phosphokinase concentrations,
clinic and at home following discharge. The lymphopenia, neutrophilia, erratic response to
veterinary team that fails to provide home- sedation and anesthesia, immunosuppression,
care education or initiate communication with hypertension and cardiac murmurs.4–6 These
the cat owner after discharge may compro- changes can complicate clinical evaluation and
mise even the best hospital treatment. treatment of cats, and prolong hospitalization.

Common stressors for cats in veterinary hospitals

✜ Other animals and humans ✜ A cage environment that does not allow hiding
✜ Noise (eg, medical equipment, telephones, barking, human ✜ Unfamiliar caretakers
conversation) ✜ Unfamiliar food and feeding routines
✜ Smells and odors (eg, other animals, disinfectants) ✜ Sensory overload from busy hospital environments

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 S P E C I A L A R T I C L E / AAFP/ISFM guidelines on feline-friendly nursing care

While the veterinary team cannot eliminate Anesthetic complications are more common
all stressors, it can identify at least some in cats than dogs and are associated with
factors to modify or eliminate. The Feline- health status, age, weight, procedure type and
Friendly Handling Guidelines contain more urgency.9,10 Careful attention to patient assess-
information on environmental factors affect- ment and management before anesthesia can
ing hospitalized cats.1 reduce perioperative complications. However,
the cat’s response to fear and anxiety may
Recognizing fear and anxiety complicate or even preclude a thorough
Fear and anxiety in cats may first manifest as preanesthetic evaluation. Reducing or pre-
changes in ear position, eyes and facial expres- Avoiding empting stress in hospitalized cats can
sion, body posture, sweating from the paw excessive facilitate the presurgical examination and
pads, and tail movement. Fearful cats may preoperative laboratory testing, ultimately
attempt to escape. Vocalization (eg, mewing, restraint of the improving patient safety.
growling, hissing, spitting) may indicate an
escalating stress reaction. Some cats then show fearful cat is Satisfied owners and increased feline visits
overtly aggressive behavior such as biting, very important. Recently published studies have revealed an
scratching or attacking. Others respond to fear underutilization of veterinary healthcare for
and anxiety by ‘freezing’, whereby they become A heavy-handed cats in the US and Canada. While cat owners
immobile, silent and wide-eyed, or by engaging generally have a higher level of education
in displacement behaviors such as frantic approach will than dog owners, they are less likely to take
grooming. Distinguishing behaviors associated most likely their cat to the veterinarian than dog owners.11
with fear and anxiety from those associated Focus groups found that one of the most
with pain may not be easy. The Feline-Friendly increase the important factors contributing to fewer feline
Handling Guidelines contain more information visits to veterinarians is signs of stress exhibit-
about recognition of fear and anxiety.1
cat’s anxiety ed by the cat.12 Both the difficulty of getting
and make a cat into a carrier, and the vocalization and
Appropriate responses to the fearful physical signs of tension displayed by cats
and anxious cat handling even while in the veterinary hospital waiting room
Avoiding excessive restraint of the fearful cat is more difficult. and during examinations, distress owners. As
very important. A heavy-handed approach will a result, many cat owners avoid the unpleas-
most likely increase the cat’s anxiety and make ant aspects of the veterinary hospital visit by
handling even more difficult. The clinician, vet- simply not taking their cat to the veterinarian.
erinary assistants and cat owner should remain Improving the cat and owner experience
calm and patient. The veterinary team should before, during and after the clinic visit, includ-
be flexible and willing to tailor the visit to ing hospitalization, will encourage cat owners
the needs of the individual patient. The staff to present their pets more frequently for
should adopt an alternate approach to accom- wellness exams and earlier in the course of
plishing the goals of the visit if the cat is fearful disease.
and resists handling. This may include seda-
tion or a period when medical activity tem- Improved safety and job satisfaction
porarily stops in order to allow the cat to calm for the veterinary team
down. If the cat’s behavior suggests the pres- Aggression is one of the most commonly
ence of pain, however slight, provide analgesia reported feline behavior problems. Fear and
and reassess the cat’s response. pain encountered in the clinic are common
sources of feline aggression. Attacks on veteri-
Benefits of reducing in-clinic stress in cats nary staff typically involve biting or scratch-
Improved patient outcomes ing. The infection rate in untreated injuries
Favorable response of cats to a synthet- from cat attacks is high, ranging from
ic analog of feline facial pheromone 30–50%.13,14 Hand wounds are
(FFP) is an example of how nursing especially prone to infection.
Facial pheromones benefit cats at all stages
care can improve patient out- of the clinic visit
Improving the hospitalization
comes in a veterinary hospital A study at The Ohio State University College of Veterinary experience for the feline patient
setting. Hospitalized cats that Medicine found that exposing clinically sick cats to a topical decreases fear-based aggression,
had synthetic FFP applied to a synthetic FFP produced significant increases in facial rubbing, and better recognition and man-
grooming, walking and interest in food compared with the
towel in their cages significantly response in cats given a placebo. Cats also ate significantly more
agement of pain reduces pain-
increased both their grooming in 24 hours if they had access to a small cat carrier in which to hide based aggression.
behaviors and food intake.7 and FFP was in the environment.7 Furthermore, exposing cats to Decreasing fear and anxiety in
Exposing cats to synthetic FFP FFP during premedication for anesthesia made cats calmer at the hospitalized cat has other
during premedication activities the time of venipuncture8 compared with the response in benefits. Improved handling and
placebo-exposed cats. These results suggest that FFP
prior to anesthesia also made the treatment and the provision of a private place to rest are
housing of cats reduces stress not
cats calmer at the time of venous beneficial in hospitalized cats. Synthetic FFP spray only for feline patients but also for
catheterization.8 is useful in cages and on tables and blankets, the veterinary team. Staff members
while an area diffuser best permeates
cat housing areas.

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S P E C I A L A R T I C L E / AAFP/ISFM guidelines on feline-friendly nursing care

may experience increased job satisfaction if Nursing care in the clinic:

patients show signs of improved wellbeing, a ‘cat’s eye’ view
better case outcomes and less stress-induced
negative behavior. Finally, reduced time Actions that reduce the stress from the cat’s
required for handling fractious and uncooper- perspective as it progresses through the
ative cats improves treatment efficiency and clinic can be implemented at each location
work flow in the veterinary practice. within the clinic (see box below).

Nursing care recommendations applicable at each location in a typical veterinary clinic

Hospitalization
Exam room ✜ Cage should be large enough to accommodate a place to hide
✜ Keep the room and table warm, with a non-slip surface and for the litter box to be away from food, bedding and water
for the cat ✜ Provide familiar bedding, toys, food and litter from home,
✜ Distract and reward with treats or play and only remove when soiled
✜ Provide guidance to owners for appropriate interaction ✜ Using calming synthetic pheromones in the cage will increase
with the cat grooming behavior and food intake
✜ Read the cat’s personality and adjust your behavior ✜ Ideally separate cat and dog wards. Other cats and dogs should
to meet the cat’s needs be out of line of sight whenever possible
✜ Make sure all necessary supplies and equipment are ✜ Consider the microclimate of each cage based on patient
available in the room and avoid unnecessary traffic needs. Sick, geriatric, sedated and pediatric cats require a
into and out of the room higher ambient temperature
✜ Use calming synthetic pheromones in the environment ✜ Consider lowering light levels to encourage rest and to calm
anxious cats
✜ For receptive cats, provide positive interaction (grooming, playing
or petting) that is unrelated to medical treatment
Diagnosis & treatment areas
✜ Choose the quietest, least distracting
place for procedures; this may be the
exam room or treatment area
✜ Avoid exposure to other animals in
ation
common hospital areas such as Hospitaliz
radiology or treatment room Reception area
✜ Optimal carrier selection and
acclimation will decrease stress
s & as
osi
iagn t are ✜ Provide an elevated surface
D me n
at (table, chair, shelf, window
tre ledge) for the cat carrier
m
roo a ✜ Consider using panels or plants
E xam are to create separate areas for cats
on
pti
ce and dogs in waiting rooms
Re ✜ Consider immediate placement
of cats into an exam room
Surgery when possible
✜ Use calming synthetic
pheromones in the environment

Surgery In all areas . . .

✜ Do everything possible to minimize presurgical stress; eg, keep cat isolated until ✜ Minimize noise
after induction, keep something familiar with the cat, create a calming environment, ✜ Separate from dogs
lower noise levels in the presurgical area (talking, vacuuming, radio, etc) ✜ Minimize traffic
✜ Perisurgical management of room and body temperature, as well as pain and ✜ Keep cat carriers
hydration, is imperative elevated off the floor
✜ Close patient observation is also imperative (most anesthetic-related deaths occur ✜ Allow cat to hide
during recovery) when possible

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Veterinary team considerations in feline case management. When employed

Use a team approach to their full potential, technicians can carry
Monitor and respond appropriately to any out many tasks typically performed by the
evidence of stress in a feline patient at every veterinarian and can delegate certain duties to
stage of the hospital visit; this is an approach Each member other team members. An experienced techni-
that will help improve safety and efficiency of the cian understands the basic needs of the cat,
for staff and cat owners. To minimize the normal feline behavior, feline disease process-
patient’s stress, each member of the veterinary veterinary team es, and subtle clinical signs that owners may
team plays a role in the cat’s experience from overlook. For many technicians, effective
the time it enters the door until it leaves the plays a role communication with owners is a core compe-
clinic, and even afterward in monitoring in the cat’s tency and a skill that increases in value when
home care. The entire veterinary team should the veterinarian’s time is limited. By maintain-
understand what makes a patient’s visit go experience ing an open dialogue with the cat owner, the
smoothly and without mishap. This broad technician is well positioned to alert the vet-
umbrella of responsibility includes educating from the time it erinarian to any concerns the owner may have
cat owners about stress-free transportation of enters the door regarding their cat.
their cats to the clinic, utilizing patient-friend-
ly examination techniques, recognizing feline until it leaves Recommendations for reducing stress
behavior patterns, and creating a low-stress in the reception area
home environment for the patient.
the clinic, and ✜ Instruct reception personnel on providing
The veterinary team should have a even afterward suggestions to owners for optimal carrier
common interest in practicing safe and effec- design and transportation of the patient
tive handling techniques, in sharing knowl- in monitoring (see Feline-Friendly Handling Guidelines
edge to maintain a high level of service home care. for additional details).1
provision and in creating a culture of continu- ✜ Provide an elevated surface (eg, table,
ous improvement. shelf, chair, bench) to keep cat carriers off the
floor.
Optimize the value of the veterinary ✜ Separate dogs from cats or minimize time
technician or nurse in the waiting room to avoid encounters
The veterinary technician/nurse plays a vital between canine and feline patients.
role within the team. Involving the technician ✜ Figure 2 shows features of a cat-friendly
can help improve efficiency and productivity reception area.

Features of a cat-friendly reception area

Figure 2 (a) Reception

personnel are readily
accessible to the cat a b
owner in order to
respond to questions
or concerns. (b) The
waiting room includes
a separate area for
owners who want
additional privacy or to
isolate their cats from
other pets or clients.
(c) Bench seating allows
for elevation of the cat
carrier and placement
next to the owner.
(d) A towel draped over
the cat carrier provides
an impromptu hiding
place in the reception
area. Images courtesy c d
of FAB/ISFM

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S P E C I A L A R T I C L E / AAFP/ISFM guidelines on feline-friendly nursing care

Recommendations for reducing encourages the cat to relax. Positive

stress in the exam room behaviors may be subtle, such as a
✜ Provide a warm, quiet room change in facial expression or
with a comfortable, non-slip relaxation of body tension.
examination surface.
✜ Ensure that all necessary Recommendations for
supplies and equipment are reducing stress in diagnosis
immediately available to avoid and treatment areas
unnecessary traffic into and out of Cats can experience considerable
the room and interruption of the pain and distress from diagnostic
examination. or emergency procedures such as
✜ Evaluate the cat’s personality repeated venipuncture, cystocente-
and temperament at the time sis or placement of a large-bore
of presentation and adjust the central line.16 The effect of these
approach accordingly. interventions can be both cum-
✜ Offer guidance on how the cat ulative and additive when the
owner can appropriately interact same procedure is repeated or if
with the patient during the several different procedures are
examination (Figure 3). performed in succession. Use of
analgesics such as transmucosal
Recommendations for reducing buprenorphine may greatly facili-
stress during the physical exam tate execution of these tasks. If
✜ The mindset and physical appropriate physical restraint has
approach of the veterinary team failed, if the cat is already in pain,
is critical to successful interaction or if the intervention required will
with cats. Be patient, calm, positive be repeated or painful (eg, wound
and confident. Figure 3 The cat owner’s debridement, bandaging), chemi-
presence during the
✜ Taking time with feline patients actually examination can help cal sedation or general anesthesia combined
improves efficiency. A hurried approach may minimize the cat’s anxiety in with analgesic agents is appropriate.
response to environmental
create anxiety in the patient or result in an or procedural stress. Tips for reducing stress during diagnosis
incomplete examination or treatment. If the Courtesy of FAB/ISFM and treatment include:
cat remains calm and relaxed during the ✜ Location Choose a quiet area for performing
examination, its owner will gain confidence diagnostic or therapeutic procedures.
in the clinician. ✜ Positioning the patient Place the cat on a
✜ Note in the patient’s medical record Taking time soft, non-slip surface and in the most natural
approaches that have previously worked or with feline position for the planned procedure. For
not worked. example, perform cystocentesis in the
✜ Open the carrier door or remove the patients position that is most comfortable for the cat.
carrier top to allow the cat to exit on its own. This may be in a standing position or in
This will give the cat a sense of control and improves lateral instead of dorsal recumbency.
safety. Avoid forceful removal of the cat from efficiency. ✜ Feline facial pheromone Using synthetic
the carrier. Food or toys may entice cats to FFP in cages, tables or on blankets in
exit that do not do so voluntarily. A hurried procedure rooms and housing areas
✜ Examine the cat where it wants to be 10–15 minutes prior to a procedure produces
examined. This may be on the exam table,
approach may a calming effect.8
floor, scale or in the carrier. create anxiety ✜ Venipuncture Jugular, cephalic or
✜ The cat may perceive someone staring medial saphenous veins are appropriate
directly into its eyes as a threat. Slow blinking in the patient choices for blood collection. Medial
conveys trust and friendliness.15 saphenous vein catheter placement is a good
✜ If a cat becomes tense or agitated,
or result in an option for short procedures and blood draws.
temporarily interrupt the exam and allow the incomplete Positioning the cat for venipuncture of the
cat to relax. In a busy practice, it is tempting medial saphenous vein usually requires
to overlook this simple approach. examination or the least restraint and may be the most
✜ The most important thing to remember treatment. comfortable for many cats (Figure 4). Shaving
when examining a cat is not to overreact with is usually not required, making the procedure
forcible restraint or correction of resistant quicker and removing a step that may alarm
behavior. Cats that exhibit minor or upset the cat.
demonstrations of anxiety, such as fidgeting, ✜ IV catheter placement Avoid multiple
may respond best if the clinician continues the venipunctures by placing an intravenous (IV)
examination in a neutral, deliberate manner. catheter for repeated blood samples, fluid
✜ Always look for an opportunity to reward therapy and/or IV treatments, or in case
positive behavior with a treat or petting. This emergency access should become necessary.

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Recommendations for reducing

perioperative stress
✜ Do everything possible to minimize the
cat’s exposure to presurgical stress:
− Keep the cat isolated in a quiet place until
after induction;
− Provide a familiar object such as bedding
from home or a toy (Figure 5a; also
appropriate for the post-surgical environment);
− Create a calming environment by minimizing
levels of ambient noise, conversation,
or operation of equipment and appliances;
− Use synthetic FFP in the cat’s cage and in
the procedure room.
✜ Maintain appropriate perioperative room
and body temperature, and ensure adequate
pain control and hydration (Figure 5b).
✜ Monitor the patient closely during
Figure 4 Medial saphenous vein catheter placement is a good option for short procedures recovery, which is when most anesthetic-
and blood draws. Courtesy of Sheilah Robertson related deaths occur.10

Topical application of local anesthetic creams Techniques to minimize perioperative stress

to desensitize the skin can facilitate catheter
placement in non-emergency situations. Two a
topical anesthetics are available, lidocaine in
a liposome-encapsulated formulation and a
eutectic mixture of lidocaine and prilocaine.
Minimal systemic absorption occurs after
application of either product.17 Use a minimal
amount of restrictive tape to secure catheters.
Check tape and bandages frequently to
ensure they are not overly tight and have
not shrunk after becoming wet. Consider
suturing jugular catheters in place and
covering them with a small amount of elastic,
self-adhesive bandage.
✜ Administering subcutaneous fluids b
Warming subcutaneous (SC) fluids to the
cat’s body temperature can lessen discomfort
associated with administration. Warming is
usually done using a microwave or a warm
water bath. Each veterinary practice should
develop a protocol for achieving the correct
temperature that avoids burning the patient.
To determine the practice protocol, take a bag
stored under stable temperature conditions,
cut open the access port, and place the bag
upright in a container to avoid spillage.
Microwave the bag at 15 second intervals. c
Because the bag has an irregular shape,
agitate the contents after each cycle and then
insert a thermometer through the open access
Figure 5 (a) Familiar objects
port until a temperature of approximately create a less threatening
100–102°F (37.8–38.9°C) is reached. Record presurgical environment.
(b) A cat bag provides warmth
the power setting and time needed to reach and gentle restraint.
the target temperature in an accessible place, (c) Placement of an IV
catheter provides venous
such as next to the microwave or in a written access for multiple injection
protocol for SC fluid therapy. procedures or repeated blood
draws, minimizing discomfort
✜ Avoid exposure to other animals This in a feline surgical patient.
includes realistic photos or models of animals Images courtesy of Sheilah
Robertson
(illustrations are preferable).

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a b

Figure 6 A hospitalized cat

can readily access a litter box
with low sides (a), whereas a
high-sided litter box (b) would
be much more difficult to
access. Images courtesy of
Susan Little

Recommendations for reducing stress a

during hospitalization
Environment
✜ Maintain separate cat and dog wards
if possible.
✜ Keep patients out of each other’s field
of vision.
✜ Maintain low levels of light to calm Instead of a
anxious cats and encourage them to rest.
✜ Instead of a one-size-fits-all approach,
one-size-fits-all
create a cage environment designed for each approach,
individual cat’s needs and preferences.
✜ Use cages large enough to provide a place create a cage
for the cat to hide and to maintain the litter
box separate from food, bedding and water.18
environment
b
✜ Litter box size and height must match the designed for
cat’s size and mobility (Figure 6). Use the
cat’s preferred litter when possible. each individual
✜ Provide familiar bedding, toys, food and cat’s needs
litter from home; change bedding only when
soiled. and
✜ Adjust the microclimate of each cage based
on individual needs; sick, geriatric, sedated preferences.
and pediatric patients require a warmer
ambient temperature.
✜ To maintain the cat’s body heat, provide
comfortable bedding such as thick towels or
fleece, orthopedic bedding or yoga mats.
✜ Provide an inside-the-cage hiding place
c
such as a sturdy paper bag, cardboard box,
cat bed or carrier (Figure 7).

Stress-reducing methods suitable

for all areas of the clinic
✜ Minimize the cat’s exposure to noise
✜ Minimize the cat’s exposure to human
traffic
✜ Separate cats from dogs and other
animal species
✜ Keep cat carriers elevated off the floor
✜ Allow the cat to hide when possible
Figure 7 Three examples of inside-the-cage hiding places
✜ Use calming synthetic pheromones that provide security for the hospitalized cat. Images courtesy
of FAB/ISFM

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✜ Yoga mat material or non-slip rug pads for

a b
lining cage bottoms, kennels, or examination
tables to provide warmth and non-slip
surfaces.
✜ Washable oven or protective gloves
designed for handling animals, preferably
with long cuffs to protect the handler’s hands
and arms.
✜ Cat masks to minimize visual stimulation
and calm some cats.
✜ Cat bags for gentle restraint.

Feeding
Figure 8 Examples of cat-friendly equipment. (a) Cat scale with elevated sides. (b) Small blood ✜ Feed the cat its regular diet during
collection tubes. Images courtesy of Dawn Brownlee-Tomasso hospitalization. Ask the owner to bring in
favorite treats if appropriate.
✜ Start therapeutic diets when the cat returns
home and its normal appetite returns.
✜ Flat food dishes, such as small paper
plates, and shallow water bowls will improve
intake by making food and water more
accessible.
✜ Warm canned food to the cat’s body
temperature by microwaving or adding
warm water. Additions of chicken broth or
tuna juice may enhance palatability.
✜ Do not leave food in cages of cats that
Figure 9 A thick towel or
fleece provides warmth and display food aversion (drooling, licking lips,
security for the hospitalized ignoring the food bowl, vomiting).
cat. Courtesy of FAB/ISFM
✜ Food should always be fresh, provided in
small portions and replenished as needed.
Cat-friendly equipment and accessories ✜ Appetite stimulants may be useful in
The following equipment and accessories will selected cases for brief periods (2 days) in
help reduce the stress of hospitalization for conjunction with the methods outlined
the feline patient: above.19
✜ Easy-to-use scale with elevated sides ✜ Figures 10 and 11 illustrate other feeding
(Figure 8a). techniques for the hospitalized cat.
✜ Small, quiet fur clippers.
✜ Small-volume blood collection tubes General tips
(Figure 8b). Figures 12–14 illustrate some general tips that
✜ Large, thick bath towels or fleece for will minimize stress and hasten recovery for
restraint or placement in cages (Figure 9). cats during hospitalization.

Figure 11 Many cats benefit from a feeding tube when other

strategies to encourage eating have failed.19 Note that a soft
Figure 10 Hand feeding of small amounts of food, short-term use of appetite stimulants, Elizabethan collar is preferable where available. Courtesy of
and petting may encourage convalescent cats to resume eating. Courtesy of FAB/ISFM FAB/ISFM

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S P E C I A L A R T I C L E / AAFP/ISFM guidelines on feline-friendly nursing care

General tips for minimizing stress during hospitalization

Figure 12 (a) Brief periods
of exercise out of the cage
in a quiet room with a litter
box and food may improve
appetite and elimination
in hospitalized cats. Cats
should be kept out of direct
line of sight of each other;
in this instance, there were
no other cats in the ward.
(b) A technician or nurse
can encourage out-of-cage
activity during the cat’s
hospitalization and ensure
its safety. Images courtesy of
Susan Little

a b

Figure 13 For receptive cats,

non-medical interaction such as
grooming, petting, hand feeding or
playing may improve mental and physical
wellbeing and speed recovery.
a b Courtesy of (a) Heather O’Steen and
(b) FAB/ISFM

Examples of good nursing care in a hospital setting

a Figure 14 (a) The individual cage b

arrangement pictured contributes
to a low-stress hospital
environment by preventing direct
line of sight among patients.
(b) A convalescing cat has soft
bedding and a cardboard box in
which to hide; a soft neck wrap
comfortably secures the jugular
catheter. (c) A cat bed provides
warmth and security.
(d) Providing the postsurgical
patient with food from home
helps re-establish a familiar
routine. (e) Positive staff
interaction with receptive cats
contributes to the patient’s sense
of security
Courtesy of FAB/ISFM Courtesy of FAB/ISFM

c d e

Courtesy of Sheilah Robertson Courtesy of Susan Little Courtesy of FAB/ISFM

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 S P E C I A L A R T I C L E / AAFP/ISFM guidelines on feline-friendly nursing care

Practical nursing care tips for the cian/nurse may also demonstrate several
veterinary team and cat owner administration techniques to help owners
decide which option might be best for them.
Pet owner behavior in the exam room Owner education is especially important
Cats are not alone in experiencing anxiety because administering home nursing care is not
during a visit to the veterinary clinic. The cat intuitive to most cat owners. The veterinary team
owner who accompanies the patient into the can facilitate the process in the following ways:
exam room often feels some apprehension as ✜ Reinforce nursing care instructions for
well. When a cat senses its owner’s apprehen- The ability of the cat owner by providing them verbally
sion, the animal’s anxiety often increases. and in writing, as well as using available
The following pointers will help the pet owner the cat owner multimedia and online resources; if
to be a calming influence in the exam room: to provide a appropriate, demonstrating techniques
✜ Avoid human behaviors that, while (eg, administering medications or SC fluids)
intended to comfort the cat, may actually continuum of can be helpful. An owner instruction sheet
increase its anxiety. Examples include that includes the rationale for the patient’s
clutching the cat, talking or staring in its face,
care at home medical treatment, along with follow-up
and disturbing or invading its personal space. will contribute instructions and tips for appropriate home
Human sounds intended to soothe or quiet nursing care, will help ensure compliance.
(like ‘shhhh’) may mimic another cat hissing. substantially to ✜ Following the cat’s discharge, communicate
✜ Physical correction such as tapping the with the owner to confirm successful
a successful
cat’s head and delivering stern vocal treatment and address unexpected issues.
corrections may startle the cat and provoke case outcome.
the fight-or-flight response. Cat owners and The pet owner’s role at home
veterinary team members should remember The following nursing care tips will help the
that despite being family members, cats are cat owner become an extension of the veteri-
not human and react differently to discipline. nary team after the patient leaves the clinic:
✜ The cat will dictate when it wants to be ✜ For acute home care, identify a quiet,
handled. In the clinic setting, instruct the familiar, private space such as a small
owner not to handle or remove their cat from enclosure or alcove with good light where
its carrier until a member of the veterinary the owner can easily access their cat. A small
team requests otherwise. space allows for close monitoring of the cat
✜ Reinforce the cat’s positive behavior and and provides it with a sense of security.
ignore negative behavior rather than trying ✜ Establish a routine for administering oral
to correct it. medication to the cat.
✜ A bathroom sink lined with a soft towel or
Home care nursing tips for Home care nursing fleece provides an enclosed, secure place for
pet owners administering medication to a cat.
The veterinary team’s ✜ Successful patient ✜ Give the cat positive reinforcement (eg, treats,
responsibilities outcomes are dependent brushing, petting) for accepting medication.
Successful case outcomes are often on the ability of owners to ✜ Except when medications must be
dependent on the ability of the cat provide a continuum of care administered with food (eg, phosphate
owner to continue at home the nursing ✜ With appropriate client binders), do not use food as an aid to giving
care that began in the clinic. The veteri- education, guidance and medications, especially if this causes aversion
nary team’s responsibility is to ensure ongoing support cats can and reduces the cat’s food intake.
that the owner maintains optimal care be discharged sooner, ✜ Forcing the cat to accept medication is
of the patient at home. Appropriate which is beneficial to all stressful for both the owner and the cat.
owner education, guidance and on- ✜ Optimal nursing care Do not forcibly remove the cat from
going support by the team can also is not intuitive to most a hiding place or interrupt eating,
enable early discharge of the feline owners; therefore, client grooming or elimination for purposes
patient, which may benefit everyone. education is very important of administering medication.
When discussing treatment options ✜ Proactive follow-up ✜ Welcome questions and encourage owners
with an owner, the technician/nurse communication with the to call if they have any concerns about
may describe drug formulations that owner will confirm home nursing care, including administering
are available and ask the owner which successful treatment or medication. Offer alternate ways
option best matches both the cat’s identify unexpected issues (eg, different medication formulations) to
personality and the owner’s physical ✜ Give nursing instructions accomplish the treatment goal.
abilities. If an owner has no prior verbally, in writing and ✜ Explain to the owner healthy cat behaviors
experience of administering medica- using practical and signs of wellbeing that signal full recovery.
tion, the technician/nurse can offer demonstrations and/or Cats that feel good tend to sleep most often in
suggestions, such as a flavored liquid other multimedia resources a curled position. They groom themselves,
that may be easier to administer than when possible follow a normal routine, interact with their
a bitter tablet or a capsule. The techni- owner, and eat and eliminate regularly.

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Avoid things that annoy cats

Two common nursing practices that can be annoying ✜ When an Elizabethan collar is required,
to cats, and alternatives to each use one made of soft material instead of rigid
plastic (Figure 15a,b).
✜ Cats do not like tight or restrictive
dressings and bandages. Cats like to stretch
and move freely. Elastic, self-adhesive and
non-restrictive bandages are well tolerated
(Figure 15c,d). Most cats prefer a tubular
stockinette instead of white zinc oxide tape
or non-expandable gauze dressings.
✜ Many cats react negatively to alcohol for
skin cleaning or ‘wetting down’ an area prior
to venipuncture because they dislike the
smell or sudden cold sensation as the alcohol
evaporates. Use warm sterile saline or water
a b as an alternative.
✜ Cats mark their territory with facial
pheromones and will exhibit this behavior
in a hospital cage. They may display facial
rubbing of bedding, boxes, cage walls and
doors. Avoid cleaning some of the marked
areas in the cage.
✜ Cats are well known for cleanliness and
attention to grooming. Sick or debilitated cats
are typically less able to groom and need
caregivers to groom them. Remove any
blood or medicinal solutions from the cat’s
c d
skin or hair to decrease the personal hygiene
the cat must perform. Remove substances
Figure 15 A soft Elizabethan collar (a) is more comfortable than a rigid collar (b). A flexible
self-adhesive bandage (c) is preferable to a stiff, restrictive bandage (d). Images courtesy of that may taste unpleasant to the cat when
Sheilah Robertson it grooms.

First steps in implementing the Guidelines

✜ Designate a clinic champion to lead the
effort to implement the Guidelines in your Using action planning
practice Select a trained individual who Simply put, an action plan is a series of steps designed to achieve your
understands feline behavior, needs and disease objective – in this case, implementing these Guidelines in your practice.
processes, and is willing to coach other A good action plan is SMART: specific, measurable, attainable, realistic
members of the veterinary team and educate and time-specific. Develop a separate action plan for each initiative you
owners about feline nursing care. Encourage want to focus on. An action plan should include the following elements:
the nursing care champion to recommend ✜ A stated objective
changes to facilities, equipment, procedures ✜ Specific tasks to accomplish the objective
and staff behaviors that will enhance feline ✜ A person responsible for each task
nursing care. ✜ Target date for completion
✜ Use action planning to implement the ✜ Expected outcomes
Guidelines Include follow-up team meetings to
assess progress and make adjustments to the
Tips for putting together a SMART action plan
original plan (see right).
✜ Involve all members of your veterinary team in preparation
✜ Pick two or three nursing care initiatives to
of the action plan, or at least those individuals who will be
focus on initially Incremental progress will be
responsible for the tasks involved
more successful than trying to implement all the
✜ Clarify the success factor-related goal and create a prioritized
recommendations in the Guidelines at once.
list of tasks to achieve the goal
✜ Hold periodic meetings of the veterinary
✜ Identify any barriers or constraints that will keep you from
team Discuss the best approaches for
reaching the goal, and ways of overcoming the barriers
implementing recommendations in the
✜ List any resources that are critical to achieving your goal
Guidelines, review progress that has been
made, and find solutions to problem issues.

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SUMMARY POINTS
✜ Veterinary practices that care about their feline patients enough to utilize nursing
methods that accommodate the specialized needs of cats will reap numerous rewards:
– Veterinary team members will provide better care that facilitates treatment and recovery
of their feline patients;
– Owners will appreciate and respond to an approach that emphasizes the cat’s safety and security;
– Veterinarians will earn owner loyalty and will have a more productive, safer and happier veterinary team.
✜ These Guidelines are comprehensive and may seem daunting. However, even small improvements and
incremental progress in feline nursing care can pay immediate dividends and start building a culture of
skilled and compassionate feline care.

Acknowledgements for anaesthetic-related death in cats: results from the

confidential enquiry into perioperative small animal fatalities
The AAFP and ISFM would like to thank Boehringer Ingelheim and (CEPSAF). Br J Anaesth 2007; 99: 617–623.
Nestlé Purina for their sponsorship of these guidelines and for their 10 Brodbelt D. Feline anesthetic deaths in veterinary practice.
commitment to helping the veterinary community develop projects Top Companion Anim Med 2010; 25: 189–194.
that will improve the lives of cats. Grateful thanks also to all the 11 Perrin T. The Business of Urban Animals Survey: the facts and sta-
practices that are photographed within these guidelines. tistics on companion animals in Canada. Can Vet J 2009; 50: 48–52.
12 Volk JO, Felsted KE, Thomas JG and Siren CW. Executive summa-
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STRATEGIC PARTNERS IN FELINE HEALTH AND WELFARE

TOGETHER IMPROVING CATS’ LIVES WORLDWIDE
Collaborating to build a future of unparalleled cat care by:
✜ Raising the profile of the cat in the veterinary clinic ✜ Creating continuing education opportunities for veterinary care professionals
✜ Developing practice guidelines to facilitate high standards of feline health care ✜ Providing tools and resources to improve veterinary skills and knowledge

Available online at jfms.com, www.catvets.com

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