Table of Contents

• List of Contributors xvii
• Acknowledgments xix
• Introduction xxi
• About the Companion Website xxv
• Part I Overview of Hospice and Palliative Care 1
• 1 Introduction to Animal Hospice and Palliative Care 3
  Alyssa Eslinger
• 1.1 Introduction 3
• 1.2 Terminology and Definitions 4
• 1.3 Psychosocial Considerations 5
• 1.4 The Interdisciplinary Team 5
• 1.4.1 Role of Veterinary Technicians 8
• 1.4.2 Role of Veterinary Social Workers 8
• 1.4.3 Effective Use of Interdisciplinary Teams 9
• 1.5 Hospice Care Approach 9
• 1.6 End-of-Life Care Delivery Models 10
• 1.6.1 Role of Telemedicine 11
• 1.6.2 Informed Consent and Liability Considerations 13
• 1.7 Takeaways 13
• References 13
• 2 Pain Recognition and Assessment 15
  Alyssa Eslinger and Amy Birchall
• 2.1 Introduction 15
• 2.2 The Physiology and Classification of Pain 15
• 2.2.1 Somatic and Visceral Pain 17
• 2.2.2 Acute vs Chronic Pain 17
• 2.2.3 Neuropathic Pain 17
• 2.3 Pain Recognition 18
• 2.3.1 Fear, Anxiety, Stress, and Pain Recognition 19
• 2.4 Pain Assessment Tools 20
• 2.4.1 Simple Pain Scales 20
• 2.4.2 Multidimensional Acute Pain Scales 21
• 2.4.3 Multidimensional Chronic Pain Scales 22
• 2.5 Practical Pain Assessment 28
• 2.6 Caregiver Communication and Education 29
• 2.6.1 Caregiver Myths and Misconceptions 29
• 2.7 Takeaways 30
• References 31
• 3 Pain Management 33
  Alyssa Eslinger
• 3.1 Introduction 33
• 3.2 Role of Veterinary Technicians and Approach to Pain Management 33
• 3.3 Pharmaceutical Pain Management 35
• 3.3.1 NSAIDs 35
• 3.3.2 Opioids 36
• 3.3.3 Corticosteroids 38
• 3.3.4 Gabapentinoids 38
• 3.3.5 NMDA Receptor Antagonists 39
• 3.3.6 Other Adjunctive Analgesics 40
• 3.3.6.1 Local Anesthesia 41
• 3.3.6.2 Monoclonal Antibody Therapy 41
• 3.3.6.3 Bisphosphonates 41
• 3.3.6.4 Cannabidiol 41
• 3.4 Physical Modalities 42
• 3.4.1 Manual Therapy Techniques 43
• 3.4.2 Thermotherapy 43
• 3.4.3 Therapeutic Laser 43
• 3.4.4 Electrotherapy 44
• 3.4.5 Therapeutic Ultrasound and Extracorporeal Shockwave Therapy 45
• 3.4.6 Acupuncture 47
• 3.5 Nutrition, Nutraceuticals, and Herbal Medicine 47
• 3.5.1 Nutrition 47
• 3.5.2 Chondroprotectants 48
• 3.5.3 Herbal Medicine 48
• 3.6 Pain Management Case Studies 48
• 3.6.1 "Leo" – Canine Osteosarcoma 48
• 3.6.2 "BB" – Feline Osteoarthritis and Intestinal Lymphoma 49
• 3.7 Exotic Pet Pain Management 50
• 3.8 Caregiver Education and Communication 51
• 3.9 Takeaways 51
• References 52
• 4 Hospice and Palliative Nursing Care 55
  Alyssa Eslinger
• 4.1 Introduction 55
• 4.2 General Comfort Care 56
• 4.2.1 Environmental Modifications 56
• 4.2.2 Mobility 57
• 4.2.3 Hygiene and Toileting 60
• 4.2.4 Nutrition 61
• 4.2.5 Mucous Membrane Comfort 63
• 4.2.6 Fluid Support 63
• 4.2.7 Medication and Treatment Administration 64
• 4.2.8 Mental and Emotional Wellbeing 65
• 4.3 Sign-Specific Nursing Care 65
• 4.3.1 Recumbency 66
• 4.3.2 Wounds 66
• 4.3.3 Gastrointestinal Signs 67
• 4.3.4 Respiratory Distress 67
• 4.3.5 Musculoskeletal Signs 68
• 4.3.6 Neurological Signs 68
• 4.3.6.1 Neuromuscular or Spinal Disease 68
• 4.3.6.2 Intracranial Disease 69
• 4.3.6.3 Cognitive Dysfunction (CD) 69
• 4.3.7 Neoplastic Signs 69
• 4.4 Comfort Kits 70
• 4.5 Takeaways 73
• References 74
• 5 Understanding and Assessing Quality of Life 75
  Alyssa Eslinger
• 5.1 Introduction 75
• 5.2 Quality-of-Life Assessments 76
• 5.2.1 Effective Use of Quality-of-Life Assessments 76
• 5.3 Components of Quality-of-Life Assessments 78
• 5.3.1 Physical Wellbeing 78
• 5.3.2 Social Wellbeing and Mental Stimulation 79
• 5.3.3 Emotional Wellbeing and Autonomy 80
• 5.3.4 Other Considerations 80
• 5.3.4.1 Global Score 80
• 5.3.4.2 Caregiver Burden 80
• 5.4 Selected Quality-of-Life Assessment Tools 80
• 5.4.1 Selected Quality-of-Life Assessments 81
• 5.4.2 Individualized Quality-of-Life Questionnaire 83
• 5.5 Role of Telemedicine 85
• 5.6 Large Animal and Exotics Considerations 87
• 5.7 Takeaways 87
• References 88
• Part II End-of-Life Communication and Decision-Making 91
• 6 Building Essential Communication Skills 93
  Joye Sears and Becky Taylor
• 6.1 Introduction 93
• 6.2 Core Communication Skills 93
• 6.2.1 Nonverbal Communication 94
• 6.2.2 Asking Questions 95
• 6.2.3 Active Listening 97
• 6.2.4 Showing Empathy 100
• 6.3 Emotional Intelligence 101
• 6.3.1 Self-Awareness 102
• 6.3.2 Self-Management 103
• 6.3.3 Social Awareness 104
• 6.3.4 Relationship Management 104
• 6.4 Team-Based Communication 104
• 6.4.1 Getting the Team on Board 104
• 6.4.2 Building Skills Within the Team 105
• 6.5 Takeaways 105
• References 105
• 7 Supporting Difficult Conversations 107
  Joye Sears
• 7.1 Introduction 107
• 7.2 Difficult Clients vs Difficult Situations 107
• 7.3 Applying Communication Skills to Difficult Conversations 108
• 7.3.1 Partnership Statements 108
• 7.3.2 Warning Shots 108
• 7.4 A Model for End-of-Life Conversations 109
• 7.4.1 Setting 109
• 7.4.2 Perspective 109
• 7.4.3 Invitation 109
• 7.4.4 Knowledge 109
• 7.4.5 Empathize 110
• 7.4.6 Summarize and Strategize 110
• 7.5 Conflict Resolution 110
• 7.6 Types of Difficult Conversations 112
• 7.6.1 Grief 112
• 7.6.2 Delivering Bad News 112
• 7.6.3 Anger 113
• 7.6.4 Financial Conflict 114
• 7.6.5 Disagreement Within the Team 116
• 7.6.6 Disagreement Among Caregivers 119
• 7.7 Assess for Success 121
• 7.8 Takeaways 121
• References 121
• 8 Ethical End-of-Life Decision-Making 123
  Alyssa Eslinger
• 8.1 Introduction 123
• 8.2 Communication in EOL Decision-Making 124
• 8.3 Caregiver Perspectives on EOL Decision-Making 124
• 8.3.1 Conflicting Caregiver Perspectives 127
• 8.4 Factors for Veterinary Team Consideration in EOL Decision-Making 128
• 8.4.1 Quality-of-Life Assessments in EOL Decision-Making 128
• 8.4.2 Caregiver Burden and EOL Decision-Making 129
• 8.4.3 Caregiver Preferences and Euthanasia Timing 130
• 8.5 Considerations for Hospice-Supported Natural Death 131
• 8.6 Ethical Dilemmas and Moral Stress 132
• 8.6.1 Convenience Euthanasia 133
• 8.7 EOL Decision Documentation and Debriefing 134
• 8.8 Takeaways 134
• References 134
• 9 Death and Dying 137
  Alyssa Eslinger
• 9.1 Introduction 137
• 9.2 Animal Experience of Dying 138
• 9.2.1 Signs of Dying 138
• 9.2.2 Signs of Death 140
• 9.3 Natural Death vs Hospice-Supported Natural Death 140
• 9.4 Informed Consent for Hospice-Supported Natural Death 142
• 9.5 Ethical Challenges in Hospice-Supported Natural Death 143
• 9.6 Nursing Care in Hospice-Supported Natural Death 145
• 9.6.1 Environment and General Comfort 146
• 9.6.2 Anxiety 146
• 9.6.3 Pain 146
• 9.6.4 Nutrition and Fluids 147
• 9.7 Takeaways 147
• References 148
• Part III Euthanasia 149
• 10 Providing a Compassionate Euthanasia Experience 151
  Kathleen Cooney
• 10.1 Introduction 151
• 10.2 Defining Euthanasia and Dysthanasia 152
• 10.3 Meaningful Components of the Euthanasia Appointment 154
• 10.3.1 Grief Support Materials Provided 155
• 10.3.2 Outline Caregiver and Pet Preferences 155
• 10.3.3 Offer Privacy Before and After Death 156
• 10.3.4 Deliver Proper Technique 156
• 10.3.5 Establish Rapport 156
• 10.3.6 Use Pre-euthanasia Sedation or Anesthesia 157
• 10.3.7 Thorough, Complete Consent 157
• 10.3.8 Helpful and Compassionate Personnel 157
• 10.3.9 Adequate Time 157
• 10.3.10 Narrate the Process 158
• 10.3.11 Avoid Pain and Anxiety 158
• 10.3.12 Safe Space to Gather 158
• 10.3.13 Inclusion of Loved Ones 158
• 10.3.14 Assistance with Body Care (Aftercare) 158
• 10.4 Technicians in the Role of Euthanasia Provider 159
• 10.5 Communicating Effectively Before, During, and After Euthanasia 160
• 10.5.1 Establish Rapport 161
• 10.5.2 Find Comfort with Silence 162
• 10.5.3 Use the Basics of Good Communication 162
• 10.5.4 Offer Praise 162
• 10.5.5 Piece It Out 163
• 10.5.6 Create Partnership 164
• 10.5.7 Attend to Emotional Intelligence 164
• 10.6 Medical Records 165
• 10.7 Takeaways 165
• References 166
• 11 Anatomy of a Humane Euthanasia 167
  Kathleen Cooney
• 11.1 Introduction 167
• 11.2 Technicians as Euthanasia Attendants 167
• 11.3 Euthanasia Methods and the Physiology of Death 168
• 11.3.1 Methods of Euthanasia 168
• 11.3.2 Body Changes 169
• 11.4 Pre-euthanasia Sedation and Anesthesia Protocols 171
• 11.4.1 Effects of Pre-euthanasia Sedation and Anesthesia Protocols 173
• 11.4.2 Administration of Pre-euthanasia Sedation or Anesthesia 174
• 11.5 Euthanasia Room Comforts 177
• 11.5.1 Euthanasia in the Hospital Setting 177
• 11.5.2 Euthanasia in the Home Setting 179
• 11.6 Balancing EOL Work and Well-Being 180
• 11.7 Takeaways 181
• References 181
• 12 Euthanasia Techniques in Companion Animals 183
  Kathleen Cooney
• 12.1 Introduction 183
• 12.2 Euthanasia Injection Techniques 185
• 12.2.1 Intravenous (IV) Injections 186
• 12.2.2 Intracardiac (IC) Injections 188
• 12.2.3 Intrarenal (IR) Injections 190
• 12.2.4 Intrahepatic (IH) Injections 191
• 12.2.5 Intraperitoneal (IP) Injections 193
• 12.3 Alternative Euthanasia Administration Techniques 194
• 12.3.1 Oral Administration of Euthanasia Drugs 194
• 12.3.2 Intrathecal Anesthetic Euthanasia 194
• 12.3.3 Physical Methods of Euthanasia 194
• 12.3.4 Euthanizing Fetuses 195
• 12.4 Physical Changes During Death and Pronouncing Death 195
• 12.5 Exotic Pet Considerations 197
• 12.5.1 General Considerations for Patient Comfort 198
• 12.6 Unique Circumstances 199
• 12.7 Takeaways 200
• References 201
• 13 Respectful Deceased Body Care 203
  Kathleen Cooney
• 13.1 Introduction 203
• 13.2 Aftercare Ordering Models 205
• 13.2.1 Veterinary Aftercare Ordering Model (VAOM) 205
• 13.2.2 Client Aftercare Ordering Model (CAOM) 205
• 13.3 Respectful Body Containment 205
• 13.4 Moving a Deceased Body 208
• 13.5 Modern Options in Aftercare 209
• 13.5.1 Cremation 211
• 13.5.2 Burial 212
• 13.5.3 Aquamation 214
• 13.5.4 Body Preservation 215
• 13.5.5 Educational Memorial Body Donation 216
• 13.6 Minimizing Aftercare Mistakes and Exceeding Expectations 217
• 13.7 Expected Postmortem Changes and Decomposition 218
• 13.7.1 Decomposition 219
• 13.8 Takeaways 221
• References 221
• Part IV Grief and Memorialization 223
• 14 Introduction to Grief 225
  Sarah Bernardi
• 14.1 Introduction 225
• 14.2 The Fundamentals of Grief 225
• 14.3 The Human–Animal Bond: A Unique Loss 227
• 14.3.1 Guilt and Regret 229
• 14.3.2 Anger 231
• 14.4 Recognizing Grief Responses 231
• 14.4.1 Uncomplicated Grief 231
• 14.4.2 Disenfranchised Grief 232
• 14.4.3 Anticipatory Grief 232
• 14.4.4 Prolonged Grief Disorder and Suicidality 234
• 14.5 Factors Impacting Grief Responses from Pet Loss 234
• 14.5.1 Euthanasia 235
• 14.5.2 Sudden Loss 236
• 14.5.3 Loss of Service Animals 236
• 14.5.4 Culture and Spirituality 237
• 14.5.5 Perceived Social Support 238
• 14.5.6 Age 239
• 14.6 Considerations for a Grieving Pet 241
• 14.7 Takeaways 241
• References 243
• 15 Pet Loss Support 245
  Sarah Bernardi
• 15.1 Introduction 245
• 15.2 Language Sensitivity in Grief Support 246
• 15.3 Providing Grief Support and Memorialization 246
• 15.3.1 Aftercare Services 246
• 15.3.2 Memorial Activities and Keepsakes 249
• 15.3.3 Follow-Up Care and Support 252
• 15.3.3.1 Post-Death Phone Call 252
• 15.3.3.2 Sympathy Cards 253
• 15.3.3.3 Picking Up Remains 255
• 15.4 Developing a Pet Loss Resource Guide 255
• 15.4.1 Essential Components of a Pet Loss Resource Guide 255
• 15.5 Addressing Specific Grief Responses 256
• 15.5.1 Anticipatory Grief: Preparing Caregivers 256
• 15.5.2 Integrating Cultural Sensitivity in Grief Support 258
• 15.5.3 Integrating Spiritual Sensitivity in Grief Support 259
• 15.5.4 Supporting Grieving Pet Owners with Suicidal Ideation 259
• 15.6 Takeaways 260
• 15.a Pet Loss Resource Guide Template 262
• 15.b Suicide Response Guidelines for Veterinary Practices 263
• References 264
• 16 Children and Pet Loss 267
  Sarah Bernardi and Amy Sugar
• 16.1 Introduction 267
• 16.2 The Role of Technicians in Supporting Families with Children 268
• 16.3 Children's Perceptions and Age-Specific Advice 269
• 16.4 Talking to Children About Death and Loss of a Pet 272
• 16.4.1 Use Simple and Direct Language 272
• 16.4.2 Validate Feelings 272
• 16.4.3 Be Patient and Nonjudgmental 274
• 16.4.4 Avoid Euphemisms 275
• 16.4.5 Avoid Lying 275
• 16.4.6 Avoid Blame 276
• 16.4.7 Spiritual and Religious Considerations 276
• 16.4.8 Parent/Caregiver Resources for Children of All Ages 277
• 16.5 Supporting Children Through Diagnosis and Treatment of a Pet's Serious Illness 278
• 16.6 Involvement of Children Through Euthanasia 279
• 16.6.1 Preparing the Family for Euthanasia 279
• 16.6.2 Explaining Euthanasia to Children 280
• 16.6.2.1 Why Is This Happening? 280
• 16.6.2.2 What Does It Mean? 280
• 16.6.2.3 How Does It Happen? 281
• 16.6.3 The Presence of Children During Euthanasia 281
• 16.6.3.1 Children Under the Age of Five 282
• 16.6.3.2 Middle to Late Childhood (6–13 Years) 283
• 16.6.3.3 Teens and Young Adults (14–21 Years) 283
• 16.6.4 Preparing the Veterinary Team for Children-Present Euthanasia 283
• 16.6.4.1 EOL Comfort Kits for Children 284
• 16.7 Preparing for the Unexpected 286
• 16.8 Supporting Children's Grief Through Memorialization 287
• 16.9 Considerations for Getting a New Pet 289
• 16.10 Takeaways 289
• References 291
• Part V Team Wellness and Growth 293
• 17 Empathic Strain and Veterinary Team Wellness 295
  Sarah Bernardi and Kathleen Dunbar
• 17.1 Introduction 295
• 17.2 Empathic Strain in Veterinary Practice 295
• 17.2.1 Causes of Empathic Strain 297
• 17.2.2 The Role of Moral Distress in Empathic Strain 297
• 17.3 Personal Approaches to Mitigating Empathic Strain 298
• 17.3.1 Empathic Strain Personal Warning System 298
• 17.3.2 Mindfulness Practices 299
• 17.3.3 Professional Support and Mentorship 300
• 17.4 Organizational Strategies for Enhancing Well-Being 300
• 17.4.1 Leadership's Role in Ensuring Psychological Safety 300
• 17.4.2 Developing Policies and Procedures 301
• 17.4.3 Peer Debriefing 302
• 17.4.4 Integrating Veterinary Social Work 303
• 17.5 Takeaways 303
• References 304
• 18 The Future Is Bright 307
  Alyssa Eslinger and Joye Sears
• 18.1 Technician Utilization and Lifelong Learning 307
• 18.2 Meaningful Purpose and Leadership 307
• 18.3 Business Considerations 308
• 18.4 Veterinary Social Work 309
• 18.5 Specialization and Collaboration 309
• 18.6 Quality of Life Perspectives 309
• 18.7 Research Priorities 310
• 18.8 Conclusion 310
• References 310
• Index 311