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InFocus

Cooperative care in veterinary practice

Cooperative care can help minimise stress to patients, reduce injuries to veterinary professionals and increase owner compliance and trust in the profession

Working in the veterinary profession has always been challenging, but vets are currently facing unprecedented pressures (Coldwell, 2022; Pohl et al., 2022; Epp and Waldner, 2012).

What pressures are veterinary professionals facing?

Likelihood of injury

The likelihood of injury is just one of the problems faced by veterinary professionals. Surveys have shown that at least half of veterinary staff in practices report injuries during any given year (Gabel and Gerberich, 2002; Epp and Waldner, 2012), and this includes training situations where staff and students were affected (Tulloch et al., 2023).

Cats are often of particular concern in small animal practice, where visits can be especially stressful and the likelihood of complications from apparently minor injuries is greater (Mosedale, 2009). Most injuries from patients occur during handling, and infection rates from injuries caused by cats have been found to range from 30 to 60 percent – double that of dog bites (Gabel and Gerberich, 2002).

A 2019 BVA survey found that the prevalence of relatively severe injuries in large animal practice is even higher than in companion animal practice, with vets continuing to work in spite of injury due to staffing problems, and some considering leaving large animal practice altogether because of the high risk of harm (BVA, 2019).

A 2018 study (Parkin et al., 2018) of equine practice found that 2,292 injuries were reported by 620 respondents, equating to one injury every three years and seven months. The most serious injuries occurred during examination; 33 percent resulted in a hospital admission (of which 43 percent were longer than 24 hours) and 7 percent resulted in a loss of consciousness.

Compliance with veterinary instructions

Clients also find their animals difficult to handle. Compliance with veterinary instructions can be as low as 22 percent (Amberg-Alraun et al., 2004).

As a result, clinical conditions can worsen, antimicrobial resistance is more likely and the inappropriate disposal of unused medications can cause ecotoxicity or domestic poisoning (Maddison et al., 2021). If medication is not given or is given incorrectly, health is less likely to be restored, leading to a lack of confidence in veterinary practice and demoralisation and burnout in vets.

Not dealing with stress and fear in animals has far-reaching consequences beyond the veterinary surgery, even without taking into account ethical and welfare considerations that should make it essential

Clients may also delay taking animals to the vet, risking a build-up of harm and stress, thus making the potential for injury to vets higher. Not dealing with stress and fear in animals has far-reaching consequences beyond the veterinary surgery, even without taking into account ethical and welfare considerations that should make it essential (Koch, 2015).

How can cooperative care and handling make things better?

Fewer staff members dealing with more patients and increasingly demanding clients means that restraint-based handling is often the preferred option. Adding yet another requirement for staff to learn cooperative handling techniques may seem impossible in practices already burdened with training requirements; however, initiating cooperative care in veterinary practice creates a win–win situation. Veterinary staff benefit, behaviourists and trainers benefit, clients benefit and, above all, animals benefit.

A 2022 study of 1,176 dog owners found that, overall, participants disagreed with the use of restrictive handling techniques, regardless of their dog’s behaviour (Caroll et al., 2022). Men and owners with previous veterinary experience were more likely to prefer full body restraint for fearful dogs. Inexperienced owners or those with a stronger attachment to their dog preferred minimal restraint. Of course, sensitive animals may become fearful if they have all choices removed when restrained, thereby making future visits more difficult and raising the possibility of creating stress in animals that would have been safe with minimal handling (Koch, 2015).

Cooperative care training goes beyond the toleration of handling and husbandry procedures – it enables the patient to be an active, willing participant with agency (Dixon et al., 2023).

Cooperative care training goes beyond the toleration of handling and husbandry procedures – it enables the patient to be an active, willing participant with agency

Although cooperative care benefits all animals, it is essential to ensure handler safety in large animal care, where physical restraint is difficult or not possible. This type of care has become a common protocol in zoos and wildlife parks (Giljam, 2020), and it is also used in the equine field – literally (Shaw, 2021)!

But as with all effective training, success is not instant (Wess et al., 2022). Cooperative care requires the building of trusting relationships between veterinary staff, behaviourists and trainers as well as clients.

Cooperative care requires the building of trusting relationships between veterinary staff, behaviourists and trainers as well as clients

Behaviourists, owners and veterinary professionals in it together

It is nearly half a century since Karen Pryor brought the knowledge of positive reinforcement techniques out of the lab and into the world of animal training (Pryor and Lorenz, 2004), and her other seminal works and subsequent training for professionals have expanded the work across many species (Pryor, 2002, 2009). It can, however, still seem like an uphill battle to persuade clients that positive reinforcement is the best method for training their animals, and it has been even slower to catch on in veterinary practice (Feilberg et al., 2021).

Suitably qualified paraprofessionals such as trainers and behaviourists can provide a vital service which can ultimately remove some pressure from veterinary staff and make the working environment safer and more pleasant for people and animals. When combined with other stress-reducing measures in small animal practice (such as separate areas for cats, dogs and prey animals, the use of pheromones and more), cooperative care has the potential to reduce injury rates considerably.

It is also effective in large animal practice, where treatment often occurs in situ and with little access to specialist equipment or where transporting an animal may not be desirable or possible.

Training in cooperative care – who, what, when and where?

Happy Vet Visit courses for small animals and equines enable much of the preparatory work to be accomplished in the animal’s home, where stress levels are low and the client can be helped to learn to train stress-free handling for themselves. For example, many dog owners teach their dogs to give or “shake” a paw, but when done correctly, this is more than a mere trick – it can enable examination, nail clipping and raising a vein for blood work.

Cats can be trained just as easily as dogs, and cooperative care training can be of great benefit to feline mental welfare (Todd, 2023) as well as demonstrating to clients (and vet staff!) that cats are amenable to training.

Ideally, access to a veterinary surgery during the latter stages of training enables social visits to the clinic without handling or treatment and helps to practise learned behaviours. This brings the training and its results into the public arena, thus raising the potential to demonstrate the effectiveness to other clients and benefitting the behaviourist or trainer by developing relationships with veterinary staff. Horses can also be trained in their home environment, with the benefits extending beyond the clinical.

Using conditioned reinforcers in training has proven to be effective across a wide range of species, and many owners can pick up sufficient skills in a few sessions to accomplish training themselves

Using conditioned reinforcers in training has proven to be effective across a wide range of species, and many owners can pick up sufficient skills in a few sessions to accomplish training themselves (Herron et al., 2018). It is therefore possible to effect real and lasting improvement in the tolerance of handling in a relatively short space of time (Roberts, 2016), particularly if used as a prophylactic when working with a naïve animal with no previous history of handling stress. 

Final thoughts

Improving the client–animal bond is likely to improve the client–vet buy-in, even if it takes a little time and effort. Beyond this, it also helps minimise stress to patients, reduce injuries to veterinary professionals and increase owner compliance and trust in the profession. Cooperative care – it really should happen to a vet!

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