However , there is a limitation to this , in that there is a shortage of VNs [ 51 ] . With 15,782 VNs registered in 2018 , and a total of 5,705 registered veterinary premises , there are approximately 2.8 VNs for every registered veterinary premises in the UK [ 51 ] . Another limitation is that there is no primary research on VN-led clinics , so this is an area where improvement can be made in the future . VNs are also limited in what they can do , although Schedule 3 has helped to broaden the role and remit of the VN .
VN-led clinics may also be appropriate once the dog has reached its target weight , to help prevent regain . German et al . [ 40 ] found that out of 33 dogs about half regained weight , although the majority ( 90 %) regained less than half the weight they had originally lost . Switching to a standard maintenance diet also predisposed dogs to weight regain . In practice , during VN-led clinics , the advice to owners should be dietary calorific restriction for their animal and continuation of the specific diet once the animal has reached its target weight in order to prevent regain .
Quality of life is reduced in obese dogs [ 35 ] but improves after successful weight loss [ 6 ] . German et al . [ 6 ] conducted a study in which they looked at 50 dogs and their HRQOL both before and after weight loss . In practice , VNs should utilise VN-led clinics to explain HRQOL to owners and how it would improve if their obese dog lost weight . However , as owners of overweight dogs often disagree with veterinary professionals about the status of their dogs ' weight [ 52 ] , and owners often provide personal narratives to account for their dog ' s weight status , this may be difficult .
There is no primary research on VN-led clinics , so this is an area that would benefit from further research in the future . Nurse-led clinics in human medicine were instead incorporated into this literature review . The findings can somewhat be transferred to VN-led clinics for preventing and managing canine obesity .
Doherty et al . [ 45 ] trained nurses in best-practice management of gout , including providing individualised information and engaging patients in shared decisionmaking . The study involved 517 patients , of whom 255 were assigned nurse-led care and 262 received usual care . The number of patients with a serum urate concentration less than 360 μmol / l at 2 years was higher in those receiving nurse-led care than those receiving usual care ( 60 % vs 30 %). At 2 years , all secondary outcomes favoured the nurse-led group . The implication for VNs is that VN-led clinics for canine obesity may be more effective than usual care , but more information and research is needed in this area in order to make recommendations for future practice .
Randall et al . [ 46 ] found that nurse-led clinics in human medicine have largely had a positive impact on patient outcomes , patient satisfaction and access to care , and mixed results on cost-effectiveness . Their findings are based on a systematic review , which is high up on the hierarchy of literature and therefore is academically very valid [ 53 ] . They searched in Medline , CINAHL and Embase , using the terms ‘ nurse-managed centres ’, ‘ practice ’, ‘ patterns ’, ‘ nurse ’, ‘ ambulatory care ’, ‘ nurse-led clinic ’, ‘ community ’, ‘ primary health care ’ and ‘ primary care ’. Papers were appraised using the Joanna Briggs Appraisal criteria [ 54 ] . The implications for VNs are similar to those from Doherty et al . [ 45 ] , in that we could transfer these findings to VN-led clinics . These clinics could also have a positive impact on patient outcomes , owner satisfaction , access to care and cost-effectiveness . As Randall et al . [ 46 ] is a paper on nurse-led clinics in human medicine , the author would make recommendations for further research in the area of VN-led clinics .
Qvist et al . [ 47 ] examined 596 patients from the real world and 356 patients from a clinical trial , to discover that structured nurse-led , hospital-based atrial fibrillation care appears to be effective , as patient outcomes in hospital-based , structured atrial fibrillation care are at least as good as those in trial settings . Implications for VNs are wide-ranging . Extrapolating this to VN-led clinics means that VN-led clinics in practice may be at least as good as those in trial settings . This means that if future research was carried out into VN-led clinics in trial settings , the results from this paper may enable researchers to denote that the clinics in practice are at least as good as those in trial settings .
Conclusions
Recent research on weight loss and HRQOL in overweight and obese dogs , and on nurse-led clinics in human medicine , has provided a complete understanding of the physical processes of obesity and how it could be managed via VN-led clinics . The reliability and validity of each study affect how the research may be used within practice . Current findings suggest that calorific restriction via VN-led clinics would be effective . However , the research studies do not consider the role of the VN in managing canine obesity , and this remains unclear . Consequently , this makes it hard for the VN to provide VN-led clinics . More accurate and complete future research will enable a comparison of VN-led care versus usual care in canine obesity . Once there is a clearer understanding of the VN ’ s role in managing canine obesity via VN-led clinics , steps can be taken to improve patient care .
Acknowledgements
The author would like to thank her dissertation supervisor , Claire Defries , for her ongoing support throughout her university course and the dissertation on which this paper is based ; Xenia Farmerova for her support in the final year of her degree ; and her clinical coach , Tracy Volante , for always checking in with her .
40 Veterinary Nursing Journal