Understanding Compassion Fatigue: Keys for the Caring Veterinary Healthcare Team

Abstract

Have you ever wondered, “Do I care too much?” Do you leave the hospital or clinic exhausted and carrying the burden of the daily office stresses coupled with a tiring sense of emotional connection to your patients, your clients, and staff? Veterinary medicine has been well recognized as one of the most caring of all professions. This responsibility ot care for both the client and the patient, in combination with changes that we are presently experiencing in the veterinary world, has led us to a place where we experience the “cost” of this care. The “cost of caring,” as termed by Charles Figley, is a well-defined condition in the human medical literature known as “compassion fatigue.”1 Veterinarians are likely at great risk to experience this condition as a result of the nature of the work we do, the circumstances of our workplace, and the very characteristics that make us compassionate and effective caregivers. The purpose of this article is to discuss how the human-animal bond contributes to compassion fatigue, the factors that place the veterinary community at risk, the symptoms of this common form of emotional fatigue, and a few steps that the veterinary health care team can take to prevent and mitigate this condition.The veterinary profession has undergone numerous changes in recent years. No one would argue that there has literally been an explosion in technological advances and skills. Our medical, surgical, and disease prevention capabilities are expanding exponentially, exceeding what we had imagined years earlier. These developments and advances are in part the result of an evolution of the human-animal bond, which is considered THE motivating force causing people to seek routine preventative as well as advanced veterinary care for their animals. The “Bond” has essentially resulted in a much greater demand for veterinary care. It is also felt to be an even greater future driver for the field of companion animal medicine. The KPMG mega-study stated that harnessing the human-animal bond is perhaps the brightest light for the future success and growth of our profession.2 Our clients are asking us to provide more advanced care as well as better and more complete preventative care. This results in our patients living longer and better lives in close association with their owners. The longer a pet lives in close proximity to its caregiver, the greater the attachment between the two. This greater attachment serves to drive a greater need on the part of these attached clients for an even higher and more complete level of advanced care for their pets.Companion animals are no longer “kept” for primarily utilitarian purposes. Today, pets are considered by many to play an integral role in their personal lives. Companion animals are often considered members of families and referred to as children in many of those families. There have been tremendous advances in our understanding of the health and emotional benefits of pets and the human-animal bond. In some instances, the bond becomes so strong that animals become essential for the survival of their caregivers by providing both physical and emotional support.3 The human-animal bond is nothing new to veterinary care, as it has been a part of what we have known since the inception of veterinary medicine. In recent years, however, there has been an expansion and enhanced recognition of the importance of the bond in companion animals and companion animal practice. Recognition of this bond by veterinarians and their staff is universally accepted as an important determinant of a successful private practice. As a response to the bond, the veterinary healthcare team and the profession as a whole have placed more emphasis on acknowledging and appreciating the bond between caregivers and their pets. This requires attention to the medical needs of the patient. It also necessitates providing empathy to, and supporting the emotional needs of, the client. The deeper the bond between caregiver and pet, the greater the need for support of the emotional issues that surround veterinary care. The bond also affects the veterinary healthcare team members in a more personal manner. Most members of the veterinary healthcare team entered the profession to provide care, not only for the pets in question, but also for the caregivers with whom they must interact on a daily basis. The individuals within the veterinary healthcare team work each day as a response to their own need to “care” and at the same time are faced with clients that require emotional care. The attachment experienced and expressed by our caregivers requires not only a heightened level of medical attention but also “emotional” responsibility for the care of those pets by the veterinary healthcare team. Thus, the individual members of the veterinary healthcare team are at risk for compassion fatigue each time they recognize and give the proper attention to the nonmedical/emotional needs of the caregivers and families.The 1999 KPMG study points out that the veterinary profession is one made up of “caring” individuals. It is likely that the characteristic of caring increases our risk as a profession to the condition of compassion fatigue. In this report, the authors stated that one of the key findings that makes veterinarians effective caregivers is that private practitioners “love” working with both animals and people. It is the interaction with people in situations that require empathy that we become susceptible to compassion fatigue. Veterinary practice is extremely varied with many different challenges presented to every member of the veterinary healthcare team, often on an hour-to-hour basis. For example, each day a single clinician or staff member must be prepared to deal with the delights of new puppy visits, as well as the stresses resulting from the emotional concerns of death, euthanasia, and the financial considerations which may accompany advanced care. In addition, as a profession, we are exposed to death frequently. It has been estimated that veterinarians experience pet loss and death approximately five times more often than general medical practitioners. The pain and emotional stress of these deaths are felt not only by the veterinarian, but by the entire veterinary staff. Each time an emotionally charged situation is experienced by a member of the veterinary healthcare team, it is termed a “critical incident.”4 One can easily see the number of potential critical incidents that may be experienced by team members on any given day and how these can be compounded by day-to-day expectations of our clientele. Pet owners rank veterinarians first in compassion relative to seven other professions (physician, accountant, lawyer, etc.). Thus, as a profession, not only do we care, but we are expected to care compassionately by our clientele.Compassion fatigue is often mistaken as burnout. The two conditions are uniquely different; however, they appear to “feel” the same. Understanding the difference between both conditions is critical, because they have uniquely different causes and paths to recovery. Compassion fatigue is a condition that is the result of a depletion of our internal emotional resources. This depletion occurs when a clinician/staff member provides care to clients who are experiencing an emotional situation. Often these team members will listen intently, place themselves in the client’s “shoes,” and wish to lessen the pain that the client is experiencing. During these critical incidents, the veterinarian or staff member provides empathy to the client. Compassion fatigue results when the clinician/staff member are exposed to one or a series of these critical incidents. Each member of the veterinary healthcare team must be considered unique, and the way he or she deals with critical incidences is different and often based on unique life experiences, beliefs, and values. Burnout is driven by organizational concerns, policies, procedures, and bureaucracy. It is felt to be a significant contributor to compassion fatigue by intensifying the sense of exhaustion one experiences during compassion fatigue. Healthcare team members that do not adequately “care” for themselves or allow time and energy to replenish themselves enhance their susceptibility to compassion fatigue.Once compassion fatigue is experienced, it may affect our lives inside and outside of the workplace and affect us socially, biologically, and spiritually. Traditional methods for alleviating burnout are often employed to alleviate the symptoms of compassion fatigue; however, they are not effective for individuals experiencing compassion fatigue. In extreme situations, the cost of compassion fatigue has been that promising professionals or even seasoned ones have changed the direction of their career path.Veterinary healthcare team members experiencing compassion fatigue may exhibit a number of symptoms. These include psychological, emotional, behavioral, work-related, and interpersonal symptoms. Symptoms may be mild and considered the result of a stressful day, but they also can be severe and potentially devastating. Mild symptoms can include lowered frustration tolerance, loss of confidence, dread of working with certain clients, subtle manipulation of clients to avoid painful/traumatic situations, and loss of enjoyment of one’s career. The more severe symptoms can result in reduced functioning in one’s job situation or in noticeable changes outside the workplace. For example, compassion fatigue may result in mood swings and altered ways in which the affected individual may interact with a spouse, friends, and family.So how does one care compassionately, meet the medical and nonmedical needs of the caregiver and patient, and touch the heart of what brought them to a caring profession without experiencing fatiguing and potentially devastating consequences? First, we must acknowledge that as a profession, by the very nature of what we do and who we are, we are “at risk” for this condition. By knowing the name of this condition and believing that we are vulnerable, we can see the potential hazards, recognize situations that place us at risk for experiencing compassion fatigue, alleviate burnout, and hopefully prevent the devastating outcomes. We also must work with all members of our caring staffs to experience and then celebrate the sense of achievement in the work in which we are involved. On a daily basis, veterinary healthcare teams intervene in the lives of our clients and their pets to provide high-quality medical/surgical and preventative care while providing emotional support and validation for the bond that brought those pets and people to our offices. This is compassionate care, and when it is accomplished well, it requires a great deal of emotional energy from the clinician/staff member. By caring in this manner, we provide for the needs of our patients and caregivers. We need to appreciate the act of caring as the epitome of our success, regardless of the emotional nature of the situation or the medical outcome. There are many other strategies that will help our team members to manage the impact of this condition. Unfortunately, there is no way to avoid compassion fatigue completely. Besides just acknowledging the condition and knowing that we are at heightened risk to experience compassion fatigue, there are a number of strategies that one may employ to help manage the consequences. One must first take proactive steps to develop and maintain self-care, and achieve balance between personal and professional life by establishing and maintaining boundaries. Examples of “boundaries” might include utilizing alternate 24-hour care/emergency facilities, not going to the office on days off, not sharing home phone numbers with clientele, and not allowing work to encroach on previously scheduled family time. Relaxation techniques both within the hospital as well as outside the workplace are important. Taking breaks during the day and providing a sanctuary or comfort room for caregivers as well as staff members/doctors within the hospital may also be helpful. Getting in touch with nature and the outdoors is very helpful. Consistent ongoing aerobic exercise is vitally important. It is also thought that interacting with children and animals can help relieve the symptoms of fatigue. Finding a friend or colleague who understands and appreciates your empathy and level of compassion and who is willing to allow meaningful exchange can also be a significant mediator. Management policies that allow for debriefing after shared critical incidents as well as time during regularly scheduled staff meetings to allow for healthcare team members to discuss the emotional components of various client and patient interactions may be helpful.Providing compassionate care requires our ability to express empathy. It is in the action of this empathetic response that compassion fatigue can develop. When we find ourselves giving more than what we are replenishing ourselves with, it is only a matter of time before we will experience a shortage of our compassion and a sense of fatigue. Simply put, we have depleted our resources from within as we care for others. This paucity is not a reflection of our character, professionalism, or professional skill level, but rather our willingness to be emotionally engaged with another being that is hurting. The members of the veterinary healthcare team joined the profession to care, from their minds through medical/surgical/preventative skills and through their hearts by supporting and providing for the emotional needs of caregivers. This is vital for the success of veterinary care, as our deeply bonded clientele require attention. We as a profession must provide an enhanced level of compassionate care while at the same time preventing the emotional depletion of those individuals providing the care. By recognizing the issues surrounding compassion fatigue and providing mechanisms within a practice to mitigate its effects, a practice can thrive by providing the finest in compassionate care.