Compassion Fatigue in Veterinary Medicine
Compassion fatigue is another risk-factor in the veterinary profession for job dissatisfaction, burnout, moral distress, and attrition. Ethical dilemmas such as animal cruelty, a client’s inability to afford treatment and euthanasia can contribute to compassion fatigue.
What is Compassion Fatigue?
The term compassion fatigue or secondary traumatic stress is used to describe feelings of fatigue and job stress in healthcare professions, including veterinary medicine. Compassion fatigue is distinctly different than burnout, which is related to one’s working environment, including problems within an organization’s personnel makeup and/or management. [1]
Compassion fatigue, according to Charles R. Figley, PhD, who coined the term and has contributed extensively to research around this condition, “emerges suddenly with little warning…there is a sense of helplessness and confusion, and a sense of isolation from supporters; the symptoms are often disconnected from real causes, and yet there is a faster recovery state.” [2] Others have similarly defined compassion fatigue as “the deep feelings of suffering, sorrow, or sympathy to the point of exhaustion, associated with a deep desire to alleviate the pain or suffering of another person.” [3]
As we learn more about neuroscience, social science continues to evolve. Researchers are now proposing a change in how we think about compassion fatigue and secondary traumatic stress. Using a framework of empathy which allows us to experience another’s pain, fMRI data have documented that observing pain in others activates parts of the brain which mediates empathy for the person that is suffering.[4-5]
In other words, a person can empathize with someone who is experiencing pain, including emotional pain, without taking on that person’s emotional pain. This is referred to as compassion or “other-centered” care.[6] Whereas, for the person who becomes distressed at another person’s pain, a new term has been proposed, empathic distress, [4-5] which leads to problematic issues as outlined in the symptoms of compassion fatigue section.
Symptoms of Compassion Fatigue
While the veterinary profession attracts people who care deeply about the health and well-being of animals, they may be at risk for developing compassion fatigue, which has been attributed to the cost of caring. [2,7] The AVMA identified four of the more common signs and symptoms of compassion fatigue in veterinary medicine. [8]
1. Isolation
Isolation occurs when an individual is unable to connect with other people at work or outside of work. They may be in a room with othersand still feel isolated, alone and disengaged.
2. Apathy
Apathy is a lack of interest or energy about their situation. A person who is apathic tires easily and is disengaged in their life. They may disengage from personal or professional interests and relationships.
3. Bottled-up Emotions
Bottling-up emotions, regardless of the emotion can lead to memory problems, elevated blood pressure, or problems with memory, increased anxiety or depression. In one study of patients with suppressed emotions, they were shown to have an association with a risk for cardiovascular death by 30%. [9]
4. Sleep Problems
Sleep problems have been associated with adverse health effects such as an increased risk for stroke, diabetes, obesity, hypertension, depression, and heart attack. Sleep problems have also been associated with loss of productivity, mistakes on the job, and an increase in the likelihood of injury. [10]
Organizational Compassion Fatigue
Compassion fatigue can also be found at an organizational level, where an individual’s symptoms can affect the culture of an organization and its mission. The AVMA defines organizational compassion fatigue as “a toxic work environment that hinders efficiency and limits a practice’s growth potential.” [11] Organizational Compassion Fatigue symptoms include:
High absenteeism
Changes in co-worker’s relationships
Inability for teams to work well together
Aggressive behaviors between co-workers and with clients
Inability of staff to complete assigned tasks
Inability of staff to respect and meet deadlines
Lack of flexibility with staff
Constant changes in organization’s policies
Rampant rumor and gossip
Unhealthy competition between staff members [12]
How to Address Compassion Fatigue
As with any intervention, assessing well-being is the first step. Numerous organizations, including the AVMA, recommend the Professional Quality of Life Assessment (proQOL) tool. The proQOL is free and can be used by any helping profession, including healthcare.
In a review of interventions for compassion fatigue specific to veterinary medicine very few were found. Instead, the recommended interventions were occupational stress interventions from other healthcare professions. Recommended self-care or self-compassion training that sought to enhance personal resilience included:
· Therapy or counseling
· Coping-skills training
· Relaxation within a cognitive-behavioral framework, including mindfulness
· Cultivate compassion for others
· Grow compassion satisfaction
· Sustain social support [13-14]
Prevention of Compassion Fatigue
Organizational changes can help decrease compassion fatigue. Stowen (2022) outlines four categories of organizational changes.
1. Reduce workplace stress
· Review work schedules
· Review and adjust work hours and workloads
· Variety in routines
· Up-to-date equipment
· Adequate staff and administrative support
· Assess communication practices and update if needed
· Procedures for flextime and vacation
2. Minimize euthanasia stress
· Create criteria for the use of euthanasia
· Create criteria for the refusal of euthanasia
· Conduct all-staff debrief sessions when a particularly difficult euthanasia occurs
· Create a “safe place” for staff to unwind in the clinic
3. Provide interventions for stress
· Psychoeducation training for destressing
· Compassion fatigue or empathic distress training
· Employee assistance program (EAP)
· Handouts with on-line support
4. Promote social support
· Interventions that promote teamwork
· Culture building
· Peer support
· Encourage participation in on-line support groups [15]
Conclusion
Compassion fatigue or empathic distress is more common in the helping professions. Some of its symptoms include isolation, apathy, bottled-up emotions, and sleep problems. Without addressing compassion fatigue organizations are at risk for high absenteeism, lack of teamwork, and uncompleted tasks.
There are numerous ways to address compassion fatigue that include self-care and organizational changes. Having psychoeducation and coping skills training on site for all staff is seen as a good first step. Organizational changes are also recommended that include policies to reduce workplace stress, policies to minimize euthanasia stress, interventions for work-related stress, and systems that promote social support.
There are numerous resources specific to the veterinary profession as well as other resources that seek to address and reduce compassion fatigue. Most are free and several are also recommended by the AVMA.
Additional Resources
Veterinary-specific Resources
AVMA Reading List: Work-life Balance
This list offers resources that can help establish and maintain a good work-life balance.
This self-check guide suggests ways to lower stress and reduce your chances for health problems
Compassion Fatigue Workshops for Veterinary HR Teams and Managers
Katherine Dobbs, RVT, CVPM, PHR, speaks at veterinary conferences and local meetings in addition to providing consulting work and workshops on compassion fatigue for the veterinary team.
Compassion Fatigue in the Animal-Care Community
Written by Charles R. Figley, Ph.D., and Robert G. Roop, Ph.D., this book examines the causes of compassion fatigue and offers help for fighting it.
Coping with Stress and Burnout as a Veterinarian
Written by Nadine Hamilton, Ph.D., this book presents an examination of the problem, the ways veterinary mental health is influenced by their daily work and how to tackle it.
Creating Wellbeing and Building Resilience in the Veterinary Profession: A Call to Life
Written by Sonja A. Olson, DVM, this book aims to help veterinary caregivers increase self-efficacy, decrease unnecessary suffering, and increase sustainability in their mission to support animal health around the world
Stress, Compassion Fatigue and Burnout Handling in Veterinary Practice
Written by Patricia Smith and Inmaculada Pérez Madrigal, MBA, BVM, this book provides an in-depth look at burnout, compassion fatigue, stress, and vicarious trauma, along with strategies to manage the symptoms.
When Helping Hurts: Compassion Fatigue in the Veterinary Profession
This book, published by the American Animal Hospital Association, offers veterinarians and their teams tips for recognizing compassion fatigue and provides strategies for how to deal with it.
University of Tennessee Veterinary Social Work Program
The University of Tennessee veterinary social work program provides resources and insights on grief and pet loss, animal assisted interactions, the link between human and animal violence, and compassion fatigue and conflict management.
National Associations
American Foundation for Suicide Prevention (AFSP)
The AFSP is made up of scientists, survivors of suicide loss, people with mental disorders and their families, and a network of business and community members dedicated to understanding and preventing suicide through education, research and advocacy. The group organizes events across the nation each year.
Center for Workplace Mental Health
The Center for Workplace Mental Health provides employers the tools, resources and information needed to promote and support the mental health of employees and their families.
Compassion Fatigue Awareness Project
The mission is to promote an awareness and understanding of compassion fatigue and its effect on caregivers. They disseminate useful information that can be readily introduced into caregiving environments in order to impact the lives of caregivers in a positive way.
Job Burnout: How to Spot It and Take Action
The Mayo Clinic offers signs and symptoms of work-related burnout, and how to combat them.
National Suicide Prevention Lifeline
The National Suicide Prevention Lifeline is a 24/7, confidential, toll-free suicide prevention hotline for anyone in emotional distress or suicidal crisis. It works with a network of more than 150 local crisis centers that provide mental health referrals and counseling day and night. The Lifeline site provides crisis center locations and information about getting help and contacting a safety team. 1-800-273-TALK (8255)
References
[1] Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-11.
[2] Figley CR. Compassion fatigue as secondary traumatic stress disorder: An overview. In: Figley CR, ed. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York, NY: Taylor & Francis Group; 1995:1-20.
[3] Tabor PD. Vicarious traumatization: Concept analysis. Journal of Forensic Nursing. 2011;7. doi: 10.1111/j.1939-3938.2011.01115.x
[4] Klimeck OM, Singer T. Empathic distress fatigue rather than compassion fatigue? Integrating findings from empathy research in psychology and social neuroscience. In: Oakley B, Knafo A, Madhaven G, Wilson DS, eds. Psychological Altruism: New York: Oxford University Press, 2012:368-383.
[5] Hofmeyer A, Kennedy K, Taylor R. Contesting the term ‘compassion fatigue:’ Integrating findings from social neuroscience and self-care research. Collegian. 2020;27. https://doi.org/10.1016/j.colegn.2019.07.001
[6] Dowling T. Compassion does not fatigue! Canadian Veterinary Journal. 2018;59:749-750.
[7] Cohen SP. Compassion fatigue and the veterinary health team. Veterinary Clinics of North America: Small Animal Practice. 2007;37:123-134.
[8] American Veterinary Medical Association. Work and compassion fatigue. https://www.avma.org/resources-tools/wellbeing/work-and-compassion-fatigue. Accessed June 15, 2022.
[9] Chapman BP, Fiscella K, Kawachi I, Duberstein P, Muennig P. Emotion suppression and mortality risk over a 12-year follow-up. Journal of Psychosomatic Research. 2013;74(4). doi:10.1016/j.jpsychores.2013.07.014.
[10] Institute of Medicine. Introduction. In: Colten HR, Altevogt BM, eds. Sleep Disorders and Sleep Deprivation: An Unmet Health Problem. Washington, DC: National Academies Press; 2006. https://www.ncbi.nlm.nih.gov/books/NBK19961/. Accessed June 15, 2022.
[11] American Veterinary Medical Association. Organizational symptoms of compassion fatigue. https://www.avma.org/resources-tools/wellbeing/organizational-symptoms-compassion-fatigue. Accessed June 15, 2022.
[12] Smith P. Health Caregiving: A Guide to Recognizing & Managing Compassion Fatigue, Presenter’s Guide, Level 1. Las Vegas, NV: Compassion Fatigue Awareness Project; 2008-09:49-51.
[13] Rohlf VI. Interventions for occupational stress and compassion fatigue in animal care professionals-A systematic review. Traumatology. 2018;24(3):186-192. DOI: 10.1037/trm0000144.
[14] Stoewen DL. Moving from compassion fatigue to compassion resilience-Part 5: Building personal resilience. Canadian Veterinary Journal. 2021;62:1229-1231.
[15] Stoewen DL.Moving from compassion fatigue to compassion resilience-Part 6: Building organizational resilience.Canadian Veterinary Journal.2022;63:203-205