From “When Caring Hurts: Managing Compassion Fatigue”, VetMedTeam
Caregivers have been helping others – humans and animals – for so long that we forget how to help ourselves. If you are feeling fatigued, muttering “I don’t care” or “whatever”, take some time to read this article. Thank you Andy Galvan for the wonderful sharing at Mount Pleasant (East). Never feel guilty about taking care of yourself. First!
Compassion Fatigue can be described as the “cost of caring for others in emotional need.”
Veterinary professionals (and all caregivers) are known for their love and passion for animals. This passion, coupled with positive and negative outcomes of the work they do, puts veterinary professionals in a position to face compassion fatigue in their lives.
The common factor is the desire to help animals who cannot help themselves. Many individuals turn to animals as a form of comfort. The animals provide support, love and security and they hope to return the compassion in the same manner.
Identifying Compassion Fatigue
The Human-Animal Bond can be defined as a mutually beneficial and dynamic relationship between people and animals, influenced by behaviours essential to the health and well-being of both.
People feel connected to the animals in their lives, displayed by the expression of affection and sense of understanding between people and pets.
- Pet ownership improves health by increasing exercise and reducing anxiety.
- Pets can decrease loneliness and depression.
- Owners feel that their pets greet them when they get home (when some spouses do not), make them smile, reduce their stress, and also show concern when they are sick.
When the human-animal bond is broken by abuse, neglect and torture, caregivers often become angered with the perpetrator. Increased anger leads to increased emotions and attachment to the patient. Anger then gives way to the desire to care for the suffering animal, which can lead to compassion fatigue.
Causes of Compassion Fatigue
Empathy is generally defined as the identification with, and understanding of, another’s situation, feelings and motives. Facial expressions, asking questions with passion and listening with intent expresses empathy to the client. Empathy is also relayed by a soft, moderate tone of voice.
Burnout can be defined as physical and emotional exhaustion as a result of prolonged stress and frustration. Burnout results from stressors associated with where one works, rather than the nature of the work.
In a study completed by the United States Humane Society in 2004, front-office team members and practice managers received the greatest reward from contact with the animals and thankful clients. These team members are reported to have the lowest level of burnout.
Webster’s dictionary defines compassion as a virtue, one in which the emotional capacities of empathy and sympathy are regarded as a part of love itself, and a cornerstone of greater social interconnection and humanism. These feelings often give rise to an active desire to alleviate another’s suffering, and embody the principle “Do unto others what you would have done unto you.”
Gaining the client’s trust and understanding their wants and needs allows the team to deliver the message (good or bad) in an effective, efficient manner. Gaining this trust and understanding can be emotionally and physically draining for the team.
Compassion stressors may include non-compliant owners, problems with co-workers, lack of sufficiently trained team, insufficient time for each patient, performing euthanasia, critically ill patients, and fractious or dangerous animals.
Fatigue is often defined as a feeling of tiredness or exhaustion or a need to rest because of lack of energy or strength. Fatigue may result from overwork, inadequate sleep, worry or lack of exercise. It can be caused by an illness, medical treatment, anxiety or depression. Fatigue can arise from attending to the emotional and physical need of others.
Any person can struggle with being overtired or overworked from time to time. Chronic fatigue, however, lasts significantly longer, resulting in mental weariness that decreases one’s energy and mental capacity. Fatigue at this level impacts one’s emotional, physical and psychological well-being.
Vicarious trauma is defined as experiencing traumatic stress by witnessing and hearing stories of other’s traumatic events. It is “when external trauma becomes internal reality” and can cause nightmares, preoccupation with a story, an event or a situation.
Recognising Compassion Fatigue
Veterinary team members give and give until the tank is empty, which tends to be the norm for many veterinary professionals.
Compassion fatigue is is characterised by a deep physical and emotional exhaustion and a noticeable change in the individual’s ability to feel empathy for their clients, the pets they care for, their loved ones and co-workers.
The demands of work in a veterinary hospital are high:
- long hours
- providing physical care to pets
- tending to the emotional needs of the pet’s family members
- physical and emotional strength to get through the necessary requirements of the job.
Most, if not all, individuals in care-giving professions have some form of compassion fatigue. Team members must learn to recognise signs and identify what pushes them from feeling “ok” – in the green zone – over the edge and into the red zone of compassion fatigue.
Treatment for compassion fatigue: developing methods for self-care
Do you have someone you can trust at work or home that you can debrief with if you are pushed into the red zone? Are you practicing good self-care? Are you sleeping enough and eating right? Are you getting “off the couch” and exercising once in a while?
Signs and Symptoms
- Cognitive signs – decreased concentration and/or ability to concentrate, apathy, rigidity, preoccupation with trauma, confusion, disorientation, difficulty making decisions, loss of meaning, decreased self-esteem, thoughts of self-harm, perfectionism
- Emotional signs – powerlessness, anxiety, guilt, numbness, fear, helplessness, sadness, depression, feeling depleted, shock, blunted or enhanced effects/responses, experiencing troubling dreams, sudden recall of a frightening or highly emotional experience while working with a pet/patient, cynicism, hypersensitivity to emotional material, insensitivity to emotional material, emotional rollercoaster
- Behavioural signs – irritability, withdrawn, moody, clingy, appetite changes, losing things, hyper-vigilance over patients and co-workers, isolating one’s self, poor sleep, substance abuse, nightmares, accident proneness, lowered tolerance for frustration
- Spiritual signs – questioning life’s meaning, pervasive hopelessness, loss of purpose (in job and/or in life), questioning religious beliefs, loss of faith, skepticism
- Somatic signs – sweating, rapid heartbeat, breathing difficulty, aches and pains, dizziness, impaired immune system, headaches, difficulty falling or staying asleep
- Interpersonal signs – failure to develop non work-related aspects of life, voicing excessive complaints, difficulty separating personal and professional life, poor self-care, projection of anger or blame, mistrust, decreased interest in intimacy or sex, loneliness, impact on parenting (protectiveness), isolation from friends
- Work Related signs – dread of working with certain co-workers, clients or situations, decreased feelings of work competence, diminished sense of purpose, diminished enjoyment with career
Managing Compassion Fatigue
THE 4 R’S OF MANAGING COMPASSION FATIGUE
The first step is to identify triggers and stressors both on a personal and professional level. Reflect on your current state of work and life:
- Are you dreading the start of your shift?
- Does your heart race when another emergency case is on its way to the hospital?
- Do you fight the urge to yell, scream or roll your eyes at the pet owner who just launched into the fifteenth “I can’t pay for all of this stuff” speech you heard today?
- Are you switching shifts to avoid that pushy, control freak technician?
Once the triggers have been recognised, find methods to reduce them in your daily life. Be kind to yourself! If you are asked to work yet another extra shift or stay late, set the boundary. Put your foot down. You cannot continue to do good work if you have already worked a 13-hour shift. You cannot help patients when your brain and body need to recharge.
Take positive action to change your environment:
- Start a suggestion box at work.
- Offer positive solutions to problems or issues you find frustrating or stressful.
- Offer to develop policies and procedures for new team members to help streamline training.
Restore yourself to a state of balance and get back to a place where you are able to do good work. Do NOT feel guilty about practicing good self-care. Start with the basics:
- Proper diet, sleep, exercise.
- Make time for yourself.
- Participate in hobbies you like.
- Spend more time with family, friends and pets.
- Spend time with yourself. Sometimes a bubble bath is the best type of alone time.
- Participate in activities that are physically and/or emotionally nourishing.
Recharging both physically and mentally are keys to continue doing the demanding work that we do. Repeat the processes of recognise, reduce and restore to keep compassion fatigue under control.
* Finally, if you are feeling out of control or overwhelmed, depressed, hopeless – seek professional assistance. There is no shame in seeking help.
What You Do as a Manager IN A VET PRACTICE, SHELTER OR VOLUNTEER GROUP.
The ultimate goal of all veterinary professionals (and caregivers) is to provide exceptional care for our animals. As a manager, it is essential to support our team and provide tools for them to navigate the waters of compassion fatigue.
- Learn about their history, goals and ambitions.
- Start from the beginning, at the interview process.
- Try to understand what prompted the individual to become a veterinary professional.
- Why are they passionate about veterinary medicine?
- Create an employee handbook. Include the mission and core values of the hospital. Provide the new employee the ability to see the whole picture of the hospital, the goals the practice wishes to attain and a roadmap to get there.
- Have regular team meetings to create a culture of support. Do not allow them to be negative, gripe sessions. Guide the tone of meetings and construct positive solutions.
- Provide team building events to help your team members recharge and get to know one another.
- Do not make negative comments about “suffering from CF.” It can further alienate a team member who is struggling with stress-related issues and create a stigma that can be detrimental to individual and team.
- Lead by example. Take your vacation time and don’t overwork yourself. Encourage your team to find that work/life balance for themselves.
- Help your team keep perspective. If they have just lost a critical trauma case, remind them of the bigger picture. Help them move forward from the loss and refocus on the good they are able to perform.
- Maintain a positive work environment. Just being aware of compassion fatigue can make a huge difference for the team.
Compassion fatigue can affect any team member within a practice, as well as family members and friends who surround them. Learn to identify signs leading up to compassion fatigue and utilise strategies to manage or prevent it from happening.