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Compassion fatigue: When helping hurts

Sep 26, 2017

Reprinted with permission from EquiManagement

Over time, veterinarians have been trusted and respected professionals in society; however, the toll on humans that comes from providing veterinary care to animals has only recently received attention. The deaths of Dr. Sophia Yin and Dr. Shirley Koshi by suicide were widely discussed in the profession. However, recent studies suggest that their deaths are not isolated events. 

Research has shown that the prevalence of death by suicide in veterinarians is significantly higher than in the general population. 1-3 The number of veterinarians who have contemplated suicide is alarmingly high, with two independent studies reporting that more than 1 in 5 veterinarians had seriously considered suicide.4,5

What is leading to the high rates of death by suicide and suicidal thoughts?

Research has demonstrated that veterinarians experience higher levels of anxiety,1 depression,1 burnout and stress6 than the general population, and it has been reported that one in 10 veterinarians experiences psychological distress.3

The increased rates of mental illness and stress in veterinarians is worrying on its own; this concern increases when one considers the findings of a 2012 study that suggested that veterinarians are unaware of the mental health vulnerability of those in the veterinary profession.4 One area of mental health in which research is sorely lacking is in "compassion fatigue." It has garnered attention recently in the veterinary and shelter blog-sphere and is increasingly being recognized as an issue requiring more attention.

What is Compassion Fatigue?

Compassion fatigue is a concept that has been recognized in those that have care-providing professions, such as veterinarians, veterinary technicians, animal rescue workers, nurses and physicians. While there is no widely accepted definition, one that is used in nursing transfers well to the veterinary profession: Compassion fatigue is “the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress.” 7

This definition highlights the consequences of the ongoing provision of care to clients and patients, the cost of having who you are impact the care you provide, and the result of a stressful job.

You might be wondering whether enjoying being a compassionate practitioner and feeling like that is a strength will protect you from compassion fatigue. Despite its name, compassion fatigue is not simply exhaustion that results from caring about one’s patients. There is a dynamic balance between compassion satisfaction (the pleasure derived from helping others), the exhaustion that results from doing so (compassion fatigue) and having trouble performing one’s job effectively.8 Compassion fatigue results when there is an imbalance between these things.

Signs of Compassion Fatigue

Individuals tend to respond to the types of continuous stressors that lead to compassion fatigue in one of two ways: One can conserve energy or one can remain overcharged. 9 As such, the manifestations of compassion fatigue differ in each individual. Compassion fatigue can result in changes in a variety of aspects, including the physical, spiritual, behavioral, emotional and cognitive.10

The following is an abbreviated list of symptoms and signs that have been recognized as occurring in individuals suffering from compassion fatigue:

  • avoiding work 11,12
  • feelings of inadequacy or low self-esteem 11,12
  • dissociation and numbness 9
  • difficulty sleeping 9,10
  • tearfulness 9
  • anger and frustration toward coworkers and colleagues 11,12

Most of us can likely relate to experiencing at least one, if not more, of those signs at some point in our careers. After all, who hasn’t stayed up worrying about a case, or questioned whether that last client was happy with the care he or she received? It is when these behaviors or signs are present in combination or for more than a couple of days that reflection about what is going on is warranted. If you wonder whether you are experiencing compassion fatigue, there is a self-test accessible from proqol.org/ProQol_Test.html.

What Can Be Done?

Whether you are currently experiencing compassion fatigue, recovering from a previous bout or hoping to prevent it, here are some techniques to try.

  • Set limits:9 Does work run your life, or do you exert control over how work influences your life? Consider setting boundaries to your work, whether it be the number of scheduled euthanasias in a day, the hours you work, the number of annoying clients you’ll see in a day, etc. By advocating for what you want and can handle in the work day, you will set yourself up to be healthier and happier at home and work.
  • Practice mindfulness: Mindfulness is a concept that centers upon attending fully to the activity that one is doing and immersing oneself in the experience while withholding judgment. In today’s society, multi-tasking is ubiquitous. We eat while writing records, check our email while watching television, and so on. By purposefully choosing to be aware of what you are doing as you are doing it, you will become more connected with your surroundings, which can help mitigate stress.
  • Embrace social connection:9,13 Whether it be through your informal social circle or a more formal support group, seek out others and connect with them. This can help you establish your life and identity away from work, which can help you become more resilient to the pressures faced when working with clients and patients.
  • Attend to your body’s needs:9 Sleeping, eating and exercising often take a back seat to those that come to us for help, whether they be clients, patients or family. By ignoring what your body needs, you are adding to the stress and strain it must cope with. Without adding more to your to-do list, try to ensure you are getting an adequate amount of sleep, eating nourishing foods and getting daily exercise.

Take-Home Message

The take-home on this topic is clear: It’s time to care of ourselves the way we care for our patients and clients!

Additional resources can be found on compassionfatigue.org and vetlife.org.ukComplete references are available below.

References

1. Bartram, D.J. A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession. Diploma of Fellowship Thesis, Royal College of Veterinary Surgeons, 2009.

2. Jones-Fairnie, H., Ferroni, P., Silburn, S., et al. Suicide in Australian veterinarians. Aust Vet J 2008;86(4):114-116.

3. Study: 1 in 6 veterinarians have considered suicide. JAVMA News. April

1, 2015. https://www.avma.org/News/JAVMANews/Pages/150401d.aspx

4. Skipper, G.E., Williams, J.B. Failure to acknowledge high suicide risk among veterinarians. J Vet Med Educ 2012;39(1):79-82.

5. Miller, L. Wellness of veterinarians: CVMA National Survey Results. CanVet J 2012;53:1159-60.

6. Hatch, P.H., Winefield, H.R., Christie, B.A., et al. Workplace stress, mental health, and burnout of veterinarians in Australia. Aust Vet J 2011;89(11):460-468.

7. Coetzee, S.K., Klopper, H.C. Compassion fatigue within nursing practice: a concept analysis. Nurs Health Sci 2010;12(2):235-243.

8. Bride, B.E., Radey, M., Figley, C.R. Measuring compassion fatigue. Clin Soc Work J 2007;35:155-63.

9. Cohen, S.P. Compassion fatigue and the veterinary health team. Vet Clin North Am Small Anim Pract 2007;37(1):123-34.

10. Portnoy, D. Burnout and Compassion Fatigue, watch for the signs. Health Progress 2011, July/Aug:47-50.

11. Potter, P., Deshields, T., Berger, J.A., et al. Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncol Nurs Forum 2013;40(2):180-187.

12. Mathieu, F. Signs and symptoms of compassion fatigue and vicarious trauma. 2009. Accessed June, 2015: https://compassionfatigue.ca/signs-and-symptoms-of-compassion-fatigue-and-vicarious-trauma/

13. Rogelberg, S.G., DiGiacomo, N., Reeve, C.L., et al. What shelters can do about euthanasia-related stress: an examination of recommendations from those on the front line. J Appl Anim Welf Sci 2007;10(4):331-347.