The future of veterinary caregiving: finding our way forward with wisdom and compassion

To be alive is to know both pain and joy. Pain may be inevitable, but suffering is optional. Our ubiquitous negativity bias may have many in caregiving roles around the world focused on the negative impacts of compassion fatigue syndrome and/or of burnout in the workplace, particularly over the last 2.5 years since the COVID-19 pandemic impacted every aspect of our lives. However, do you know about compassion satisfaction or about eudaimonia? Keep reading.

Veterinary professionals are some of the most intellectually curious, generous, and intuitively caring individuals. Choosing a profession with rigorous and stressful admission criteria and training to then focus their life’s work on caring for non-human species’ health and well-being demonstrates a commitment to compassionate community service. However, the majority of veterinary caregivers would admit that the community they feel compassion for and wish to focus their healing energy on is the veterinary patient, not necessarily the inevitable humans that come with the equation. Herein lies the conundrum: the emotional, physical, and psychological challenges that come with working as a veterinary caregiver are compounded by these necessary human interactions. Preparation and strategies to skilfully navigate these interactions have been historically sparse, but fortunately are growing in curricula, in training programmes, and through professional literature and resource sharing.

There is a psychosocial concept that when utilised can support self-efficacy of caregivers during difficult emotional and psychological circumstances: “Name it to tame it.” The human medical community has been actively exploring and researching the myriad of caregiving challenges and potential impacts on caregivers for over 40 years. It is understood that just as the well-being of individuals and teams may be compromised by detrimental work factors, so may be the quality of patient care and professional fulfilment for medical professionals. Many of the same work-related concerns such as moral distress, secondary traumatic stress, compassion fatigue, and caregiver burnout experienced by medical workers are recognised in veterinary professionals as well. However, it is only in the last 10 years that the awareness and subsequent conversations that “name” these concerns are being investigated as they pertain to veterinary work and environments. With that, novel approaches to support caregiver well-being and cultural shifts that support growth, safety, and flourishing in practice environments are being discussed globally. Fortunately, there is an abundance of resources, tools, and approaches that have been identified and developed to support the health and quality of professional life for humane caregivers that can be drawn upon and applied to the many veterinary ecosystems. The New Zealand Veterinary Association Wellbeing Symposium (8–9 November 2022) and this issue of the New Zealand Veterinary Journal with its associated online Collection, are exploring some of these topics and strategies such as mindfulness practices, acceptance and commitment training, novice professional preparation and mentorship, ethics and ethical conflict in veterinary medicine, and building healthy coping strategies and resilience.

In the spirit of clarifying vocabulary so that we can speak a common language to create well-being strategies for medical caregivers, an article published in February 2022 is worth discussing here. This Iran-based study of nurses explored workplace factors and psychosocial variables on medical nurses’ well-being and occupational status. The focus was to explore the relationship between the nurses’ professional quality of life, mindfulness, and hardiness during the outbreak of COVID-19 (Zakeri et al. 2022). The Professional Quality of Life (ProQOL) questionnaire, Occupational Hardiness questionnaire, and Freiburg Mindfulness Inventory – Short Form were used to explore these questions. The ProQOL survey (Stamm 2010) has been used extensively in both human medical and veterinary research endeavours that explore secondary traumatic stress (that contributes to compassion fatigue), compassion satisfaction, and burnout factors since being developed by Beth Stamm in 2010. The other two surveys were not familiar to me but were also apparently developed to explore professional well-being (Buchheld et al. 2001; Moreno-Jiménez et al. 2014).

To frame the valuable results of this study and others like it that were published between 2020 and now, it would be useful to define the psychosocial elements impacting the well-being of caregivers that were being investigated.

Compassion stress is the unavoidable strain experienced when helping patients and clients that are in distress. This sense of responsibility and desire to alleviate suffering can contribute to either medical caregiver fatigue or to compassion satisfaction. When a sense of purpose and professional satisfaction are derived from working as a care provider, positive feelings towards one’s own and coworkers’ abilities to contribute to the better good are fostered. Gratification and professional fulfilment, which are essential ingredients for professional thriving, are strengthened as a result. These are the components of compassion satisfaction (Singer and Klimecki 2014). When caregivers experience holistic exhaustion from dealing with another’s suffering (animal and/or human), a diminished ability to empathise for others (empathic distress) or to have the energy to care (compassion fatigue) can occur if concurrent efforts are not made to care and fortify one’s own health and self-care needs. Vanessa Rholf’s (2018) publication was one of many excellent reviews of occupational stress on animal care givers and the relevant and meaningful interventions that may support caregiver well-being.

Secondary traumatic stress occurs as a reaction to secondary or indirect exposure to traumatic events experienced by another (Bride et al. 2007). It has been described as a component of compassion fatigue (Salimi et al. 2019). Medical caregivers are more prone to the negative emotional, psychological and physical impacts of secondary traumatic stress as they are frequently exposed to the suffering of others, may work in stressful environments, and invest their time and energy disproportionately on the care of others rather than self-care. All of these components can reduce empathic capacity which has been described as the “price of caring” and a component of compassion fatigue (Peters 2018; Salimi et al. 2019).

Burnout is a potential work-related hazard that negatively impacts many aspects of an individual worker’s well-being. Burnout is a state of physical and emotional exhaustion that may occur in long-term high-stress situations. Chronic job-related stressors that are associated with low job satisfaction and fulfilment contribute significantly to an individual’s experience of feeling “burned out.” Other factors include toxic relationships, incivility, and emotional and cognitive detachment. Trauma does not have to be present for burnout to occur but can exacerbate its development and the symptoms experienced. Burnout occurs in all professions, not solely in caregiving (Maslach 1981; Bauer-Wu et al. 2015; Olson 2022).

Compassion satisfaction refers to the positive feelings and attitudes that people have toward their job (Zakeri et al. 2020). As medical caregivers, it is the degree of fulfilment and sense of purpose and thus satisfaction that can be derived from changing and saving lives. Compassion satisfaction occurs when one is aware of one’s work being aligned with one’s values, and the work that is being done is personally and professionally meaningful. Compassion fatigue and compassion satisfaction may be coexisting constructs, and research demonstrates that meaningful relationships, professional recognition, support from coworkers and family, self-awareness and coping strategies that fortify resilience, and years of professional experience all contribute positively to compassion satisfaction over compassion fatigue while mitigating burnout.

Mindfulness has no one universally agreed upon definition. However, a widely cited description comes from Jon Kabat-Zinn, who introduced the concept of mindfulness into Western psychology in 1979. He founded the Mindfulness-Based Stress Reduction programme at the University of Massachusetts Medical Center at that time. He defined mindfulness as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding experience moment by moment” (Kabat-Zinn 2003). Numerous studies have explored the impact of mindfulness practices on distress tolerance, compassion satisfaction, burnout and resilience. Research demonstrates positive impacts in reducing psychological problems of individuals (Dehghan et al. 2021; Malakoutikhah et al. 2021), decreasing burnout and increasing compassion satisfaction (Taylor and Millear 2016; Ducar et al. 2020), and supporting quality of professional life (Mou et al. 2016).

Lastly, psychological hardiness is defined as the ability to withstand stressful situations, and focuses on human inner experience and mental perception (Moreno-Jiménez et al. 2014). There are three factors considered to contribute to hardiness:

1. Control: the individual has an internal locus of autonomy as they feel they are in control of what happens to them rather than feeling they are a victim of circumstances.

2. Commitment: the individual tends to have and to hold a sense of purpose in what they do.

3. Challenge: the individual gets involved in life and is stimulated by challenge. Stress is a motivator rather than a threat (also known as eustress, in contrast to distress).

Vagni et al. (2020) showed that hardiness reduced distress and burnout, and increased personal accomplishment among emergency workers during the COVID-19 outbreak. Other studies (Bartone et al. 2008; Park et al. 2018) demonstrate that hardiness allows the individual worker to promote active attitudes, be committed to a goal, and perceive external situations (even negative ones) as opportunities to challenge. It reduces the stress that predicts secondary trauma, increases compassion satisfaction, and decreases burnout (Zakeri et al. 2022).

Eudaimonia is the concept of “flourishing,” of living a life that is worthwhile and fulfilling, originating from the classic Greek philosophers Plato and Aristotle. The more recent translations that have been proposed are “human flourishing,” “prosperity” and “blessedness.” This state of being is deeply rooted and connected to one’s values and principles. This is a call to develop and express our full human potential, regardless of the ebb and flow of fortune and circumstances in our lives. Self-determination and actuation to meet one’s destiny is the powerful message of living a life aligned with eudaimonia.

If these terms are new to you as you read through them, you are not alone. An integral part of creating individual skills and coping strategies and larger system approaches to support holistic well-being is better understanding the integral elements, or root causes. When left unacknowledged and untreated, these work-related stressors can compound leading to empathic distress, compassion fatigue, burnout, increased anxiety, and increased feelings of depression. When this lack of knowing is combined with the historical veterinary culture of stoicism and the broader societal stigma around acknowledging emotional and mental challenges, increased isolation may occur. When perfectionist and impostor syndrome tendencies arise, a veterinary caregiver may be less likely to ask for help, to seek professional support and resources, or to create the necessary healthy boundaries to support meaningful self-care. The lack of psychological safety historically in veterinary environments has perpetuated the unnecessary suffering that occurs when compassionate community and valuable resources are not made available.

This is where we return to the important conclusions of the Iranian nursing study: (1) secondary traumatic stress, compassion satisfaction, and burnout were all moderate among the nurses in the study; (2) hardiness was the best predictor of compassion satisfaction; (3) mindfulness was the best predictor of awareness of both secondary traumatic stress and burnout, and mindfulness practices, when applied, mitigated the negative impacts of these caregiving concerns for many of the nurses in the study; and (4) psychological hardiness and mindfulness had the greatest impact on the nurses’ quality of professional life during the COVID-19 pandemic.

Now, what about you, for your team, for our veterinary profession? This is the “Call to Life” I present to each of you: lean into the discomfort of growth and change that will beget a healthier way of work and living for us as a veterinary community. Trust your intelligence, your intuitive wisdom, and your capacity to be compassionate to foster your health and the more authentic relationships needed with the larger veterinary community (and our clients!). Please, do not isolate yourself; stay connected. Seeking help is courageous and offering it is part of your healer’s heart and nature. Understand and develop the elements that beget a culture of psychological safety, of learning, and of innovation with your team, your practice, your organisation. Clarify your values and live into your purpose. These are the key steps to cultivate compassion satisfaction, hardiness, resilience. Eudaimonia, a life of meaning and fulfilment, is yours to determine and to create.

Your unique voice, perspective and energy are needed. This is how our veterinary community and profession will collectively develop the interventions and cultural spaces needed to mitigate caregiving challenges and for us all to thrive personally and professionally.