Introduction

Veterinary medicine is filled with ups and downs. While many of us are trained on how to perform skills and discuss cases, it is only recently that communication skills have been looked at. With compassion fatigue and burnout plaguing the industry, it is important to know what they are, and how they change our interactions. It is also important to recognize grief and the way it impacts understanding. This session delves into defining grief, as well as anticipatory grief, and how to work through it. It also goes through various types of communication and how to get your message through.

Grief

There has been a lot of debate around the various stages of grief; what they are and do they even exist. Five stages used to be the standard; however, there are now commonly seven recognized. Rather than adding two separate stages, it just breaks down the original ones further. The five stages discussed here are shock and denial, pain and guilt, anger and bargaining, depression, and acceptance. These stages are not milestones and do not go in any specific order. Someone can start with any of them and hit all or even none of them. There is also no length of time, or anything preventing circling back through them.

Shock and denial are that state of disbelief. A person can seem numb. This is a way of their brain protecting them from absorbing more than they can handle. It is not a state of uncaring. Pain and guilt are the acute manifestation of physical plain. This is where internal blame takes hold. Anger and bargaining are the opposite. This is where outward blame is displayed. This is often very intense and can often be mistaken for just being a difficult client in the veterinary world. Bargaining generally means trying to make deal with God in times of grief. Depression is usually the longest stage and the most socially acceptable because it is expected. This encompasses sadness and loneliness. The final stage is acceptance. This is when people begin to see hope for the future and what their life will look like after the loss. It is a good idea to remember that the other stages can resurface well after a person has gone through acceptance.

In veterinary medicine, our clients can experience grief in any number of situations. In many of these, the client is not prepared for decisions that have to be made or able to understand what is happening. In situations that do not involve an immediate loss of life, anticipatory grief can begin. This type of grief happens when an owner is confronted with the mortality of their pet. In other words, their pet may die from this condition. The stages are the same for this as with the actual loss of their pet and can be just as intense. At this moment, a grieving client can easily look like a difficult client. All of the blame, anger, and denial that is seen can be attributed to grief. This is not to excuse truly difficult clients or their bad behavior, but to provide insight on how to proceed.

Communication Cycle

There is a communication cycle that happens with every single thing that we communicate, including medical information about a pet. It starts with the sender, who decides to send the message and how to send it. This can be done in person, in writing, or over the phone. Outside factors come into play here with noise levels and nonverbal signals the sender is emitting. Then it gets to the receiver. They begin processing the message based on their knowledge and understanding and recall previous messages they have received regarding that information, from any life experience they have. Then, based on this new knowledge and understanding, they respond and restart the cycle as the sender.

Grief changes everything about this cycle. It interferes with every step. It affects brain chemistry, memories, and even focus. They are distracted and may not have heard things correctly or completely. They may not be watching for nonverbal cues or even able to see them, depending on the form the message was sent in. Their ability to process information is completely different because the grief becomes all-encompassing in their brain. There was a study done on people making decisions about treatment of family members in the ICU, and it showed that grief worsened the ability to make those decisions.

Types of Communication

There are 2 types of communication: verbal and nonverbal. However, nonverbal has a subsection (paraverbal) made up of just tone of voice. A majority of communication is nonverbal, including body language, which accounts for 55%. Paraverbal, or tone of voice, is 38%. This leaves verbal at just 7%.

Nonverbal communication is not just body language though. It is also facial expression, eye contact, speech rate and volume, and tone of voice. The barriers to being effective in communicating this way are personal stress, distractions, environmental factors, including delivering more messages over the phone or via email. The ways to combat this are the 3 As—awareness, attentiveness, and acknowledgement. Be aware of what signals you are sending and the ones you are receiving. Be attentive and focus on the case immediately in front of you. Acknowledge what is being sent back, especially if it is clear your message is being received incorrectly. Pay special attention to surroundings, a decrease in face-to-face interactions, and the new learning curve associated with everyone wearing masks.

Verbal communication is much less intensive. This is literally the words we use. The barriers here are vocabulary, the knowledge gap between the sender and receiver, and what perception a certain word choice can convey. The 3 As are also extremely useful here. Be aware if you are using complicated medical words versus common language. Pay attention to how your words are being received, and acknowledge their understanding or misunderstanding. Take note of the fact that there are more surroundings and less nonverbal communication happening. Word choice is much more important now without those other cues.

Compassion Fatigue

In veterinary medicine, staff are exposed to intense medical decisions and grieving clients constantly. This can lead to compassion fatigue, which is absorbing trauma and the emotional stresses of others, creating secondary traumatic stress. This is caused by the work that is done. This is from the stress of being a caregiver. Some signs or symptoms are a lack of empathy, exhaustion, anger or anxiety, excessive complaining, and physical ailments. This can be treated with appropriate self-care, a vacation, and sometimes requires professional help. Self-care is the biggest method of prevention. This is not to be confused with burnout.

Burnout

Burnout is exhaustion. This is caused from our work environment: workload, work–life balance, lack of support, and stress. This is what a majority of veterinary professionals go through, especially now. Signs of this are anger and impatience, dehumanizing others, substance abuse, physical ailments, withdrawal. Treatment can be complicated, and recovery is not guaranteed. It includes a support system, self-care, communication, even professional help or a career change. Prevention is also more involved than with compassion fatigue because a simple vacation does not often work. One needs to have recognition of it, communication, awareness and then must enact change and avoid toxicity.

References

1.  Ellis C. Pet Parents: A Journey Through Unconditional Love and Grief. Bloomington, IN: iUniverse; 2011.

2.  Ayl K. When Helping Hurts: Compassion Fatigue in the Veterinary Care Professional. Lakewood, CO: AAHA Press; 2013.

3.  Assess Your Wellness. (n.d.). Retrieved January 27, 2018, from https://www.avma.org/resources-tools/wellbeing/assess-your-wellbeing. (VIN editor: The original link was was modified on 8-27-20.)

4.  MacEwen EG, Vail DM, Page, RL. Withrow & MacEwen’s Small Animal Clinical Oncology. St Louis, MO: Elsevier-Saunders; 2013.

5.  Moore AS, Frimberger AE. Oncology for Veterinary Technicians and Nurses. Ames, IA: Wiley-Blackwell; 2010.