Monday, October 14, 2013

Compassion fatigue: interview with Rebekah Scotney

Rebekah Scotney with a canine companion.
Phd candidate Rebekah Scotney has a long history in the animal industry and has worn many hats. I learned about Rebekah's work through the Getting2Zero Summit and wanted to ask her more about compassion fatigue.

Hi Rebekah. Tell us a bit about yourself?

I graduated from the University of Queensland in 1993, taking my first position within the School of Veterinary Science shortly thereafter. I am an Associate Lecturer, an experienced Veterinary Technical Officer, qualified Veterinary Nurse and Workplace Trainer and Assessor.  I am passionate about teaching and life-long learning, lecturing extensively in all areas of companion animal welfare, husbandry and behaviour.

I have a strong background in animal welfare, behaviour and ethics, having been a member of one of UQ’s Animal Ethics Committee’s since 1997. With more than 15 years’ experience in animal facility management, I am the Director of the Clinical Studies Centre (CSC) within the School of Veterinary Science, a $16m purpose built, companion animal facility for which I was pivotal in the design and consultation phase. The CSC is the only one of its kind in the southern hemisphere and boasts the highest standards of animal housing, care and welfare.

I have a keen interest and also lecture widely in the areas of compassion fatigue, stress and emotional intelligence in the animal industry and am currently completing my PhD in this field.

What is compassion fatigue and what are the signs?

It is hard to describe in only a few lines what compassion fatigue (CF) is. However, in simple terms it has been described as the ‘negative’ aspects of working as a care-giver or the ‘cost of caring’. It is described in people who are exposed to the trauma and suffering of others or, of those in their care. 

Many people are familiar with the terms Post Traumatic Stress Disorder (PTSD) or Secondary Traumatic Stress (STS). Both of these are or can be components of the ‘negative effects’ of caring and can be a major contributing factor in the development of CF. Another term that is so often used interchangeably with CF is ‘Burnout’. It is important to understand that CF and Burnout, whilst they might ‘feel’ the same and the symptoms or signs are very similar, are NOT the same thing. 

Burnout results from the stresses that arise from our interactions with the workplace (environment, policies, procedures, workload etc.) whereas CF evolves specifically from the work that we do, the relationship between ourselves and the patient (or client). We can often change our work environment or the policies or we can change jobs and that will alleviate the burnout. However, if we are suffering from CF, we can change jobs but the CF will follow…

When discussing the signs of CF it is important to remember that there can be both emotional effects and physical effects. Not everyone will react or be effected in the same way.

Some of the emotional effects can include:
-          Stress
-          Grief
-          Anxiety
-          Anger
-          Frustration
-          Betrayal/Guilt
-          Self-doubt
-          Detachment
-          Emotional dysfunction
Some of the physical side effects can include:
-          Exhaustion
-          Broken sleep
-          Nightmares
-          Weight loss/weight gain
-          High BP
-          Nausea
-          Lethargy

Generally CF and Burnout come as a couple – they are often present in sufferers at the same time. It is important to be aware that both types of stress are cumulative and if not addressed, will lead to extreme cases of physical and emotional exhaustion.

How did you come to be interested in compassion fatigue?

I first became aware of CF many years ago, in what I consider my former life (pre-CF awareness). There was a period of a number of years where I was tasked with euthanasing companion animals that were considered a surplus to society. I would dutifully carry out this task, twice a week, every week, to the utmost of my ability; professionally, competently and most definitely compassionately. 

In hindsight, I look back and remember how distressing this was from day one but it would be many years before I realised the actual toll it was taking on me emotionally and physically. The penny finally dropped that something was terribly wrong when one morning I broke down in the middle of my kitchen because I couldn’t decide what I wanted for breakfast! The simplest of decisions and I couldn’t see my way to making it! The sheer panic I felt inside was so debilitating. Wow, that was a powerful message!! 

I went to see the health nurse and then was sent to see the doctor who diagnosed depression and put me on some pills. These worked well enough to even out the moods but they certainly weren’t addressing the problem. I believed for a long time that it was the euthanasia that was causing my ‘depression’ and so I began to research to see if there was any evidence of others being effected in the same way. There was not a lot in the way of literature out there and it took about 6 months of research trying to gather as much info as I could to get me back on track.

This is when I decided to make it my mission to get more awareness out into the industry. What I have learnt over the years is that the act of euthanasia is only a portion of what contributes to CF, there are many internal and external factors that can also contribute. These include attributes such as a person’s own personality type, sensitivity to suffering, level of connection/attachment and their personal support system. The emotional climate of a person’s work setting, the level of exposure to death and grief, time constraints, red tape, limited finances and resources and so forth. Some of these we can have control over and others we do not. It is how we deal with the factors, and our response to any given traumatic situation that can help us combat CF. Combating CF is about taking mental and emotional self-care seriously and, being proactive in our own self-care programs.

Do you know how common compassion fatigue is in the veterinary/animal industries?

In Australia, there is much anecdotal evidence of CF in the animal industry but there have been no empirical studies that actually define the extent to which CF is present. The animal industry is extensive in itself, for my mind, it includes; veterinary, animal management, rescue and rehoming and, the fields of biomedical science and research. Everyone that works in these areas does so because they love animals, they are compassionate and caring in nature – a common attribute of all CF sufferer’s. Charles Figley (2006) stated, ‘only compassionate, empathic, loving and caring people suffer from compassion fatigue – the very people who are so vital to the animal – care field’.

Can compassion fatigue be treated? If so how?

CF can be treated but better yet, it can be prevented!

Treatment is multifaceted and what works for one person may not work for the next. However, the most beneficial step every person working within the animal industry can take is recognising that CF does exist and ensuring that they have an awareness of the signs and symptoms. Not only for oneself but also for ones colleagues. It is about acknowledging your own internal and external contributing factors as well as recognising the triggers that may set off a painful emotional response in us. 

Triggers can be anything from a smell, a noise or even a time of year. Being aware of our triggers gives us the opportunity to be as prepared as possible for when they occur. There is no quick fix or wonder drug that can treat CF, the only way through CF and to heal from painful and traumatic loss or experiences is to recognise, honour and express our pain while remaining proactive in our self-care.

Combating CF, I believe, consists of 3 parts:
  • Coping – the quick fix
  • Healing – a process of self-reflection with long term benefits
  • Prevention – long term strategies and self-care plans

Ten points to focus on:
  1. Learn about grief and mourning
  2. Focus on your successes (big and small, what made/makes you feel good on any given day/week – COMPASSION SATISFACTION!!)
  3. Have a positive attitude and be involved (you can and do make a difference)
  4. Ensure you have good work/life balance
  5. Be able to say ‘NO’ (which will help with point 4!)
  6. Be realistic (know your limits, can’t solve all the problems – do your best: it IS good enough)
  7. Initiate workplace communications (formal and informal debriefing)
  8. Get help when you need it (medical, emotional, spiritual)
  9. Take a break!! (few minutes, LUNCH, few days & holidays!)
  10. Work together as a team (debrief, decompress, support each other, focus on goals – makes for a strong defence against CF)

Its a tough subject. How do you recharge or wind down when you've been working in this area?

It’s all about having that self-care plan. Things that relax and unwind you; painting, running, listening to music, spending time with your own animals, your family, your friends. Whatever HEALTHY activity that you derive pleasure from, do it, make the time. Be open and honest with yourself and keep stock of your mental wellbeing whether that be through written reflection and the use of a journal or through other means.

Do you have any tips for veterinarians or veterinary students on dealing with compassion fatigue, or inoculating themselves against it?

Awareness is the key and having a good support network.

What would getting to zero (euthanasias of "surplus" animals) mean to you?

Getting to Zero for me would mean that our mechanisms for educating the public and industry are working. That all of us, as a pool of national rescue and rehoming resources, are finally working together. Pulling in the one direction, focusing on the same goal – zero euthanasia of healthy, adoptable animals.

If you want to read more about the Getting2Zero Summit, check out our interview with Dr Lila Miller on shelter medicine here, our interview with Diane Chua on the extent of the "surplus" pet population in Australia here, and interview with animal trainer Dr Cecile Ashen Young here.