AAHA Team Well-being

Hello and welcome to our last session in the

Euthanasia portion of our End of Life Education program.

This is euthanasia and team well-being and I'm Doctor Kathy Cooney.

It's nice to have you again.

This is a very important session because we

cannot provide euthanasia without well-being within our team,

sustainability and resiliency.

We know that euthanasia is laid with emotion.

A lot of times there can be moral distress

and conflict with the decisions that we're making,

but we're always out there doing our best and I want you to love the work that you do.

In fact, I have been an end of life specialist now since 2006. And there are days

where I help as many as 10 patients,

uh 10 families that need my help with euthanasia.

And I feel like I'm doing this work well enough that I

can get up the next day and do it all over again.

So I wish that for you too. And I'm hoping that this session

will, will help you to see some of the skills that I've built over the years.

And certainly some of the skills that I've been

working with other teams and trying to make them stronger

with that. Let's go ahead and take a look at our agenda.

We're going to talk about some factors

that impact your staff's well-being yourself included,

always the important part of standardizing those protocols, which helps so much.

And we're very going to briefly touch on compassion fatigue.

It's likely that you've had training in this area before,

but we're going to just explore it a little bit together in this session

and show you some of my approach to it and the way that I look at compassion fatigue

and then those resiliency strategies, which are so important.

If you would please ask yourself, what do you like about euthanasia work?

And it's ok to say lots of things,

this really resonates with a lot of people and their personalities

out there where you gravitate towards hearing stories and seeing and witnessing

the beauty of the human animal bond. And probably

most importantly is being able to release a patient from suffering

when they've got significant disease or very advanced age related changes,

where being able to release them from their body feels like a real positive

and doesn't feel like a negative where you get to do good work.

So think about if there's other factors about euthanasia that you like.

And I'm I'm hoping there is something,

there's something about your protocols and your approach

that really click that work for you.

My guess is though you're also gonna have angles

or approaches that you don't like about it,

things that you'd love to change or improve.

And I hope that too, that this is a big part of the program,

what you're taking away from it is to make all of this is as good as it possibly can be.

We don't get into veterinary medicine because we want to kill, we want to end life,

we get into it because we want to help and support

and a part of that becomes euthanasia.

It's just an outcome that is inevitable for many of our patients,

but we do it for the right reasons, the right time for the right reasons.

I look at a team like this and think

hopefully they're working as a well oiled

machine that everybody knows their roles,

they know what they need to do

and that when the client calls or arrives at the hospital, everybody is working in,

in synergy and harmony

to, to make this a very safe and meaningful appointment, right?

Where we're thinking about what's best for our patient

to reduce down their fa s and their stress, to keep them comfortable,

to keep it pain free.

But to be able to answer the questions

that the clients have to to remain compassionate,

to convey those three CS that compassion, confidence and control.

So that at the end of the appointment,

everybody feels as good about what took place as possible, right?

Our patient has been released from their suffering

the client feels like this was as good as it could possibly have gone.

And the team feels resilient in their work sustainable and able to do it again

because you,

many of you work in practices where you might

be helping 50 or more euthanasia in one week,

sometimes it's 10 a day or more, just depending.

And some of you out there might be seeing a couple of euthanasia a month.

We're all over the board,

but no matter what that volume is that we're doing things to the best of our ability,

we've touched on before the importance

of standardizing those euthanasia protocols.

And in a moment,

we're going to go over those factors that can have

negative effects for a staff as well as positive.

So when you're looking at these, these attitudes that I'm sorry, these,

these factors that can affect those attitudes,

I want you to think about what you can do with your euthanasia protocols and

how you would standardize those to help take away some of these pain points,

right?

Get rid of the bad

and keep and harness the good.

So let's go ahead and take a look at those factors,

affecting staff attitudes in a negative way as it pertains to euthanasia.

Number one insufficient time where we're rushing through the appointment.

We don't have time to incorporate in all the elements that we've learned about so far

and it feels very clinical. Ok. So that could be a negative

talking about money, not many people to do it.

So the more that we can do that ahead of time, the better.

But talking about talking about money during euthanasia can feel very dirty

and it also can lead a team to want to give euthanasia services away for free,

which I don't really recommend.

I think that it's like any other procedure that we do in vet me,

it warrants,

it warrants cost associated with it.

Because of all of the things that we incorporate in.

If we have a client with low moral value of their pet,

that can be hard because a lot of a lot of professionals in veterinary medicine

take great care of their animals. They have them as family members, right?

Really, really loving and strong relationships.

So if you've got a client that comes in, that is just like, oh, it's just a dog,

I don't care or you can tell that the animal has been very neglected

that can negatively affect our attitudes,

aggression cases.

Nobody wants to work with a behavior aggression

case where it's clear that this animal would

much prefer different circumstances.

But it's possible that this client has tried everything under the sun

to make things better and just hasn't been able to do so.

It's still not good.

And when we have to do restraint and often heavy restraint,

physical restraint for our patients, that's hard

and more reason to leverage those oral previ

pharmaceuticals to try to make it so that our patient is sound asleep.

By the time they arrive

convenience, euthanasia, we could talk a long time about this.

But if,

if the team is not on the same page of what is and isn't a convenience euthanasia

that can add to their moral stress. Convenience.

Euthanasia is, I mean, true convenience. Euthanasia is typically things like

the family is moving, there is an allergy in the house, the, you know,

the animal just doesn't match the furniture anymore.

You've you've likely heard lots of different reasons.

So, so ideally,

we are euthanizing because their patient is clearly sick and suffering in some way,

we don't like to see our patients in fear and not wanting to be in our presence, right?

That's the case of whether or not it's euthanasia or

uh a life continuing treatment, right?

We don't like to see our patients really stressed out and nervous and fearful.

We'd much rather see them comfortable and accepting of, you know, being in the room,

being in the hospital

and certainly being in our presence

we've talked about before and after care and body handling,

the importance of having respectful body handling.

So it can be difficult if this body is treated with,

with disrespect as if it's trash or refuge.

So the more that we can care for this, this body

and treat it as if it were our own, the better

and then unsupportive staff, you know,

there might be somebody who's really struggling with

the loss of one of their patients,

they've just experienced the loss of one of their own pets.

And so,

and so, sadness and grief is very fresh in their mind.

And you know,

whether or not somebody has a rather flippant attitude about the loss

that can be very difficult and nobody wants that in their work,

regardless of the situation

on the flip side are the positives.

So it's you you might be picking up on already that

this is the opposite of what we just went through.

But let's explore it a little bit

where we've got ample time to connect. We can slow down, we can hear those stories

and and see the beauty of the human animal bond. Love it,

minimal paperwork.

So as much as we can get done ahead of time with preplan and payment

logistics even about rabies, right?

As with this mammal, do we have risk of rabies exposure,

any of that kind of stuff that we can talk about ahead of time?

So we can just focus in on, on saying goodbye to the to the pet or our patient.

That's great,

a gentle death for sure where we're not seeing any real struggle,

difficulty breathing to resistance in any way.

Just a nice peaceful death.

That's why we take so much time to talk about these new approaches,

these modern best practices

in particular with the techniques so that we have plan a plan B and plan C at the ready.

Therefore, we don't have a difficult death any more than necessary

things that are consistent, right? With no surprises.

Nobody wants surprises during euthanasia.

And the more that we can get things standardized for the team, the better

as we said before, it's difficult when our patient is not sick,

if it's like a convenience, euthanasia.

So it's so much better when

you know, you can just tell that

even though we don't want to see a patient really struggling,

you know that they are ready for euthanasia when they can barely breathe

when they're in a lot of pain

and they're just really struggling. That's nice.

It's a nice,

it's a nice time to be choosing euthanasia versus when the patient isn't ready.

And beneficence means to do good,

right? Where we're trying to do our best to release this putt from their body.

Non

maleficence means to do no harm. So that's also very similar in our approach.

Sure enough, if we're going to have a negative from disrespectful body handling,

we have more of a positive when we care for these pets

and then supportive staff who care for each other, who think,

who think about uh the emotional impact of a euthanasia on another

and to reach out and show that empathy and that compassion,

that's always wonderful.

So we've talked about just the importance of standardizing protocols so that we can

try to avoid some of these negative attitudes and instead have the positive.

Let's go ahead and work through what a euthanasia manual should include

thinking about lots of different things here. We should have standardized.

What's the appointment length that we offer for euthanasia?

And what's the ideal time of day? Is it going to be first thing in the morning?

Is it going to be closer to the lunch hour or maybe at the end of day

might even be on the weekends where we know that a lot of clients want euthanasia.

Maybe we bring in more staff to be able to accommodate whatever that looks like.

Just nice to have standards around it and to be able to explain why we do what we do,

we want to have consent forms and appropriate record keeping

and with consent forms. By the way,

it's very hard to

prove who is the owner of an animal.

So make sure that we're at least getting signatures

that says that they are the owner or the

agent that has full and complete authority to make

this decision because we cannot go back on it.

What are our fees? Do we give euthanasia away for free?

And if so what are the, what is the criteria for that to even choose it? Right.

So that we've got that

the standards and that's important, not only for our team, but for clients,

right?

If they get one euthanasia for free and they end up coming back three

months later with another pet and they have to pay for that euthanasia.

Why is that, what are the standards around it?

We need to determine who can perform euthanasia?

Is it the just the veterinarian or is it a licensed veterinary technician

that can perform it as well? And if so, is it going to be in the home or the hospital?

Does that make a difference?

How about restraint and the handling techniques?

Do you use forced physical restraint or do you have a policy that says no,

we're not going to do that

instead, we're going to go ahead and offer those oral previ

drugs, right? That we leverage chemical restraint versus physical restraint.

And if we do have to use restraint, what kind is it?

Are we allowing our team to use muzzles or you know, in extreme situations?

Are we using catch poles or something like that?

Are we using pinning devices, blankets laying on the pet? I've heard and seen it all.

So while we want to use the least amount of restraint possible,

if you are going to do it, it needs to be standardized.

We talked before about convenience, euthanasia.

So yeah, we need to have decision making around that.

How does your team define convenience? Euthanasia? Write it down? Ok.

That can be your,

let your manual or your standards be your know

if you don't want to move forward with Euthanasia,

you say I'm sorry, we don't do that.

We have a policy against it.

But here are some resources to help you to find the help that you need.

How about when to advocate for those home services?

You know,

is this right in the beginning when a family says that they want

to choose euthanasia and you agree that it's the right course of action?

Then do you say would you like it in the home or hospital? Right?

When are you going to bring that up?

Starting then in the upper right hand column, use of a euthanasia attendant.

Do you have a policy where somebody is going to be in the room from beginning to end?

That's the same person

that's that, that guiding light,

that beacon for that family or your client in a difficult time

room selection. I hear this one a lot.

You know, do we do we leverage that comfort room all the time?

Do we even have a comfort room?

Of course,

but are we only performing euthanasia in that room

or do we allow euthanasia in other spaces?

And if so which rooms are those right?

Is it, can it be outside in the back garden or just around the corner in the yard?

And do you record that in the records? Right.

So for the family,

if they're gonna be coming back in three months for a vaccine

appointment for a puppy or for a kitten or another animal,

are we gonna, are we gonna have them in that same room?

Or somewhere else.

Standards can include tools for mindfulness such as

pictures outside of the of the euthanasia spaces to help people get in that right,

in that correct headspace or lighting candles or doing that,

doing that dry erase board where we write the patient's name on it,

that can be a tool for mindfulness to get us in the right headspace for euthanasia

privacy policies such as going ahead.

Do we offer, do we always offer privacy before and after death?

Are we giving that doorbell system

so that the family doesn't have to poke their head out and say, hey,

I'm ready for you to come back in.

Really? What does privacy look like? And how long do you offer it for?

Do you use the pre euthanasia sedation or anesthesia?

And if so which patients get it? Which ones don't?

My recommendation is they all get it?

Memorialization? Are you making paw prints? Are you collecting fur clippings?

Are you doing nose prints? Right?

Are you, are you sending home little charms and keepsakes?

It's to say that memorialization is standard for everybody.

Everybody has it offered for them versus just those

that have a high moral value of their,

of their pet.

Sometimes it's hard to read the room, everybody gets things offered

technique selection.

I encourage you to write that down in your manual such as for cats,

you might prefer the intrarenal injection or you say we do intravenous for all of

our patients unless you can't find a vein and then you move to intra organs,

whatever it is, just make sure that it's logical.

It makes sense and everybody understands those standards.

And then circling back around to what we've talked about before,

with communication

is how do you handle those dysphasia cases when they occur?

Are you reaching out to the family?

Are you giving them time to talk and who's reaching out to the family? Is it

the veterinarian or the technician who performed the procedure

or is it the practice manager? Right? Who's appropriate to reach out?

And when do you do it? And how do you track what you learned from it?

Does that go in the medical records?

Do you debrief on it in euthanasia rounds, et cetera?

This was a huge list, right? We could spend 30 minutes just on this.

So thank you for allowing me to go through it quickly.

And in fact, I'm going to pop it back up real quick and full screen.

So if you want to take a screenshot of it, you can,

there you go.

And now we're going to switch gears and talk about compassion fatigue.

I mentioned before that I am a certified Compassion Fatigue professional,

which means that I've taken a lot of training in this topic

and it was a game changer for me.

So if you have not done anything like that,

maybe you've just had 30 minutes like like this on emotional well being

with regards to euthanasia or you've taken an hour here and there,

it's good,

but it might not go deep enough where

you really understand the complexities of this.

So,

what I'd like to do is just introduce you

to really the two main components of compassion,

fatigue and that is burnout

and secondary traumatic stress.

Now, burnout is very hard to manage.

It's hard to control, not only for you but for the rest of your team,

we have very busy lives out there.

And burnout can come from professional side of things as well as personal

and burnout is really where you just have too many demands and not enough resources,

right?

It sounds like the typical veterinary day for the most part.

But again, Children and life in general can lead to burnout.

So it's hard to control

what we can control is the likelihood of secondary traumatic stress.

So if there's a secondary traumatic stress,

that means that there's a primary traumatic stress,

primary traumatic stress in vet med typically happens

to our clients and to our patients,

especially when they're hearing bad news and and something very devastating

is happening to them such as learning that their pet is dying

or during the Euthanasia appointment itself,

our clients for the most part,

unless they're in really good self regulation and calm and under control

may be experiencing a level of primary traumatic stress during euthanasia

that said if you yourself as the practitioner

are witnessing the primary traumatic stress of another

and you yourself are very amped up nervous,

high energy

sympathetic tone, you know,

escalating up here versus nice and relaxed and parasympathetic Zen mode.

If you are amped up, witnessing the primary traumatic stress of another,

you are at risk of secondary traumatic stress which can feel

like and eventually build up like a primary traumatic stress.

So the symptoms of compassion,

fatigue that you might be familiar with

may have experienced yourself or seen and colleagues

are these

right? So if you are providing compassionate care and doing it regularly

and not necessarily taking care of yourself in the right way,

you're at risk of compassion fatigue

and some of these are more serious than others as you can see

what we hope for is that it can be identified and picked up soon enough

that we can start to address it right to pull us out of that fatigue

and instead into compassion satisfaction, that's the sweet spot.

That's where we're really humming, loving the work that we're doing

and, and finding it very fulfilling and not where we're trying to walk away from it,

trying to escape from it.

And now those escape fantasies, as you see in one of these symptoms,

one of my favorite methods of preventing compassion

fatigue is through something called self regulation.

Self-regulation is where you take yourself from, that amped up running around,

busy,

you know, tone of the day or, or or physical tone of the day

where you are now at risk of internalizing that secondary traumatic stress.

Instead, you're very calm, you're very relaxed and that's your barrier.

That's how you prevent secondary traumatic stress is

just taking those deep breaths and relaxing yourself.

And this is how you do it. So this is a little exercise and let's do this together.

This isn't something that we've done so far in our course,

but let's do this together.

So in order to calm your body, you first must recognize that you are amped up,

you are very nervous, you're anxious, you're, you're feeling rather intense,

you have to acknowledge that you're feeling a threat.

That's why you feel this way.

That's number one, number two, you take a deep breath

and exhale fully.

And as you do,

you relax all of your core muscles all the way

down through your pelvis because that's where your vagus nerve terminates

and it's your vagus nerve that is dictating what

you're doing with your sympathetic or your parasympathetic state.

So you relax all of those core muscles all the way down through your pelvis.

And then you're going to bring your attention back up to your

vision and you're going to expand your vision out to the periphery.

Because when you're feeling threatened, right?

When you're nervous, anxious, ramped up, you tend to lock in,

you tend to focus your vision.

It's, it's one of your survival mechanisms.

So you basically trick your body into calming

by relaxing your vision out to the periphery.

This is a self regulation exercise that you can do

five times a day, 10 times a day, 20 times a day, you keep doing it to practice

and just ask yourself, how am I feeling right now? What's my physical state?

Do I want to feel this way

and then hopefully relax, relax down.

Now,

you've heard me mention this idea of you harmony before

this is what you must do to achieve you harmony.

You cannot achieve it.

When you're really again,

high sympathetic tone running around with that high energy, you have to relax down.

This is one of my favorite things about

euthanasia appointments is that you need to slow

down to take away that clinical field and to really be present with these families.

So use euthanasia as a bit of a time to

reset, to get down to that relaxed state. That state of Zen

use euthanasia a bit like a spa to relax. Hear those stories.

See the beauty of the human animal bond.

I hope that makes sense. I hope that resonates with you

and that the more control you, the more control you have over your body,

the more likely you are to prevent compassion fatigue.

Let's move on then and talk about some other

strategies we can do to minimize euthanasia related stress.

Absolutely. Provide those amazing euthanasia experiences, right?

Learn, learn your plan A, your plan B and your plan C because in doing so,

that's going to take away your stress.

It's gonna allow you to be more relaxed.

We've talked about before,

the importance of identifying those team members that like to do this work.

And yes, they are out there and they're amazing at it.

But you still need to ask everyone's euthanasia limits,

making sure that we're not pushing people

past their boundaries and not protecting them.

Right. So keep an eye on those, those symptoms of compassion, fatigue for everyone.

We all should do that, not just management but ask them right from the start.

What are your limits?

Try implementing some honoring ceremony so that we can honor these sweethearts.

So we help all these days and whether or not you do an honoring ceremony once a month,

once a year.

In fact, September, I believe it is the second Sunday of the month is,

is uh National Pet Memorial Day.

That's a great time to have an honoring ceremony.

But if you have a high volume of euthanasia in your practice, do them more regularly.

Again, you can do that every month with the euthanasia rounds

limit visual death reminders.

We talked about how you can prepare your deceased patient's

body in the comfort room after the client has departed.

If they haven't taken him for burial or cremation themselves,

you can go ahead and prepare the pet in the room and then carry them to the body,

holding space already in their container.

That's going to limit those visual death reminders.

I wouldn't necessarily encourage you to bring them back to the treatment area

and lay out the body and make the paw print there and everything.

Unless that is a part of your honoring ceremony itself where

everybody does want to lay their hands on the pet.

Be a part of the paw print making and all that. That's great.

But if you're identifying,

some people are having a hard time with that may be limited

and then certainly encourage those self care days.

You might want to do something like this,

bringing in coffee or having special lunches with those comfort foods,

encourage opportunities for more breaks. And yes, I'm going to say even naps.

If there's an opportunity to give naps to your staff during the day,

please do even more reason to have your comfort room as those spa spaces.

So everybody can go in there and get a little break from time to time.

But you can do field trips and you can have movie night, you can laugh, right?

Have whoever your, whoever your clown is and your funny person on your team,

encourage them to keep those jokes coming

because laughter truly is a good medicine,

but take care of each other and the work becomes that much more fun and enjoyable.

And yes, it's ok.

Even if you're, even if you're working for an end of life service,

you can have a lot of fun with your work.

It's ok. And that's just how we compartmentalize, right?

I have been told so many times how I am such

a different person during euthanasia than I am immediately afterwards.

And part of the reason for that is I know I'm doing really good work.

I've been there fully present for my client, for my patient.

I was working off my principles,

hopefully delivered a really good smooth euthanasia and then I can feel

good about it afterwards and get back to my normal jolly self,

bringing it all together.

You have seen some of these already,

but I just want to point out the second one there on the right that says,

create a partner buddy system.

If need be, we should have, we should have people on our team that we can talk to.

We can mention if we're struggling,

we can have debriefing sessions and talk about our issues.

But the important thing is if you do have a buddy that the

buddy gets to reciprocate and also share what's going on with them.

That way a staff member is not just dumping all the time on one person,

all their negative feelings and concerns that instead it can

be reciprocated that somebody else gets to share back.

Better yet.

Offer offer social workers,

veterinary social workers to counselors that are always

available for the staff to go to.

Ok,

I'm going to also pinpoint again uh the whole euthanasia rounds

as you see there on the left but right underneath it,

have your staff complete a professional quality of life test. This is a great one.

This is available free on this website pro

dot org.

This is where you can,

you can learn from the staff of what their level of compassion satisfaction is.

Compassion, fatigue and burnout and it's a scoring system.

So my recommendation is to have this done for yourself and for your team twice a year

and you can have a veterinary social worker or grief counselor.

Facilitate this or the practice manager can do it too.

So it's not to shame anyone to make anyone

feel bad about the symptoms that they're experiencing.

But instead use it as a catalyst for positive change

and of course, to increase our euthanasia team, well being,

we gotta increase those euthanasia skills.

So I want you to keep learning.

The American Veterinary Medical Association has their

guidelines for the Euthanasia of animals.

Those are guidelines, they're not necessarily a direct how to guide.

So instead you can find uh good useful information in

a book like this from Veterinary Clinics of North America,

as well as myself and two colleagues.

We wrote a book back in 2012 called Veterinary Euthanasia Techniques,

a practical guide that supports everything that the A B

MA guidelines talks about at least for companion animals for,

for some livestock, for horses and for exotics.

Aha and the International Association for animal hospice and palliative care.

Put together their 2016 end of life care guidelines, which is wonderful.

I mentioned there are books out there by all means, pick those up and read those.

You have the opportunity to continue learning

with the companion Animal Euthanasia Training Academy.

And then keep in mind there are a lot

of associations out there that have euthanasia position statements.

They're not necessarily going to teach you skills

in particular of how to perform euthanasia.

But they're going to help you with decision making

and knowing the benefits of these best practices that

we talked about like using pre euthanasia sedation before,

before euthanasia itself, et cetera.

And there are many new research articles coming out pertaining

to euthanasia techniques as well as ethical decision making,

moral stress and just decision making and communication in general.

So the more that you can hone these euthanasia skills,

the more you will enjoy this work, the more resilient and sustained you will be

in summary, then euthanasia, it is a complicated procedure.

It is more than just giving an injection.

I hope through the course of these first four hours, you can really appreciate that

standardize those protocols and policies help everyone get on the

same page because remember we said variation is fine,

but consistency is better.

Keep learning about the techniques

and secondary traumatic stress plus burnout.

That's what equals compassion, fatigue.

Do your best to lighten your schedule and

find more resources So you're not experiencing burnout.

But I recognize that's easier said than done.

But secondary traumatic stress, if we are in full control of our body,

getting ourselves away from sympathetic, amped up,

tone down to that relaxed parasympathetic tone,

the better off we will be during euthanasia,

we do it well, we're going to love our job, better job satisfaction.

And please let's make sure to leverage those professional quality of life

tests to give us a gauge of how well we're doing.

My hope for.

You always is compassion satisfaction with euthanasia work and that comes from

understanding how to do it well and taking care of ourselves.

So, thank you so much. I again am Dr Kay

Cooney and you can find me at Kathleen at international dot com.

Bye for now.

AAHA Team Well-being

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