• 1.

    Best CO, Perret JL, Hewson J, Khosa DK, Conlon PD, Jones-Bitton A. A survey of veterinarian mental health and resilience in Ontario, Canada. Can Vet J. 2020;61(2):166-172.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Nett RJ. Notes from the field: prevalence of risk factors for suicide among veterinarians—United States, 2014. 2015. Accessed December 25, 2022. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6405a6.htm

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Hatch PH, Winefield HR, Christie BA, Lievaart JJ. Workplace stress, mental health, and burnout of veterinarians in Australia. Aust Vet J. 2011;89(11):460-468.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Bartram DJ, Yadegarfar G, Baldwin DS. A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession. Soc Psychiatry Psychiatr Epidemiol. 2009;44(12):1075-1085.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Nett RJ, Witte TK, Holzbauer SM, et al. Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. J Am Vet Med Assoc. 2015;247(8):945-955.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Lovell BL, Lee RT. Burnout and health promotion in veterinary medicine. Can Vet J. 2013;54(8):790-791.

  • 7.

    Pohl R, Botscharow J, Böckelmann I, Thielmann B. Stress and strain among veterinarians: a scoping review. Ir Vet J. 2022;75(1):15.

  • 8.

    Platt B, Hawton K, Simkin S, Mellanby RJ. Systematic review of the prevalence of suicide in veterinary surgeons. Occup Med (Lond). 2010;60(6):436-446.

  • 9.

    Batchelor CEM, McKeegan DEF. Survey of the frequency and perceived stressfulness of ethical dilemmas encountered in UK veterinary practice. Vet Rec. 2012;170(1):19.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Foote A. Moral distress, compassion fatigue and burn-out in veterinary practice. Vet Nurs. 2020;11:292-295.

  • 11.

    Cocker F, Joss N. Compassion fatigue among healthcare, emergency and community service workers: a systematic review. Int J Environ Res Public Health. 2016;13(6):618.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Hill EM, LaLonde CM, Reese LA. Compassion fatigue in animal care workers. Traumatology. 2020;26(1):96-108.

  • 13.

    De La Rosa GM, Webb-Murphy JA, Fesperman SF, Johnston SL. Professional quality of life normative benchmarks. Psychol Trauma. 2018;10(2):225-228.

  • 14.

    Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One. 2016;11(7):e0159015. doi:10.1371/journal.pone.0159015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Wright AA, Katz IT. Beyond burnout—redesigning care to restore meaning and sanity for physicians. N Engl J Med. 2018;378(4):309-311.

  • 16.

    Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med. 2017;177(2):195-205.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Schwenzer KJ, Wang L. Assessing moral distress in respiratory care practitioners. Crit Care Med. 2006;34(12):2967-2973.

  • 18.

    Dodek PM, Wong H, Norena M, et al. Moral distress in intensive care unit professionals is associated with profession, age, and years of experience. J Crit Care. 2016;31(1):178-182.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Epstein EG, Whitehead PB, Prompahakul C, Thacker LR, Hamric AB. Enhancing understanding of moral distress: the measure of moral distress for health care professionals. AJOB Empir Bioeth. 2019;10(2):113-124.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Prim Res. 2012;3(2):1-9.

    • Search Google Scholar
    • Export Citation
  • 21.

    Moses L, Malowney MJ, Boyd JW. Ethical conflict and moral distress in veterinary practice: a survey of North American veterinarians. J Vet Intern Med. 2018;32(6):2115-2122.

    • Search Google Scholar
    • Export Citation
  • 22.

    Jameton A. Dilemmas of moral distress: moral responsibility and nursing practice. AWHONNS Clin Issues Perinat Womens Health Nurs. 1993;4(4):542-551.

  • 23.

    Hamric AB. A case study of moral distress. J Hosp Palliat Nurs. 2014;16:457.

  • 24.

    Piers RD, den Eynde MV, Steeman E, et al. End-of-life care of the geriatric patient and nurses’ moral distress. J Am Med Dir Assoc. 2012;13:80.e7-80.e13. doi:10.1016/j.jamda.2010.12.014

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics. 2009;20:330-342.

  • 26.

    Hamric AB, Epstein EG. A health system-wide moral distress consultation service: development and evaluation. HEC Forum. 2017;29(2):127-143.

  • 27.

    Morgan CA, McDonald M. Ethical dilemmas in veterinary medicine. Vet Clin North Am Small Anim Pract. 2007;37(1):165-179, abstract x.

  • 28.

    Neumann JL, Davis L, Jernigan C. Methods to address moral distress experienced by stem cell transplantation nurses and build resiliency. Biol Blood Marrow Transplant. 2018;24:S117-S118.

    • Search Google Scholar
    • Export Citation
  • 29.

    Rodriguez-Ruiz E, Campelo-Izquierdo M, Veiras PB, et al. Moral distress among healthcare professionals working in intensive care units in Spain. Med Intensiva (Engl Ed). 2022;46(7):383-391.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Pulcrano M, Evans SRT, Sosin M. Quality of life and burnout rates across surgical specialties: a systematic review. JAMA Surg. 2016;151(10):970-978.

  • 31.

    Valid and reliable survey instruments to measure burnout, well-being, and other work-related dimensions. National Academy of Medicine. Accessed December 18, 2022. https://nam.edu/valid-reliable-survey-instruments-measure-burnout-well-work-related-dimensions/

    • Search Google Scholar
    • Export Citation
  • 32.

    Trockel M, Boham B, Lesure E, et al. A brief instrument to assess both burnout and professional fulfillment in physicians: reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Acad Psychiatry. 2018;42(1):11-24.

    • Search Google Scholar
    • Export Citation
  • 33.

    Kogan LR, Wallace JE, Schoenfeld-Tacher R, Hellyer PW, Richards M. Veterinary technicians and occupational burnout. Front Vet Sci. 2020;7:328.

  • 34.

    Fumis RRL, Junqueira Amarante GA, de Fátima Nascimento A, et al. Moral distress and its contribution to the development of burnout syndrome among critical care providers. Ann Intensive Care. 2017;7(1):71.

    • Search Google Scholar
    • Export Citation
  • 35.

    Karakachian A, Colbert A. Nurses’ moral distress, burnout, and intentions to leave: an integrative review. J Forensic Nurs. 2019;15:133.

  • 36.

    Dzeng E, Wachter RM. Ethics in conflict: moral distress as a root cause of burnout. J Gen Intern Med. 2020;35(3):409-411.

  • 37.

    Schwerdtfeger KA, Bahramsoltani M, Spangenberg L, et al. Depression, suicidal ideation and suicide risk in German veterinarians compared with the general German population. Vet Rec. 2020;186(15):e2. doi:10.1136/vr.105430

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Fritschi L, Morrison D, Shirangi A, Day L. Psychological well-being of Australian veterinarians. Aust Vet J. 2009;87(3):76-81.

  • 39.

    Shirangi A, Fritschi L, Holman CDJ, Morrison D. Mental health in female veterinarians: effects of working hours and having children. Aust Vet J. 2013;91(4):123-130.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Dow MQ, Chur-Hansen A, Hamood W, Edwards S. Impact of dealing with bereaved clients on the psychological wellbeing of veterinarians. Aust Vet J. 2019;97(10):382-389.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Code of Professional Conduct for Veterinary Surgeons. Royal College of Veterinary Surgeons (RCVS). Accessed December 25, 2022. https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/

    • Search Google Scholar
    • Export Citation
  • 42.

    Yeates JW, Main DCJ. Veterinary opinions on refusing euthanasia: justifications and philosophical frameworks. Vet Rec. 2011;168(10):263.

  • 43.

    Magalhães-Sant’Ana M, More SJ, Morton DB, et al. Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology. Vet Rec. 2016;179(17):437.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Manette CS. A reflection on the ways veterinarians cope with the death, euthanasia, and slaughter of animals. J Am Vet Med Assoc. 2004;225(1):34-38.

  • 45.

    Newsome JT, Clemmons EA, Fitzhugh DC, et al. Compassion fatigue, euthanasia stress, and their management in laboratory animal research. J Am Assoc Lab Anim Sci. 2019;58(3):289-292.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Crane MF, Phillips JK, Karin E. Trait perfectionism strengthens the negative effects of moral stressors occurring in veterinary practice. Aust Vet J. 2015;93(10):354-360.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Stull JW, Shelby JA, Bonnett BN, et al. Barriers and next steps to providing a spectrum of effective health care to companion animals. J Am Vet Med Assoc. 2018;253(11):1386-1389.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Brown CR, Garrett LD, Gilles WK, et al. Spectrum of care: more than treatment options. J Am Vet Med Assoc. 2021;259(7):712-717.

  • 49.

    Shivley CB, Garry FB, Kogan LR, Grandin T. Survey of animal welfare, animal behavior, and animal ethics courses in the curricula of AVMA Council on Education-accredited veterinary colleges and schools. J Am Vet Med Assoc. 2016;248(10):1165-1170.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Traudt T, Liaschenko J, Peden-McAlpine C. Moral agency, moral imagination, and moral community: antidotes to moral distress. J Clin Ethics. 2016;27(3):201-213.

    • PubMed
    • Search Google Scholar
    • Export Citation

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Veterinarians and moral distress

Lori R. KoganCollege of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO

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Mark RishniwVeterinary Information Network, Davis, CA

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Abstract

OBJECTIVE

Assess veterinarians’ reported levels of moral distress and professional well-being. Determine the predictive value of moral distress, controlling for demographic factors, on veterinarians’ levels of Professional Fulfillment, Work Exhaustion, Disengagement, and Burnout.

SAMPLE

Members of the Veterinary Information Network.

PROCEDURES

An electronic survey distributed via the Veterinary Information Network data collection portal.

RESULTS

A total of 1,919 veterinarians completed the survey. For both associates and owners, gender and age were significant predictors of moral distress with younger female veterinarians reporting higher levels of distress than older male veterinarians. For associates, age was a positive predictor and moral distress score was a negative predictor of Professional Fulfillment. Age was a negative predictor, and female gender and moral distress score were both positive predictors for Work Exhaustion. For Interpersonal Disengagement and Burnout, age was a negative predictor and moral distress score was a positive predictor. For owners, age was a positive predictor and moral distress score was a negative predictor for Professional Fulfillment. Age was a negative predictor, and female gender and moral distress score were both positive predictors of Work Exhaustion, Interpersonal Disengagement, and Burnout.

CLINICAL RELEVANCE

We found that, controlling for age and gender, higher levels of moral distress predicted lower levels of Professional Fulfillment and higher levels of Work Exhaustion, Interpersonal Disengagement, and Burnout. Given the prevalence of moral distress and its impact on mental health, it is imperative that the veterinary field provide training and education on how to recognize and navigate ethical conflicts.

Abstract

OBJECTIVE

Assess veterinarians’ reported levels of moral distress and professional well-being. Determine the predictive value of moral distress, controlling for demographic factors, on veterinarians’ levels of Professional Fulfillment, Work Exhaustion, Disengagement, and Burnout.

SAMPLE

Members of the Veterinary Information Network.

PROCEDURES

An electronic survey distributed via the Veterinary Information Network data collection portal.

RESULTS

A total of 1,919 veterinarians completed the survey. For both associates and owners, gender and age were significant predictors of moral distress with younger female veterinarians reporting higher levels of distress than older male veterinarians. For associates, age was a positive predictor and moral distress score was a negative predictor of Professional Fulfillment. Age was a negative predictor, and female gender and moral distress score were both positive predictors for Work Exhaustion. For Interpersonal Disengagement and Burnout, age was a negative predictor and moral distress score was a positive predictor. For owners, age was a positive predictor and moral distress score was a negative predictor for Professional Fulfillment. Age was a negative predictor, and female gender and moral distress score were both positive predictors of Work Exhaustion, Interpersonal Disengagement, and Burnout.

CLINICAL RELEVANCE

We found that, controlling for age and gender, higher levels of moral distress predicted lower levels of Professional Fulfillment and higher levels of Work Exhaustion, Interpersonal Disengagement, and Burnout. Given the prevalence of moral distress and its impact on mental health, it is imperative that the veterinary field provide training and education on how to recognize and navigate ethical conflicts.

Supplementary Materials

    • Supplementary Appendix S1 (PDF 165 KB)
    • Supplementary Table S1 (PDF 138 KB)
    • Supplementary Table S2 (PDF 128 KB)
    • Supplementary Table S3 (PDF 126 KB)
    • Supplementary Table S4 (PDF 125 KB)
    • Supplementary Table S5 (PDF 127 KB)
    • Supplementary Table S6 (PDF 128 KB)
    • Supplementary Table S7 (PDF 125 KB)
    • Supplementary Table S8 (PDF 125 KB)

Contributor Notes

Corresponding author: Dr. Kogan (lori.kogan@colostate.edu)