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Easing the pain
How does your staff handle client grief?
Whether it is an unexpected accident or a planned euthanasia, veterinariansneed to be trained on how to deal with the intensely emotional experienceof death, experts say.
For pet owners, grief can trigger many feelings from a deep sense ofsadness to outrage, panic and anger. When done compassionately and withattention to detail, experts agree that euthanasia can be one of the eventsthat bond your clients to your practice for life.
For veterinarians, death remains one of the most difficult subjects tobroach with clients, yet helping clients with their emotional pain can alsobe one of the greatest services DVMs provide.
Laurel Lagoni, managing director of the Argus Institute for Familiesand Veterinary Medicine at Colorado State University (CSU), explains, "Whenyou have been in practice for a while, you come up with a method that worksfor you, and seems to work for most of your clients in terms of handlingend-of-life issues. It doesn't always mean it is the most effective or mostsupportive way of going about things."
CSU thought there was a better way too, and ponyed up for the creationof the Argus Institute to prepare veterinary teams to successfully meetthe emotional needs of pet-owning families. The institute is composed ofan interdisciplinary team of veterinarians and mental health professionalsto train and study these issues. One such project has focused exclusivelyon pet loss.
"What we are trying to do is to really make the emotional care thatis offered at veterinary practices somewhat standardized and somewhat predictable,"Lagoni explains.
Helping with the burden
Lagoni says that people react very differently when they are informedthat death is imminent for their pet.
The reaction could depend on the circumstances, too. For example, anaccident is much different than a terminal prognosis that has resulted inextended treatment.
Each situation has different sets of circumstances, and each has differentways of effectively helping clients work through their anguish.
"Some people accept it fairly easily and want to do everything theycan for their pet; for other people it is marked by a lot of anxiety."
Whether a client is in anticipatory grief or coping with an unexpecteddeath, veterinarians need to help clients make decisions.
"They need to know how to help people turn that corner from tryingto do everything they can medically to help a pet owner say goodbye,"Lagoni says.
"I think it is a privilege when an animal is sick or injured tobe able to perform euthanasia and to let people be there and say goodbyein a way that is meaningful to them," she says.
"If you are going to let the family be there, I think veterinariansare going to have to have a really solid technique on how that euthanasiais conducted."
Prepare for the end
One aspect of euthanasia that the institute espouses is the concept ofa comfort room.
Typically, it is an examination room that can be quickly converted intoa comfort room when needed. The idea is to create a serene atmosphere forthe client and owner when euthanasia is the most humane option.
Lagoni also recommends conducting euthanasias at ground level on largerubber mats. It's a nice place for the family to sit with their pet to saygoodbye. The euthanasia could also be conducted right on the floor withthe pet's entire family present.
If it is feasible, let the clients decide whether or not they want theeuthanasia performed in the hospital or possibly outside.
If a euthanasia is going to take place in the hospital, the goal is tocreate an atmosphere in the examination room that makes this experiencepeaceful and serene for both the client and patient. It could include equippingthe room with dimmer switches to dim the lights. Privacy signs on the doors,plants and greenery, a cassette or CD player for music, plenty of handoutsand plenty of tissues.
Lagoni says that it is important to give your clients time to experiencegrief with their pet.
And it should be conducted as a ceremonial ritual. Clippings of fur isa nice way to remember the pet. Another option might be use of clay pawprints as way to remember a client's pet.
Talk to me
Before and after the euthanasia, Lagoni says that listening is a veryimportant skill when preparing an owner for euthanasia.
Some clients may sob uncontrollably, while others can act almost indifferent.Despite the outward appearance, all these clients are experiencing griefin their own way.
From a communications standpoint, Lagoni cautions against clichésor attempts to cheer the client up. "With grief, that is probably theworst thing to do. We want to help facilitate those feelings and reallymake the person who is grieving feel safe and comfortable in a place wherethey can express what they are feeling," she says.
Common clichés that are said might include: "Well, she hada really good life, or she is in a better place now." Another mightbe, "Just try to keep your mind off of it."
Instead, a better response is "I know she had a good life, but itis very tough to lose her." Lagoni says the goal is to give a clientthe chance to talk and to express his or her feelings about the pet.
Paraphrasing is an effective communications technique. Acknowledge theclient's feelings.
For example, if a client expresses guilt about the pet's illness or death,don't try to talk them out of it. Instead, you might say, "I can hearhow awful this is for you." Or, "I can imagine how badly you arefeeling."
Lagoni says that research shows that people in grief are looking fortwo things, a feeling of support and emotional catharsis, which is an opportunityto cry and wail and just get it out.
Staying in the room and effectively helping a client through this catharticexperience takes practice and training.
When veterinary students are trained, a typical reaction is to get outof the room as soon as the death occurs. It is a very natural and defensivereaction, Lagoni explains.
Training, however, is focused on raising the veterinarian's comfort levelwith intense emotion. In the coursework for veterinary students, pet ownerscome in to explain how painful this experience is for them.
"It is not fun, and it can trigger some of your own thoughts andfeelings, but each time you do it and you learn ways to cope with it, yougain more confidence and still focus on what needs to be done," saysLagoni.
Disposition of the body is another very important detail to address withyour clients, whether it is cremation or preparing the body for burial.
Remember, you could do everything right in performing the euthanasia,but the stark reality of seeing a deceased animal in a garbage bag afterdeath may negate everything you have tried to do. Be proactive and addressbody care options upfront and before the euthanasia, so there are no surprises.
Lagoni says it is very important to define the details, including dispositionof the body, whether it is communal, cremation or rendering.
Protocol for delivering a terminal diagnosis and supporting clientsduring difficult situations.
* Assess family situations to determine any special needs of clientsbefore the discussion.
* Attempt to deliver diagnosis in person, not over the phone.
* Make sure all staff members are aware of the diagnosis in person,not over the phone.
* Use private room (comfort room if possible).
* Allow at least 20 minutes for discussion.
* Make sure tissues are nearby.
* Sit at the same level with client on floor.
* Use slow, soft voice.
* Tell the client that there is bad news. Validate that givingthem this news may be difficult for them to hear and difficult to deliver.
* Anticipate that clients will respond with varying types anddegrees of emotion (shock, sadness, crying, anger, denial).
* Give clients permission to express themselves (e.g. It's okayto cry. I would cry too if I just found out my dog had cancer," or"it's okay to be angry")
* After the initial response to the diagnosis, explain it anddiscuss all of the options.
* Because the client may be in shock and unable to retain informationwell, write down or tape record what is discussed and send it home for themto review later.
* Offer referral list of veterinary specialists and human serviceprofessionals that may be able to provide more information and/or additionalsupport.
* If appropriate, follow-up phonecall within 48 hours to see howclient is doing, and to answer any further questions.
Source: Argus Institute for Families and Veterinary Medicine, ColoradoState University