Hello and welcome to today's lecture where we're gonna be discussing bereavement in practise. I'm Katie, I am a veterinary nurse, and I have worked in a variety of different, in practises, and most recently when I was clinical, I was working as a senior emergency and critical care nurse at the Royal Veterinary College, where I was there for about 10 years. I actually have been training now in, psychotherapy instead, and work permanently as a hospital counsellor at the Ralph Veterinary Referral centre, where I support both the team and also our patients, carers as well.

Just sort of depending on what they're coming into practise for, I'm just there to provide them extra support. So the learning objectives of today, we're going to go through and understand why we use euthanasia in veterinary practise and what we think about when we come to making this big decision. We're going to look in at describing what grief is and include the different types of grief that our clients are likely to experience and also the grief that potentially we might experience ourselves as veterinary professionals.

We're also gonna have a brief look at understanding veterinary mental health and how bereavement can affect us and what we can do about it in practise. So euthanasia, we all know is a humane death. Every veterinary professional that I have had the experience of working with, especially in the UK has felt that it is a privilege to be able to carry out euthanasia as a treatment option for our animal companions.

I know that this isn't the same all over the world and we'll be touching on that a little bit later. But it does relieve suffering and it is not a welfare concern. And so often we might think about euthanasia as a treatment option first line for some patients who may come to practise, maybe with multiple traumas, or maybe for other reasons as well, which we'll cover.

So when we think about euthanasia, what are the things that we encompass in making these decisions? All of these things are really difficult to talk about. There's also see a lot of emotion tied up in euthanasia and death, and so the first thing might be a patient's diagnosis.

The level of suffering that our patient might be in, but also the level of suffering that we might perceive them to be in danger of, coming into contact with, depending on how long we let them continue with whatever disease process they have. And also thinking about the prognosis, if we know that the prognosis is really poor and that maybe treatment options might make them feel a little bit worse rather than making them feel better, then this might be something that we want to discuss with our clients. We also consider our ability to provide a good standard of care, so maybe this is that we are treating patients in a different part of the world where our facilities aren't as good, maybe we don't have the consumables that we are used to in the UK, but also thinking about finances, and so that might be applicable in other areas of the world, but even in the UK finances can really come into it when we're thinking about making these decisions, especially for a patient who maybe is uninsured and who maybe has multiple different conditions.

We also want to consider people's own beliefs, so we're gonna cover some religion and what that might encompass for us. Patients background, what they maybe are comfortable with, the patient themselves, so whether they are happy to be hospitalised or whether they really struggle with that. But also thinking about our client's previous experiences.

We may have a client come to us, with a patient who we diagnosed with something that we believe to be quite treatable, but in their past they may have had a pet with a similar, similar disease process, for example, that maybe didn't cope very well. And so actually, having had that experience might cloud their judgement in terms of what they want for their future pets with maybe similar issues. And so this is all something that we need to talk about really openly with our patient carers.

And obviously poor prognosis being one of our main sort of concerns and especially one of our main things when we think about euthanasia. We know that Med has made really huge progress in recent years, and just sort of picking out one thing, so, cancers are obviously an easy thing to discuss when it comes to comparing our dog and cat patients with human family members. We know that our dogs and cats now with cancers are more able to receive chemotherapy and have a better prolonged quality of life than they ever have before.

And so this really is something that we, we tend not to think about. But with the advancement of these vet meds and processes, we also see lots of different problems. We're very aware in the UK we don't have a National Health Service for our pets and so often this comes down to them thinking about insurance.

Will our insurance cover a prolonged sort of state of chemotherapy? Will they cover the, maybe the complications that come with that? And also thinking about increasing costs of veterinary care.

We'll come on a little bit later to the increasing costs and the financial side of veterinary care and sort of the implications of that. But I think also considering the economic climate we're in right now, I, we can only really expect that this might become a bigger concern for our pet carers. And also our current expectations, especially when we think about something such as cancers, are they comparing the sort of expectations of what we can provide for our patients to those maybe of, maybe a family member who's had a similar different cancer process?

And sort of what are their expectations around that, and, and are they kind of accurate? Do we need to really re-educate them into what we're trying to achieve here? So then quality of life, we know that this is our most important thing really when we're thinking about our patients and sort of how happy they are and when it comes to calling it at the end of their life.

Quality of life is a really difficult subject, and that's because it is subjective. So this is going to differ between every single individual. I'm sure that everybody watching the webinar is sort of having their own experiences of what they believe to be a really good quality of life.

And also that might vary in between family units. So maybe we will see families coming into the hospital with a patient and you could ask, you know, maybe 4 family members how they believe the patient's quality of life is, and they might have 4 different answers for you. I also would think that you might assess quality of life differently depending on the patient themselves.

And so actually, if you think about your own pets at home, maybe something that you might think is really important for one of your pets, quality of life. Maybe that is, you know, running across the field after a ball. Maybe you have another pet who really has never been interested in doing that, and so actually you wouldn't put that on their quality of life, and consider it in the same kind of way.

In order to be able to assess quality of life, it's really important to consider quality of life scoring. And so some hospitals are already using scoring systems to help their clients be able to see and assess the quality of life of their own pets. I'm sure that we've all in our history come into contact with people who have pets that may be present at the hospital quite cakeic with a really vague history, and our pet carers may not have appreciated potentially the weight loss that this pet has had and maybe sort of decline in maybe their coat health or how generally they seem to be.

And this is so, so common, you know, when we're living with our pets, and our, and our family members at home, we're seeing them day to day and we are sort of just continuing with our daily routine. It's very common to not see these really tiny changes until potentially you've taken them back to the vets and see that they've lost 2 kg. So when we think about quality of life scoring, it's based on the following things.

And so when we think about quality of life scoring, I think there are, there are quality of life scoring sheets and systems out there available for use, but it's also possible to encompass all of these things and actually come up with something that's a little bit, sort of unique to your hospital, potentially, unique to how you want to work, or maybe unique to the way that you, the way that you work, or maybe the area that you work in, if you're particularly interested in medicine or surgery, for example. So we want to think about obviously eating and drinking. So are our patients eating a normal amount?

Are they eating their normal diet? Are they drinking really well? Or are our patient carers having to maybe choose a different diet every day because they've gone off the food that they were eating yesterday today?

Are they having to cook different meals for them because they're feeling really fussy? And what really is going on there? We want to think about toileting habits.

Are are cats able to go and use the litter tray in the same way that they always have? Are they struggling to get into the litter tray? Are they actually missing the litter tray?

And how is that affecting their behaviour as well? With our dogs, are they able to ask to go outside or are they really struggling with urgency, maybe not really realising that they need to go to the toilet? And in terms of also thinking about our client's ability to deal with different toileting habits, especially, also thinking about whether actually are the pets happy in that scenario.

Many pets might be absolutely fine, that they have had an accident in the kitchen, and then that's cleared up, and then they don't give it a second thought. But we also know that we've got these patients that we see who will get really, really distressed if they miss the litter tray, or they'll get really distressed if they haven't been able to make it outside. And so thinking about that as well in their quality of life.

Thinking about exercise and play, it's really common for our patient carers especially to just assume that as their pets get older that they don't want to do these things. But we know that actually if a patient is happy and healthy and free from pain, they really do want to play and it doesn't really matter how old they get, they will always want to kind of do the things that they've always wanted to do. Some patients maybe have never been really into playing tug of war, for example, and so that wouldn't come into it.

But for a patient who really is, then we want to make sure that we're tailoring that to the individual. And then thinking about pain and mobility, so the ability that they're doing everyday things, if they're living in a house where they have to climb stairs, if they're living in a flat, for example, then this is a really important part of their life. And it might well be that, especially with larger dogs, that once it gets to a stage where they can't climb the stairs very comfortably, that we really need to be assessing that for a dog that maybe doesn't have to do stairs every day, that again would be different.

Noticing whether our feline patients are grooming themselves appropriately, are they actually quite matted? Are they becoming quite dandruffy, and actually, are we assessing the mobility and, and the joint pain that might be going on there, rather than just assuming that these things are happening as our patients get older, which may well be happening with our patient carers. And then lastly, looking at cognitive function and cognitive ability.

So we know, you know, we've all seen the patients who come in and the carer has described that at 3 o'clock in the morning they start howling or pacing the house and getting quite distressed. And so for some of these patients, they might, they might do this and they might settle quite quickly. We may also need to put them on some form of medication to help with this, and we do have medications available that will help.

But also, are the patients then settling well or are they getting really distressed, and are they finding this really difficult thing? And so then thinking about whether actually comparing these two dogs, both of which get up at 3 a.m.

And start howling and pacing the house, one of them may need medicating and potentially sedating in order to bring them back to a good quality of life, and the other one might do that for 2 minutes and then go to sleep and really not have any worries at all. So then thinking about this, we want to be able to ask these questions at intermittent intervals to our clients to help build a picture, and this is especially helpful in patients where they are elderly, they're getting more elderly, maybe they've got lots and lots of different issues, but maybe nothing that's very serious, and we're treating lots of different conditions at once. It's important to consider asking our our carers to keep a diary, and again, for similar reasons, it might be that actually they've got into a really sort of habit of feeding patients different things every day, maybe cooking something different every day, and they don't really give it much thought, but it's only when you've written it down that you see that actually this patient really isn't eating very well and hasn't done for some time.

Again, it's really difficult to get objective answers and as we said earlier, you may get different answers from different people in the same household. And I've put this phrase in here, so we may have heard people say a day early is better than a day too late. And I think people mean by that that, you know, you would rather euthanize a patient who is sort of still bouncing around on one day and is very happy, that maybe a patient who has really turned a corner and is really not having a very good day and potentially is suffering.

And I am not putting in this, saying to say that there's a right or a wrong answer individually. I'm sure you all have your own opinion on, on what you believe due to your experiences, but I really just wanted to put it in here to give us kind of food to thought. So is this true?

And if so, is it true for who? Are we talking about our patient? Are we talking about our carer?

Who's our responsibility for in this situation? And I just think it's an important thing to really think of. It's our responsibility to guide our clients at this difficult time.

They trust us to make these decisions as the professionals, and we are the experts in terms of the veterinary care, in terms of the medicine that we're providing, but it's important to let them know that we are aware that they're the experts of their pets. There are always going to be patient carers who need further guiding, and sometimes that might be more tricky, but actually by keeping them on side and letting them know that you are building this bond and you're both doing that for the sake of the patient, you can actually sort of get a very, a bigger picture really, and a better ability to be able to provide the care for the patient that the patient needs. So now thinking about finances, this is a very difficult subject and it is tied up in a lot of shame and guilt for, for a lot and lots of people and I, and I do think that as our economic climate is progressing, this is something that we're experiencing more and more frequently.

We all know that we get our defensive or our angry clients, but a lot of this defensiveness and angry, behaviours can just come from really feeling ashamed that maybe they, they don't have the finances in order to pay for the veterinary care that they really want to be able to do. Sometimes finances might seem like a real non-reason for euthanasia, but I would argue that they can be very valid. And I think especially when we're thinking about patients nearing the end of their life, and patients with severe comorbidities, and patients who have had maybe a multiple trauma who are.

We need sort of vast amounts of surgery, vast amounts of intensive care, and potentially come out with a bill sort of in the tens of thousands of pounds, but, but may also maybe not have a good prognosis, then actually I really think that discussing finances and discussing all of that is really part of this. And then the phrase just because we can doesn't mean we should. Again, as an ICU nurse, this is something that was talked about a lot.

It was something that was heavily debated in terms of a lot of our patients and a lot of the treatments that we provided for our patients. And again, I'm not sure. I think that again it really varies person to person, patient to patient, you know.

Talking personally with my dogs, you know, I might do something for one of them over, over what I would do for another dog because I know that maybe she wouldn't cope as well in hospital as the other dog would. And so I really think that there isn't, there isn't an objective answer to any of this at all. We know that the average veterinary visit, for something, you know, that they have come in for, maybe even vomiting, diarrhoea, can actually be up to around 108, 1010 pounds, sorry, per veterinary visit.

And these bills can exceed sort of 10,000 pounds, and I think when I first started nursing, 10,000 pounds would have been a really hefty bill. That would have been a patient that was in for a very long time. And now, actually, especially if our patients have ended up with a referral for some reason, 10,000 pounds is really not that unreasonable, and I would argue is a pretty common bill that our pet carers are receiving.

There's a lack of understanding around why this is and where this comes from, and again, we have a lack of disposable income, especially now, and so we're seeing this a lot more in our pet carers. In Europe, it's estimated that we have over 100 million pet cats and 80 million pet dogs, so that is not including any strays, and this was actually pre-pandemic, so I would really be interested to know in what that number stands at now since everything has happened. And insurance wise in the UK we know that only 24% of dogs are insured and actually under 10% of cats are insured.

Comparatively to the US, only 1%, so under 1% of their whole pet population have insurance. But again, I think this comes into the fact that they maybe are used to paying for private healthcare because they don't have the National Health Service like we do, but it's still really a very, very small percentage of the pets in this country that we see that are insured. So we know many people will have these financial struggles with their pets.

So moving on to religion, we know that lots of different religions have views on euthanasia, lots of different religions will have views on blood transfusions and treatment options as well, and I'm sure you will come across these at some point in your veterinary careers. And it's just for us to not make judgments. We know that some religions don't believe in euthanasia at all, and this can be a really, really difficult thing for us to contend with as veterinary professionals who on the whole, really do believe that euthanasia is a valid treatment option.

We need to be able to see situations from our clients' perspectives, and I think it's important to always stay on the side of that client, to be able to give them that trust and that faith, to be able to show them that you are making these choices around their pets in their pet's best interest. If we have understanding that euthanasia right now isn't an option for this particular pet, then we just need to make sure that we are talking to them about palliative care and that we are on side and we all kind of, we're all there for the greater good in terms of that pet's happiness, and sort of lack of suffering. And analgesia really is something that I think comes into this and we'll talk about that a little bit more a little later on.

So palliative care is optimising a patient's quality of life whilst we mitigate their suffering. And so we did just sort of briefly touch on analgesia, but important with our patients that are on palliative care that we talk about this in great detail with our pet carers. Depending on the situation, depending on our patients disease processes and and where these patients are being housed will obviously depend on the abilities that we have to give analgesia to patients.

So in patients maybe who are going home on palliative care, this limits us normally. To our oral analgesics. So we might well give non-steroidal anti-inflammatories, which would be helpful.

We could give, and consider oral buprenorphine, gabapentin, and really sort of trying to come up with multimodal ways of keeping this pet as pain-free as possible. And then thinking about the nursing care of these patients. And again, this might change and differ depending on the circumstances of the patient.

But looking at nutrition, and initially, especially I guess if we've got this patient who we believe should, you know, go home on palliative care, we want to think about whether placing a feeding tube is appropriate in these patients. And again, this is something that should be done on a case by case basis, and sometimes the answer might not be that we need a feeding tube in that patient. Maybe that isn't appropriate.

Whether these patients can urinate and defecate, so not only are they keeping themselves clean, but are they able to do this? Do they need assistance? Do we need to train our pet carers to be able to express bladders, for example, and also expressing the importance of keeping these patients comfortable on soft bedding, turning them frequently, looking after their oral and eye care, and sort of preventing any ulceration.

It's important to get the client's involvement in these and to feel that you're empowering them to be able to look after their really loved pet and also to make decisions, and, and know when it's time for these patients to go home, with some palliative care, but also know when it is time to say goodbye for pro. As veterinary professionals, and as vets, you have the ability to make that final decision and take that responsibility from the pet carer if you feel that that really is something that's necessary. And so knowing where your boundaries lie with that and what you want to do with that is really important.

So when it comes to saying goodbye, especially if we are euthanizing or or a patient has died after palliative care, we have a responsibility to our clients to help them through this process. It's in everybody's best interest that we prepare clients, especially with terminally ill patients, for this period of end of life care and also for sort of the, the post death of their patient and and what to expect. We should be having discussions around what the process is and why.

So if this is euthanasia, we want to talk in detail about what we are going to be doing, why we're going to be doing that. What we expecting from it? Are we actually going to be sedating this patient before we euthanize them?

They are gonna be sleepier than they were when when they came into the room because we're sedating them for XYZ reason. And what will happen afterwards. So making sure that we're having a good discussion around what they're going to expect once that patient has passed away.

It's really useful if it's possible to have discussions around options for patient care after they've passed away before they have gone, and this gives our pet carers time to consider what they would like. So when we're thinking about cremation, if we need to talk about burials, so we do still have clients that want to take home pets to bury, and especially when they're thinking about something like that, actually, there's there's quite a lot of logistical sort of things to think about in terms of burying. So county to county, the options for what depth to bury patients at.

Is very different, what the rules are around zoonotic diseases, and sort of lots of different things to consider. And so having this discussion in advance is a really a good advantage here. And so if we have a patient on palliative care with a terminal illness where we're having these discussions, getting it in earlier than later is really appropriate.

When it comes to time to say goodbye, giving them time with their love pet afterwards. If we can give them time with them before, then that's really great. If you have a special bereavement room in your practise or a quiet consult room that you can shut off and really keep private for them, then giving them that time if it's appropriate for the patient, but especially after they've passed away, allowing them to not feel rushed that they have to get out of the room because, you know, you have, you've got a list of vaccinations to get done straight away.

Encouraging our pet carers to talk and also following up, so have you got somebody in your practise that's trained to deal with grieving clients that might feel comfortable calling them in a few days to see how they are? A really sort of important certificate that I think is available is our Blue Cross pet bereavement certificate, and I know and work with a lot of nurses who have done this. I've done it myself, and it really gives a very good overview of euthanasia, grief, what our clients are going through, how to hold these conversations.

It doesn't train people in being a counsellor. But it trains them in, in feeling comfortable with knowing what to say at the right time, and really kind of gives the experience of our patient carers, something else. You know, we, we don't feel like we're euthanizing their patient and then they're just gone and they don't matter.

We're really supporting them through one of the hardest times, potentially of their lives, you know, that they're having with that patient. Now lots of practises do end of life care differently, and so a card from the practise is really popular. It's very appreciated by clients.

It's really nice that they feel that you, you knew their pet personally, especially if you've had a long relationship with them and their pets, throughout the many years that you've been treating them. And lots of different places will now do. Extra.

So in our practise, particularly, we will now provide, we'll ask them if they want us to take paw prints or nose prints, and provide them with further support information. So the Blue Cross pet bereavement line, and, and many other different things in order to try and follow up and make sure that they're OK. So when we think about grief, we have the Kubler Ross model, which is kind of the most talked about description of grief at the dabter.

So this is our denial, anger, bargaining, depression and acceptance. And often this is viewed as, sort of a standard process of grief and of people misinterpret this to think that these are the stages of grief, and that that means that actually these are the stages you should go through and that they're in a particular order and that everybody has to go through all 5 of them in order to have grieved and to be through that grief. but that's not really the case.

So there are many different types of grief. We categorise grief into into many, many different types. And so I thought I'd run through a few of them.

So our common grief is what we kind of normally expect in our wider society. It's what we're, we know about, it's, yeah, it's what. Sort of experience with our family members and our our pets, and it's quite a tolerated grief.

So if we have a family member die and we talk about it at work, it is tolerated. People understand how upset you are, and, and that's OK. You can talk about it.

Anticipatory grief is something that we experience a lot in patients that maybe are older with pre-existing conditions. Or also, if we've got a patient who's in and the pet carer has had a recent loss of another pet, anticipatory grief is really difficult because the pet or the person is still there, they're still around, but we're already starting to experience grief, whilst they're still sort of within our lives. With inhibited grief, we've actually got no outward sign of the grief at all, and it can be quite prolonged.

It can lead to lots of somatic complaints and physical manifestations, and so we might experience people getting sort of physically ill. They might have IBS flare-ups, they might get really bad headaches, they might not be able to talk, they might get sore throats, and sort of that's a, a difficult grief that we, we may not see in practise, especially with a sort of day to day. Complicated grief, is, as it says, so it only affects about 7% of people, and it can be really debilitating.

It's a complex bereavement disorder and it really sort of means that people have an inability to function and so they all need really serious mental health support for for complicated grief. Disenfranchised grief, again, something that we are going to see a lot with our patients. This is where we will have a pet carer say, oh, you know, I've gone to work and they've told me she was just a cat or he was just a dog.

People that do not understand the bond between a patient, a pet patient and their carer, there's no kind of recognition there. I think that actually even in veterinary practise, we're quite behind here. A lot of us are expected to be able to go back to work straight away, even if we have lost a pet.

And there is a lot of shame experienced with this as well, because you might feel, maybe am I weird? Did I love my dog too much, you know, should I not be feeling the way that I'm feeling here? And it can be really, really difficult.

It adds a whole other dimension onto the grief that you're already experiencing. With absent grief, it is kind of how it sounds, so we might see a lot more here of shock or denial. We may even see that the person has no signs of grief at all, or maybe even go as far as to not really accept that there has been a death.

They might act completely normally, and I would say that actually this is part of grief, as we looked at a little bit with our dabda, the Kubler Ross model. Shock and denial are parts of grief, and so this might be normal for a little bit, but it would be worrying if this was a prolonged state. And then our exaggerated grief, this is where it is overwhelming, it might worsen over time.

Our pet carers might experience nightmares or social dysfunctions and this also can be the onset of psychiatric disorders. So as we touched on, anticipatory grief is really something that is, is really important. We might see our clients become really difficult or really rude while their pet's in hospital.

And it's really important to note that this might just be an outward expression of their grief. If their pet is especially poorly or if they have recently lost a family member or another pet, they will already be experiencing this grief, and they may not know how to process it or or verbalise it to you, and everybody reacts really differently. Everybody grieves really differently.

And so just keeping this in mind. I'm not saying that, clients being difficult or clients being rude or angry is, is something that we need to tolerate, and sort of put up with, really sort of bad behaviour. But having that understanding around why somebody might be feeling this way, can go a long way into developing our, our relationships with our clients.

And as we said, disenfranchised grief, often, you know, they're just a pet. Even the family or friends of our clients might not understand, and definitely their workplaces on the whole, do not understand. It's quite rare to come across somebody who, who really feels that they can be open about their grief for their pet, sort of throughout their life.

They might just have one area where they feel comfortable to do so. And so we've just touched on this, but sort of just to say that the two models of grief that we're going to cover today are this Kubler Ross model, and so all of these things were kind of brought up as stages of grief, but were never sort of meant to be in a particular order. And so people will go in and out of these different sort of stages of grief at different times, and that's OK.

I think a better model is this dual process model, and it kind of talks around everyday life experiences, and so you'll have on this left side your loss oriented experiences and on the right, your restoration oriented experiences. And so on your left, you will have all your sort of really sort of difficult grief. So, the denial, your, the things that you maybe have had to do, maybe you've had to relocate since the death of somebody, you're really thinking about it.

Maybe there's an anniversary, and that really sort of affects you and you can't stop crying all day. But on the right. Side, you're gonna start to live life again in some ways.

So you might be temporarily distracted from the grief that you've had because you've had a really busy day at work, and so you've not actually given it a second thought. You may have a new relationship come into your life and so actually that kind of distracts that part of you for, for a lot. And also maybe new hobbies or new things that can also help us move forward with life, but definitely don't get rid of the grief.

They're just sort of alongside it. And so thinking about how it sort of oscillates between the two, I think is kind of a more accurate model of how I would say most people, go through different grieving processes. So now we're just gonna look a little bit about veterinary mental health.

So we've just talked about grief, and what I want us to consider is how does this affect us in veterinary practise. I think as a veterinary nurse who's worked for a long time in a, in a critical care unit, actually working alongside very, very sick patients for a long time, often with poor prognoses, often seeing a lot of euthanasia, and with that coming a lot of patient carer grief as well, dealing with the grieving, carers has has actually had a really big impact. I think that another thing we're thinking about is how we are coping now since the pandemic, as to pre-pandemic as well, because we've all kind of had a collective grief in terms of the life that we lost pre-COVID, and sort of the different life that we're moving forward into now and how we're coping with all of that.

And so actually, our ability potentially to cope with these different things, may well have changed. Do we think that crying with clients is acceptable, and again, I don't really feel like I want to give answers for any of this today. I don't think that talking about rights or wrongs is, is appropriate here.

I think that everybody's experiences are really different. I think that on the whole, we could probably agree that crying with every client is probably not acceptable. You know, these are their pets, they are, this is their moment where they need you to be a professional.

But I would also argue that actually, if you have been looking after that patient for a really long time, and you have a really close bond, then actually, you know, showing some vulnerability and showing that you were just human and that you really do care again is also appropriate at times. Our disenfranchised grief, I think that this is something that can affect us as veterinary professionals as well. I think this comes into this crying with clients actually, because if you've looked after a patient for 10 plus years, you've seen maybe that little dog as a puppy, you have been its vet for their whole life, and you've now come to a stage where maybe you're euthanizing them at 1214 years old.

And you feel really, really upset. That's a bond that's been broken. That's a patient you've really cared for for a long time.

I think this disenfranchised grief can actually be applicable here too, because you may not feel that it's appropriate for you to be grieving because you've lost a patient, you know, you might feel that that is for the client only to be grieving about, but actually, I would argue that that is also your grief. You know, you've cared for that patient. And so being able to be sort of honest around how you feel about that.

Do you take this home at the end of the day, or what do you do to help yourself? And who do you talk to about these things? Have you got a very supportive family member who is willing and able to listen to your day, your veterinary day?

I know from lots of my colleagues that actually a lot of non-veterinary professionals find it really, really hard to listen to the things that we do put up with every day and the things that we experience every day. And so sometimes we might go home and feel that we can't talk about these things. And that might be OK, but I think it's still important to know who you can talk to, especially when you need to at the end of, especially a busy day.

So then thinking about our self-care and how we care for other people. I know that it's talked about a lot, it's something that is more and more discussed, especially in veterinary medicine, but making yourself a priority is, is really, really important. We've all heard the phrase that we cannot pull from an empty cup, and that really cannot be more true.

So you can't expect yourself to be able to provide excellent veterinary care to your patients, excellent care to your clients, be a good person to be working around in terms of being a colleague, a friend, a family member if you are not putting yourself first, at all times really, to, to make sure that you are healthy. It's important we consider our nutrition. I know it's difficult when we're working really long days, but making sure that we are eating sort of a few times a day.

We're getting enough sleep, making sure that we are turning off screens before bed, getting exercise where we can, whether that is just a really brisk walk outside. And I think especially important now. We're moving into the winter months, considering, actually, how much sunlight are we getting?

Because if we're going to work in the dark in the morning and we're coming home in the dark in the evening, have you seen the sun today? Have you, have you been outside and actually had a brisk walk? Because even just doing that for 10 or 15 minutes in the middle of the day can really, really help you, feel more centred and grounded.

Thinking about mindfulness, and again, this might not sit well with some people. I know some people find it really fluffy, but actually mindfulness is really, really important. We know it's a huge part of our personal well-being.

So whether this is that we are fully on board and we're really into meditating, great, let's do that. Let's take Minds there. But if not, just actually finding something that can help you feel mindful.

This might be an activity such as crochet or knitting or drawing, just something that can sort of busy your hands and sort of take your mind out of that everyday sort of thought process and onto something a little bit less intense. It's really important to take regular breaks. I would argue that we need to push for these in veterinary practise.

I hope that it is getting better. I think I see it a little bit more often with people, and especially when I talk to people, I think it is something that we are pushing for a little bit more. But being able to advocate for ourselves and say, do you know what, we can't, we can't work like this without, without an adequate break.

But also important alongside this is encouraging other people to take their breaks too. It's not really good enough to be the person who is running around like a headless chicken all day and and not sort of taking your breaks, but also not encouraging others. And if you see somebody else taking a break, it can be quite tempting if you're feeling very stressed and very overwhelmed.

To maybe not feel that that's appropriate, but actually if we can all sort of develop a safe psychological culture where we feel comfortable taking breaks, we encourage each other to take breaks, and we, we know that we need them and that they make us feel better, then actually that's a better environment to work in for everybody. And in order to do that, we should factor them into the working day. Now this is really difficult and especially in a practise that maybe it's doing a lot of out of hours work, a lot of emergency work, it can be really tricky.

But actually maybe taking the time in the morning to discuss maybe after patient rounds, who's doing what that day, what the plan is, and actually maybe a rough estimate of when people are planning on leaving and going for breaks will help everybody stay on board and maybe keep people on track, in order to do that. And then thinking a little bit about group activities, so whether that is something such as sort of icebreaker activities, if you've got new members of staff, whether this is team building activities, but also thinking as well about more mindful things. So whether we actually try and factor in a meeting every.

Where we discuss the difficult things that have happened, maybe in practise, the things that we've struggled about, bringing in what we think we are proud of a colleague for achieving or or a colleague for doing, just so that we can open up this forum to be honest and have these discussions with each other. We haven't got time today to talk about Schwartz rounds, but Schwartz rounds are something in human medicine, which are very, very common and popular now. They came over from America, but they are, they are widely utilised now in European hospitals, too, especially in the UK, and there are a few practising veterinary hospitals that do schwartz rounds.

Here, and the concept of shorts rounds is really that you, provide refreshments, so food, drink, sort of a sit down, and that you have a panel discussion where you maybe have a theme and talk around that theme, and what stays sort of what happens in the room stays in the room. So if we're having a discussion about maybe Difficult clients, for example, that could be a theme, and you might have different people bringing in stories of clients that they found challenging and that might be for personal reasons, that might be because they really touched on something for them that was personally very difficult at that time, and really opened that forum to have that discussion. It means that people can show their vulnerable side.

It means that people can see that everybody's human. And it also really works to sort of level out hierarchies as well in the veterinary practise. So being able to make sure that receptionists and surgeons and PCAs and and veterinary nurses and, and everybody else can kind of be seen on this even keel, that we can't do this job without one another, and that we all have individual experiences of all of these things.

It's just really important and something to think about. And lastly, just to talk, so throughout all of this, I think, you know, it's very important that we are talking, if we're talking to each other, that's really great. We have shared experiences, we understand where each other are coming from, so talking to colleagues is really important.

I'd also say that actually it's really important to talk to people outside of veterinary practise, just for your own sort of mental wellbeing, and whether that is finding a personal counsellor, whether that is going to a group that you can have a talk with, just finding people who will listen to you, be non-judgmental, and help you work through some of the most challenging parts about this job because. We all know that this is a difficult job to do, and we all need help. We are all only human, and so making sure that you feel comfortable enough to do that.

And again, if you're seeing a colleague, you're worried about a colleague, maybe they're not acting themselves, then being able to open that conversation with them and feel comfortable to do that with them, really can help, help people's lives change. So today we've covered why we use euthanasia in veterinary practise and the different things that we think about when we make that big decision. We've looked at grief, we've looked at all the different types of grief, and especially the ones that our clients are likely to experience both in practise, but also understanding our, our veterinary mental health, the different grief that we might experience whilst we are looking after our patients in practise, and the little things that we can do to kind of help ourselves, but also help each other through these difficult times.

Thank you very much for listening.