Understanding grief in student veterinary nurses and its wider implications

IT is increasingly recognised that veterinary professionals, including veterinary nurses, are exposed to a wide range of emotional stressors as part of their everyday clinical practice.1, 2 These stressors include the emotional burden of euthanasia, difficult or demanding clients, long hours, financial pressures and the emotional labour of suppressing their own emotions while appearing empathetic.3 Although individuals' responses to emotional stressors vary, research on the prevalence and impact of stress, burnout, compassion fatigue and moral injury has shown that these experiences can have a variety of adverse effects on individual wellbeing, productivity and workplace cohesiveness.4-6 For example, a study of veterinarians in Norway found that when grief – defined as the distress experienced after patient loss – is not processed healthily and continued grief is felt through multiple patient losses, it can lead to more serious mental health issues such as depression and suicidal ideation.7 However, there is currently little information available on the impact of grief on veterinary nurses. A recent study by Wheatley and Yon,8 summarised on p 329 of this issue of Vet Record, helps address this knowledge gap. This study used the adult attitude to grief scale (AAGS) to explore the prevalence of grief in student veterinary nurses in the UK and assess their coping styles. In addition, the study investigated whether student veterinary nurses felt adequately supported by their academic institution and training practice when experiencing grief. When the participants were categorised according to which of the three main grief-processing styles (balanced, controlled and overwhelmed) they predominantly displayed, most were in the 'controlled' category – that is, they tended to suppress emotion and avoid expressing grief.8 While this grief-processing style is potentially beneficial in the short term, it is not a productive way to manage feelings of grief in the long term and may increase the risk of disenfranchised grief, compassion fatigue and burnout.9-11 Student veterinary nurses experience grief when a patient dies or is euthanased. However, research suggests that they may be internalising their grief rather than processing it healthily, which may have a detrimental effect on their mental wellbeing and ability to work effectively, potentially increasing their likelihood of leaving the profession Studies show that those who feel that they are unsupported are more likely to develop disenfranchised grief.10 While most of the students (83 per cent) in Wheatley and Yon's study felt supported by their academic institution and their placement practice, there were some who felt unsupported in processing and managing their grief.8 However, the study did not indicate whether students were aware of what support was available to them, so those stating they felt unsupported might simply have not been aware of the support options open to them. Nevertheless, this finding indicates a gap in support – whether real or perceived – that institutions and practices must work to address. Interestingly, degree students reported feeling less supported by their institution than diploma students.8 One possible explanation for this finding is that diploma students spend less time at their institutions than degree students, meaning that they have to rely on them less and, consequently, have fewer opportunities to be unsatisfied with the level of support offered. In conclusion, Wheatley and Yon's study8 demonstrates that grief is prevalent among student veterinary nurses in the UK, with some of them not recognising when they are experiencing grief. While this study was limited to student veterinary nurses only, the findings could indicate a more widespread problem within the veterinary nursing profession. Various studies have already highlighted that the mental health of veterinary nurses is often not as positive as it could be,1, 5, 14-16 and unrecognised and unresolved grief is likely a contributor to this. This research provides an opportunity for all those involved in the education, training, employment and registration of veterinary nurses to acknowledge the prevalence of grief in the profession and the importance of processing grief in a healthy way. To help protect veterinary nurses from the negative effects of unresolved grief, it is recommended that training in recognising and managing grief be embedded within veterinary nursing curricula. In addition, grief support should be made readily available through educational institutions, and if this is not possible, available external support should be explicitly signposted.