Standards for Psychological Health and Safety

by Coral Doherty

Wellbeing as A Day One Competency for ALL Veterinary Healthcare Professionals

by Virginia Corrigan

What if all schools and colleges of veterinary medicine, as well as all veterinary technology/veterinary nursing, and veterinary assistant programs, had comprehensive and evidence-based wellbeing frameworks and programs in place in order to best set up students, faculty, and staff for success? What if wellbeing wasn’t just something that was talked about, but was actually integrated into the culture, the formal and informal curriculum, and within the core values and leadership philosophy of the institutions themselves? How can prioritizing and operationalizing our approach to wellbeing help us to not only foster the passion that draws people to this profession, but also keep that fire burning brightly for a sustained and thriving career in veterinary medicine?

My idea is to develop a comprehensive wellbeing framework, including day one wellbeing competencies for all veterinary healthcare professionals, that could be applied to AVMA accredited veterinary medical and veterinary technician/nurse educational institutions. I propose creating a pilot program within our newly developed Veterinary Technology Program at Appalachian State University as the first step.

An excellent example that we can adapt on the human medical side is The Ohio State University’s LIVE WELL framework that is integrated into their human nursing program. The National Academy of Medicine (NAM) has recognized Ohio State as the first university in the nation as a role model in wellness and prevention. The efforts span across multiple areas of the university, and have resulted in a significant return on investment. The college has identified “personal and professional wellness” as core values and incorporates wellbeing throughout academic programs, as well as an established culture in the workplace.

In order to ensure that the wellbeing framework is comprehensive, all aspects of wellbeing should be considered; Cornell has an excellent infographic that outlines a holistic approach to wellbeing.

A specific program that can be piloted, alongside the framework, is the MINDBODYSTRONG program. This is an evidence based, cognitive-behavioral skills building effort that all nursing students participate in as part of the curriculum that enhances resiliency and mental wellbeing, and is backed by more than 20 years of research. A very recent JAVMA publication revealed that a pilot of the MINDSTRONG program in veterinary students led to significant improvements in depressive symptoms, anxiety, and healthy lifestyle beliefs and behaviors.

Proposed steps to implementation:
Research and adapt existing evidence-based overarching wellbeing frameworks
In Australia, The Enhancing Student Wellbeing project has been developed by the Melbourne Center for the Study of Higher Education, which is a suite of resources to assist university educators to develop policies, curriculum and teaching and learning environments that better support mental health. Looking at our colleagues in human nursing; an entire chapter within the recent book “The Future of Nursing 2020-2030” is devoted to supporting the health and professional wellbeing of nurses. Within this chapter, wellbeing frameworks for educational institutions are outlined that are recommended by the National Academies to support students, faculty, staff, and students to contribute to a culture of wellbeing as a strategic priority. Several successful wellbeing interventions within human nursing educational programs are also outlined.

Develop standards for workplace wellbeing and psychological safety
Regarding the clinical settings in which our students are being educated (inclusive of veterinary teaching hospitals as well as distributive model clinical sites); we can develop national standards for workplace wellbeing and psychological safety and utilize evidence-based approaches that are being implemented in other countries. Garth Jordan proposed integrating the National Standard for Psychological Health and Safety in the workplace that has been developed in Canada.

Develop day one wellbeing competencies for all veterinary healthcare professionals, including methods of assessment
Define and refine what specific competencies are needed to reduce stress, anxiety, depression, and suicidal ideation in veterinary medical professionals, including resilience and mindfulness. The AAVMC Wellbeing Curriculum Competencies Working Group is currently working on developing wellbeing competencies, including specific assessment strategies, for DVM curricula within the Competency Based Veterinary Education (CBVE) framework. These could be translated over into the newly formed Competency Based Veterinary Nursing Education (CBVNE) framework. Implement evidence-based wellbeing educational programs, such as the MINDBODYSTRONG program, to develop and assess these core competencies.

Develop and implement needs assessment and outcomes assessment strategies
Wellbeing frameworks will need to be proactive, flexible, adaptable, and individualized in order to be successful. In order to best assess the needs in each specific setting, wellbeing needs assessments can be performed to understand what specific strategies will lead to the largest impact and return on investment. Many wellbeing needs assessment strategies have been outlined by the Department of Health in New Brunswick, Canada. Another validated instrument is the Wellbeing Assessment developed by the Wellbeing Collaborative at Wake Forest University. Another important piece of developing the shared competencies, frameworks, and standards will be developing methods to assess their effectiveness. There are many evidence-based instruments available that could be widely used and effectively implemented, such as the Professional Quality of Life scale and the PERMAH Wellbeing Survey, which integrates an evidence based theory of wellbeing that is the focus of Positive Psychology research.

Hire an Academic Wellbeing Professional to oversee, implement, and assess institutional wellbeing efforts. An Academic Veterinary Wellbeing Professional should be employed in each institution; in the Ohio State example, a Chief Wellness Officer is in place to lead university-wide efforts to create and sustain a culture of wellness.

With the potential for synergy, collaboration, and widespread positive impact, it makes sense for veterinary professional educational institutions and allied organizations to collaborate on efforts to develop comprehensive wellbeing frameworks and competencies for all veterinary healthcare professionals. A pilot program could be developed within the newly developed Veterinary Technology Program at Appalachian State University as the first step.

Handling Moral Distress Accredited Course

by Kat Williams

To continuously improve the mental wellbeing of veterinary teams, a Handing Moral Distress Accredited Course could be delivered to empower employees and employers with individual AND systemic strategies to handle the moral distress and ethical trauma we inevitably face in our profession.

The wellbeing and strategies of individuals and organisations interact and affect one another, so a holistic approach is needed to order to champion effective and sustainable solutions for our veterinary ecosystem.

The course would be accessible to all roles in the profession (e.g., veterinarians, technician, nurses, customer care representatives, HR, regional managers, CEOs) and at all career stages (ideally fully subsidised for veterinary, nursing and technician students) with unique incentives for both employee and employer participation and accreditation.

Course objectives:

• Participants can identify and label moral conflict and moral distress.
• Participants can identify the situations commonly associated with moral conflict and moral distress in veterinary practice (e.g., objectionable euthanasia, lack of patient analgesia, unnecessary procedures, client cost constraints) 
• Participants understand the individual (e.g., trait perfectionism, moral integrity) and organisational (e.g., staffing ratios, workplace policies) factors that contribute to moral distress.
• Participants understand the outcomes of moral distress (i.e., to the individual, organisation, patients, and clients).
• Participants understand interventions to reduce moral distress can be targeted at the individual, organisational, and external (e.g., profession, government) level. Participants appreciate the efficacy of different interventions and the effect of interventions simultaneously applied at multiple levels.
• Participants are trained in a suite of evidence-based individual strategies to reduce moral distress and promote resilience (e.g., conflict resolution skills, moral competency, self-care, coping strategies, help-seeking).
• Participants understand evidence-based organisational strategies to reduce moral distress and promote resilience (e.g., clinic moral climate, psychological safety).
• Participants feel competent to apply individual strategies.
• Participants know when, how, and where to seek individual or organisational support for managing moral distress.

Initial 3-day group training – direct teaching of content, facilitated group discussion incorporating case studies and real participant experiences, interactive-learning components (e.g., scenario-based roleplay with peer and facilitator feedback)
Followed by 6x monthly group facilitated sessions – online, consolidates learning and application, troubleshooting implementation challenges, reflection, and peer support for recent ethical conflicts/distress
Long term support – assistance for participant to connect with tailor-fit mentors (accredited in this course) in collaboration with other mentorship organisations

Pre-and post-measures

To monitor course effectiveness, voluntary, anonymous measures of participant outcomes at pre- and post-intervention and 12-month follow up can include:

Moral distress (e.g., using the MSD-R tool)
Moral competence self-efficacy
Conflict resolution self-efficacy
Self-care activities (e.g., using the SASS-14 tool)
Self-efficacy in understanding moral distress organisational interventions

Individual and organisation accreditation:

Beyond participation, individuals and organisations can complete an additional assessment to attain summative course accreditation. This becomes a point of difference for employees and employers:

Individuals
Attractive accreditation on resume to for employers, showcases extra-clinical competency
Individual demonstrates knowledge, skills, and application via exam and/or assignment

Organisations

Attractive accreditation for recruitment and retention, showcases employer commitment to employee wellbeing and ethical responsibilities, desirable workplace culture
Organisation meets criteria via workplace assessment (e.g., appropriate leaders have current course accreditation, demonstration of appropriate organisational moral distress management strategy implementation, current Employee Assistance Program with appropriate accessibility to staff)

Costs and how to resource:

Initial course creation – garner support from academic organisations and individuals to assist with reviewing scientific literature for the course; consult with industry trainers, coaches and consultants when designing course structure and delivery
Course delivery – consult with current industry trainers, coaches, and consultants as potential course trainers; consider a “train the trainer” model

Accreditation process – approach key industry bodies and employment platforms for potential provision of subsidies

Possible future directions:
Further collaboration with educational institutes, mutual sharing of resources, possible integration into university curriculum
Collaboration with welfare groups, investigating their role in assisting with moral and ethical conflicts
Collaboration with pet insurance and financing companies, investigating their role in preventing moral conflicts
Research to assess program efficacy including assessing individual and organisational outcomes

Disclaimer:
The listed examples of contributing factors, outcomes and interventions must be verified via in-depth review of the current literature. Related psychological constructs should also be explored during course content creation. Below are recommended papers as starting points.

Arbe Montoya, A. I., Hazel, S., Matthew, S. M.,& McArthur, M. Moral distress in veterinarians. Vet Record, 185(20), 1-7. https://doi.org/10.1136/vr.105289
Burston, A. S., & Tuckett, G. A. (2012). Moral distress in nursing: Contributing factors, outcomes and interventions. Nursing Ethics, 20(3). https://doi.org/10.1177/0969733012462049
Giannetta, N., Villa, G., Pennestri, F., Sala, R., Mordacci, R., & Fiorenzo Manara, D. (2020). Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. International Journal of Nursing Studies, 111, 1-34. https://doi.org/10.1016/j.ijnurstu.2020.103767
Moses, L., Malowney, M. J., & Wesley Boyd, J. (2018). Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. Journal of Veterinary Internal Medicine, 32, 2115-2122. https://doi.org/10.1111/jvim.15315

Employee Assistance Program For All

by Joseph Fifer