"I Had No Idea That Other People in the World Thought Differently to Me": Ethical Challenges in Small Animal Veterinary Practice and Implications for Ethics Support and Education

Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study

BACKGROUND

Understanding ethical challenges experienced in relation to adverse events is necessary to inform strategies that optimise patient safety and practitioner wellbeing.

METHODS

A qualitative exploration of UK veterinary practitioners' experiences of adverse events was conducted. Data were collected via 12 focus groups and 20 interviews and analysed using an inductive coding technique.

RESULTS

Questions surrounding acceptable boundaries of care, decision-making autonomy, personal scope of practice, use of evidence and speaking up about patient safety concerns were identified as ethically challenging to practitioners when endeavouring to prevent adverse events. Issues of appropriate accountability, interaction and communication with animal owners and the prioritisation of emotional and technical support for themselves and others were identified as ethically challenging in the aftermath of adverse events.

LIMITATIONS

The qualitative nature of this study limits the generalisability of the findings.

CONCLUSIONS

Ethical challenges are experienced by veterinary practitioners in relation to both preventing and responding in the aftermath of adverse events. Strategies that facilitate ethical decision making and reflection and encourage openness and learning from adverse events would likely improve patient safety and enhance practitioner wellbeing. Further research is needed to develop and implement support for practitioners who experience ethical challenges in relation to adverse events.

Reducing Moral Stress in Veterinary Teams? Evaluating the Use of Ethical Discussion Groups in Charity Veterinary Hospitals

This study examines experiences of veterinary moral stress in charity veterinary practice and qualitatively evaluates the role of ethical discussion in reducing veterinary moral stress. Results are drawn from a thematic data analysis of 9 focus groups and 15 individual interviews with veterinary team members from 3 UK charity veterinary hospitals. Moral stress is described as an everyday experience by participants and is caused by uncertainty about their ability to fulfill their ethical obligations. Moral stress is shown to be cumulative and can interact with other forms of stress. Distinct practical and relational barriers to ethical action are identified and proposed as contributors to moral stress, and different team members experience different barriers within their roles. The potential impact of moral stress on team members' quality of life and mental health is highlighted. Results show that regular facilitated ethical group discussions may reduce moral stress in the hospital setting, particularly through familiarization with others' roles and ethical perspectives and through supporting one another's ethical decision-making. The article concludes that moral stress is an important and poorly understood problem in veterinary practice and that further development of regular facilitated ethical group discussion may be of considerable benefit to team members.

Risk Factors Associated With Increased Ethically Challenging Situations Encountered by Veterinary Team Members During the COVID-19 Pandemic

Ethically challenging situations (ECS) are commonly encountered in veterinary settings. The number of ECS encountered by some veterinary team members may increase during a crisis, such as the COVID-19 pandemic. This study aimed to determine the risk factors for experiencing an increase in the frequency of ECS in the months following the beginning of the COVID-19 pandemic, utilizing data from a global survey of veterinarians, veterinary nurses and animal health technicians collected from May to July 2020. In this study, descriptive analyses were performed to characterize veterinary team members who responded to the survey (n = 540). Binomial logistic regression analyses were performed to determine factors associated with an increase in ECS encountered since the beginning of the COVID-19 pandemic. Being a veterinary nurse or animal health technician, working with companion animals, working in the USA or Canada, and being not confident or underconfident in dealing with ECS in the workplace were factors associated with an increase in ECS encountered since the beginning of the COVID-19 pandemic. Results suggest a need to explore the ECS encountered by veterinary team members, particularly veterinary nurses and animal health technicians working in companion animal practice, in depth. Identification of risk factors may facilitate better preparation of veterinary team members for managing ECS, and minimizing the negative impact of ECS on the well-being of those who care for animals.

Frequency, Stressfulness and Type of Ethically Challenging Situations Encountered by Veterinary Team Members During the COVID-19 Pandemic

Ethically challenging situations (ECS) are common in veterinary settings and can lead to moral stress. However, there is no published information about how a global pandemic affects the frequency and types of ECS encountered by veterinary team members. An online mixed methods survey was developed to determine the frequency, stressfulness and types of ECS experienced by veterinarians, animal health technicians and veterinary nurses since the advent of the global COVID-19 pandemic in March 2020. Responses from 540 veterinary team members from 22 countries were analyzed. With the advent of the COVID-19 pandemic, the median frequency of ECS encountered by respondents increased from several times per month to several times per week (Spearman Rank Correlation 0.619, P < 0.0001). The most common ECS (encountered at least several times per week) were: challenging decisions about how to proceed when clients have limited finances (64.4%), conflict between personal well-being and professional role (64.3%), conflict between the interests of clients and the interests of their animals (59.6%). These were followed by challenging decisions about what counts as an essential veterinary service (48.1%); conflict between well-being of family/household members and professional role (46.3%); and challenging decisions about whether to perform non-contact veterinary visits (46.3%). The most stressful ECS (reported to be very or maximally stressful) were: conflicts between the interests of clients and the interests of their animals (50.2%), other (42.9%), conflicts between the interests of my employer and my own interests (42.5%), challenging decisions about how to proceed when clients have limited finances (39.4%), conflict between personal well-being and professional role (38.0%), and conflict between well-being of family/household members and professional role (33.6%). Thematic analysis of free-text responses revealed biosecurity, client financial limitations, animal welfare, working conditions, and client relations as prominent themes. This is, to the best of our knowledge, the first study to describe the impacts of the pandemic on ECS experienced by veterinary teams globally. It identifies an increase in the frequency of ECS associated with the COVID-19 pandemic, and a number of stressors unique to the pandemic. We identified a number of resources and strategies that may help veterinary team members navigate ethical challenges that may emerge in their daily work, as well as in the context of global crises.