Author name: Healthcare Salute

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Hello and welcome.

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I hope all of you are well.

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My name is Garvia Bailey,

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and I will be your moderator
for today’s symposium.

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Welcome on behalf of the MacKinnon Trauma
and Recovery

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Lab Back Project Health Care Salute.

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This is symposium
number two Risk and Resilience

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in health care providers during the COVID
19 pandemic.

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Now, before I go much further,
it would be rude of me

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not to share a little of myself with you.

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I am a journalist by trade,
a storyteller by nature.

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I’m honored to be with you today.

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My own
family came here from Jamaica in the 1970s

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and we continue to be ever so fortunate
and grateful

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to have come to this country on this land
and on this terror territory.

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As immigrants and settlers.

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I live and work on land that we recognize
as the traditional territories

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at the Haudenosaunee
and Anishinaabe nations and recognize

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and act on the responsibility
that comes with that.

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I’d also like to acknowledge the land
on which McMaster University is located,

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which is also the traditional territory
of the heart, nation and honest

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Nabi nations and within the lands
protected by the dish with one spoon.

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Wampum belt that wampum uses

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the symbolism of a dish

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to represent the territory and one spoon
to represent that the people are to share

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the resources of the land and only take
what they need further to that.

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The Truth and Reconciliation Commission
94 calls to actions and reaffirms

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that the Treaty with Indigenous peoples
must be lawfully honored.

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We are all treaty

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peoples and are responsible for honoring
and upholding those agreements.

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Again, I welcome you to this symposium.

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Over the past close to three years,
we’ve heard much about the strain

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of the health care system and on health
care providers due to the pandemic.

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This research project seeks to shine

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a light on the impact that the pandemic
has had on mental health.

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Of all those health care providers
who have given

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and continue
to give so much of themselves.

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So some of you here today

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will hear it will be
it will be a difficult process.

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We’re going to hear a lot of stories.

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We will be discussing instances
of moral distress and moral injury

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and the challenges at home and at work
that health care providers have faced

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and continue to face
during the COVID 19 pandemic.

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We’ll be here together for a while.

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So take the time you need.

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If you need to break, please do so.

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Step out.

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Breathe deeply.

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Do whatever it is necessary
to take good care of yourselves.

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We also have links in the charts
that link to wellness support.

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Take a look.

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And if you need anything, please
do take advantage of those resources.

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Please note that there is closed
captioning

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and transcription and French translation

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available for this event For those
who would like to access those services.

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You’ll see interpretation
on the bottom of the zoom screen

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and you can just hit that and
you can have this in French or English.

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A huge thank you

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to the public Health Agency of Canada

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and all of our partners
for their commitment and support.

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This symposium is being recorded
as part of a broader research project,

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so you’ll have the opportunity

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to revisit the information
that you’ll take in today.

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There is an open chat function
for this virtual event.

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Please be respectful in your interactions

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and try and keep the chat on topic

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and it would be great right now

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if you’re here to get a sense
of where you are logging in from.

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I’m sorry that I don’t have any prizes
for someone that’s coming from far away,

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but we should test this chat
function really quickly.

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Where are you coming from?

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Remember that each section

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today will also be.

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Oh, Innisfil St Thomas.

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Hello, Winnipeg.

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Hello. Good to see you.

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Each section
today will be open to audience questions.

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You can use the Q&A box
to drop in your questions.

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Again, at the bottom of your zoom screen
you will see the Q&A box.

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Now, we won’t be able to get to all of
your questions, but we will do our best.

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Now, links to the extended bios of all
participants can be found on the screen.

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It’s as important.

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So if you’re hearing someone speak
and you want to learn more about them,

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you’ll see that the sessions will be in

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three parts, 1215 will take a break.

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And that, my friends, is the
how of all of this happening today.

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Now I want to tell you
why this research is

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a crucial part of establishing
the spirit of today’s session.

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And with that, I’d like to introduce
and welcome Dr.

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Margaret MacKinnon,
who leads the team on this project.

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Hello, Margaret.

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Garvia, lovely to see you.

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It’s wonderful to see you as well.

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Now, can you tell me first
what you and your colleagues were hearing,

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seeing, experiencing
that kind of set the table for conducting,

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collating this research
that will go through today?

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Thank you so much, Garvia.

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And I want to begin first by thanking

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those of you
who are here today for your service.

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I’ve worked for a very long time
with the military, with veterans

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and first responders, and we often say
we salute you for your service.

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Today, we would like to salute health
care workers across the country,

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in North America and beyond
for their service during the pandemic.

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In many instances,
it is felt like with that war

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footing over the past three years,
and as a clinical psychologist,

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I have the privilege of being on
some of the COVID 19 and ICU units

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to provide mental health supports
to health care workers during the pandemic

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and to hear their stories,
to learn of the sacrifices that they

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and their family members were making,
and to see the distress

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that many of them were in over
the course of the pandemic

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as it now continues
and into the aftermath, we hope, one day.

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We just want to be there to support
health care workers, to hear

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and know their stories,
and also to thank them for their service.

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Mm hmm.

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Now, Margaret, why are risk and resiliency

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in tandem for our discussion today
so much Garvia.

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You know, all of us have individual
reactions to what’s happening right now.

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And for some people,
there will be things that contribute

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to resiliency,
to making things a bit easier

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to to cope with, with what health care
workers are facing.

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There are also factors
that contribute to risk.

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And we know, for example,
having experienced childhood abuse

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and neglect, for example,
can make one more vulnerable

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to experiencing strong emotions
from the situations that people face.

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We know that not having a support system
or not having access to a support system

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is also very much a risk factor
for experiencing mental health

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difficulties and during the pandemic,
what we heard from many health

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care workers, we’ve interviewed over
124 health care workers

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across the country
and survey close to 600 now.

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And what we hear
is that, you know, during the pandemic,

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there were access to gyms
being able to see friends and family.

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These were things
that often weren’t available.

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And so we want to look at what
are some of the factors that help people

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on their mental health journey
and what are some of the factors

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that contribute to risk
if we know what those risks are?

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And we’re going to hear that today from
the work that we’re going to hear about.

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And we can target these areas
to try to prevent

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or at least to help heal
some of the mental health workers there.

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So, for example, can we set up social
support systems for via the Internet

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or other means where we can support health
care workers and what they’re facing?

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You know, being on the units, what I saw
so often with the strength of team

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and the strength of together nurse
and health care workers often talked about

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how they didn’t

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want to go home because they felt
they were letting their team down.

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We want to find that space

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for self-compassion
and putting the oxygen mask on ourselves

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so that we can help others and also
strengthening and building our teams.

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Mm hmm. Absolutely.

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You know, we’re going to

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have a very deep conversations.

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We’re going to hear a lot of stories.

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And I wonder about where you’d like
this conversation to go next.

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Once we’ve, you know, all the researchers
we’ve had, all the this

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this what I will probably,

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I think is going to be like
a real groundswell

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of of support for this project.

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What happens next?

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Yeah.

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And, you know, I’m going to think
about where I was last night.

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So I was speaking to the Saskatchewan
union nurses.

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And you know what we’ve heard in these
interviews from health care workers,

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The first thing that they ask
for people to know their stories,

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they don’t want to have to tell
the stories over and over again.

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Many people feel alone in the struggles
that they face.

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I mean, they want policymakers,
they want clinicians.

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They want members of the public
to know what their struggles have been.

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And we think about how we support health
care workers as both thanking them,

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knowing their stories
and setting up systems and supports

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that will be available
to these healthcare workers.

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A lot of the work that we’re doing
for the Public Health Health

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Agency of Canada and other groups across
the country are doing is really to set up

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concrete supports
that are available to health care workers

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and also first responders and public
safety personnel who have served

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in other essential workers
who have suffered because of the pandemic.

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I think at the federal level,
we really want to talk about

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organized supports that are equitable
and available to all Canadians.

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So we think about individuals,
for example,

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who are joining us
from the Northwest Territories today.

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How do we ensure that the supports that we
provide are available to all Canadians,

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those who serve,
and also the general population

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who have really experienced
a lot of mental health

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difficulty throughout this as well.

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But we place here a very special emphasis,
a very special thank you

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to those who have served a great sacrifice
not only to themselves,

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but also to their families.

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And we’ve heard from nurses,
physiotherapists, occupational therapists

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say, when I get home,
I have two words maybe left for my family.

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I’m so tired.

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We know that the partners

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parents have taken over
caregiving responsibilities.

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So collectively
there has been a great deal of service

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and sacrifice and we need to be available
and have mechanisms

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to support those individuals
and their families.

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Yeah, absolutely.

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Well, thank you so much.

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We’re going to dive in right now.

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Thank you, Margaret.

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Now I’m going to turn it over to Dr.

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Kim Ritchie and Mina Pichtikova
with a summary of the research

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findings on moral injury
in Canadian health care

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providers.

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Hi, everyone.

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My name is Mina Pichtikova to cover,

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and today I’ll be presenting alongside
my wonderful colleague, Dr.

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Kimberly Ritchie on the topic
of resilience among health care workers.

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So before we get started,
it’s important to highlight

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what resilience is
and why it’s so important.

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So there are a lot of different
definitions of resilience,

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but the most straightforward one

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and the one that we’ve used
for the purpose of this study

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is that resilience is the ability
to bounce back or recover from stress.

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And what resilience really allows
one to do

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is to cope with adversities
that occur during stressful periods,

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which may otherwise trigger mental
or psychological problems.

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And to highlight that point,
there is ample evidence to suggest

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that during stressful events
such as disasters

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or disease outbreaks,
in the case of the COVID 19 pandemic,

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people are more likely to

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suffer negative mental
health and psychologic consequences

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when they’re not equipped with ample

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levels of resilience.

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Now, this is especially true
for health care providers

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in recent years during the pandemic,
as they’ve repeatedly been faced

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with increasingly stressful situations
for a very prolonged period of time now.

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And now what we’re seeing
is that as a result, health

0:13:09.583,0:13:12.250
care providers have suffered
an immense deterioration

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in their mental and psychological health
during the pandemic

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on a number of different measures,
including anxiety,

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depression, burnout,
PTSD and psychological distress.

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And they’re experiencing

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these this deterioration in mental health

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at higher levels than the general public.

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So that being said, resilience
isn’t something that’s set in stone

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and it can be influenced either positively
or negatively

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by a number of different factors,
including individual factors,

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organizational factors,
or even societal factors.

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So all those things considered resilience

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is an incredibly important concept
for us to explore.

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And what we’ll be talking about
today is our study

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on the relationship between resilience
and a number of different variables,

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including mental health,

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burnout, organizational support
and social support, just to name a few.

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And ultimately, doing

0:14:07.833,0:14:11.750
this is incredibly important,
as it seems that resilience is likely

0:14:11.750,0:14:15.416
a strong safeguard of mental health
among health care providers.

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And exploring

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these questions will ultimately allow us
to develop and implement interventions

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that are aimed towards using evidence
based interventions to enhance resilience

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and strengthen health care providers
defenses against the various mental

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health and psychological consequences
of the pandemic.

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So just to give you
a little bit of a brief overview of

0:14:37.041,0:14:38.416
how our study was set up.

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So we started off with the recruitment
stage where we invited

0:14:42.125,0:14:45.333
Canadian Health care workers
who were directly or indirectly involved

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in patient care during the COVID 19
pandemic to participate in.

0:14:50.375,0:14:55.958
The first thing they did was fill out
a collection of online questionnaires.

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So a total of 460 health care providers

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filled out the questionnaires
May 20, 22 to January 2023.

0:15:06.166,0:15:09.083
And then some of those participants
were also that indicated

0:15:09.083,0:15:13.083
they were interested in being interviewed,
were invited to a virtual interview,

0:15:13.333,0:15:14.708
and the interview was semi-structured.

0:15:14.708,0:15:17.875
That was kind of to get more
into the nuances of their experiences.

0:15:18.458,0:15:23.458
And then a quantitative and qualitative
analysis was done on the

0:15:24.166,0:15:27.375
questionnaire data and the interview
transcripts, respectively.

0:15:28.500,0:15:29.083
So in terms

0:15:29.083,0:15:33.666
of the demographics of the individuals
who participated in the study,

0:15:34.333,0:15:36.750
the average age was 43 years old,

0:15:37.416,0:15:40.500
and about 50% of our participants
were nurses.

0:15:40.916,0:15:43.625
The majority of them came
from the province of Ontario.

0:15:43.625,0:15:49.041
Specifically, it’s 64%
and 89% of them identified as female.

0:15:49.750,0:15:53.166
So another questionnaire
that we used to capture resilience,

0:15:53.916,0:15:56.166
this is the brief resilience scale.

0:15:56.166,0:15:59.166
And essentially like we discussed earlier,
it assesses

0:15:59.166,0:16:01.541
one’s ability to bounce back
or recover from stress.

0:16:02.166,0:16:04.750
And I’ve put items up here
just so you can kind of get a sense

0:16:04.750,0:16:06.791
of the kinds of questions
people were asked.

0:16:06.791,0:16:10.083
And the brief resilience scale
is an established, reliable

0:16:10.083,0:16:12.666
and valid measure of assessing resilience.

0:16:13.375,0:16:15.791
So now that we know why resilience

0:16:15.791,0:16:20.041
is so important, let’s explore what our
what story does

0:16:20.041,0:16:23.583
our data tell us and unfortunately, it’s
not a very good one.

0:16:23.583,0:16:29.541
So out of the 460 participants,
51% scored in the range of low

0:16:29.541,0:16:34.583
resilience, 45%
scored in the normal resilience range

0:16:35.000,0:16:39.500
and only 3.5%
scored in the high resilience range.

0:16:40.416,0:16:44.250
So what we did next was a correlation
analysis, which is essentially

0:16:44.250,0:16:48.958
just a statistical test
to explore how variables are related.

0:16:49.625,0:16:53.416
Specifically, we were interested in
how resilience is related

0:16:53.416,0:16:57.541
to all the variables that I’ve listed here
in blue on the right.

0:16:58.166,0:17:01.291
And all of this was done
using the questionnaire data.

0:17:01.291,0:17:05.333
And what we see by this is that resilience
is significantly negatively

0:17:05.333,0:17:08.125
correlated
with all these variables in blue,

0:17:08.833,0:17:11.916
which means that people
who reported higher levels of resilience

0:17:12.333,0:17:17.000
reported experiencing less moral injury,
PTSD,

0:17:17.541,0:17:21.166
burnout, insomnia, depression,

0:17:21.166,0:17:25.083
anxiety,
stress and emotional dysregulation.

0:17:26.041,0:17:28.791
Now, PTSD in moral
injury is something that we’re hearing

0:17:28.791,0:17:31.916
about a lot lately
amongst health care providers,

0:17:32.375,0:17:36.958
and so we thought it would be worth it
to explore these two variables further.

0:17:37.625,0:17:41.833
So along the horizontal, horizontal axis,
we have resilience,

0:17:41.958,0:17:44.750
specifically
low normal and high resilience,

0:17:45.916,0:17:49.208
and we see very similar
trends amongst the two graphs.

0:17:49.875,0:17:52.416
So on the graph on the left,
we’re looking at

0:17:52.416,0:17:56.250
how resilience is associated
with PTSD symptoms,

0:17:56.583,0:18:01.208
which were assessed
using the PCL five questionnaire.

0:18:02.541,0:18:06.333
And what we see is that individuals
who have low resilience

0:18:07.458,0:18:09.958
have significantly higher levels of PTSD

0:18:09.958,0:18:12.041
symptoms than those with high resilience.

0:18:13.250,0:18:17.291
And then the same trend is seen
on the graph on the right, which explores

0:18:17.291,0:18:21.625
moral injury, and that was measured
using the moral injury outcome scale.

0:18:21.916,0:18:25.166
So once again, we see that individuals
who have low resilience

0:18:25.625,0:18:26.875
experienced significantly

0:18:26.875,0:18:30.375
higher levels of moral injury
than those with high resilience.

0:18:31.041,0:18:33.458
We also looked
at a number of questionnaires related

0:18:33.458,0:18:37.458
to organizational, social
and self-compassion factors.

0:18:38.041,0:18:40.958
And what we see here
is that resilience is significantly,

0:18:40.958,0:18:43.625
positively correlated
with all these variables.

0:18:44.250,0:18:46.500
So what that means is that

0:18:46.833,0:18:51.875
people who reported higher levels
of resilience reported experiencing

0:18:52.000,0:18:55.875
more organizational support,
more self-compassion,

0:18:56.416,0:19:00.333
more social support
and more product unity in their workplace.

0:19:01.291,0:19:03.666
Interestingly, resilience
was also associated

0:19:03.666,0:19:07.000
with the years
someone has worked and their age,

0:19:07.500,0:19:10.416
such that individuals
who had worked in the field longer

0:19:10.458,0:19:13.916
or were older reported
higher levels of resilience.

0:19:14.500,0:19:17.666
So now I’ve just put up the actual names

0:19:17.666,0:19:22.083
of the questionnaires that we use
to capture these different factors.

0:19:22.333,0:19:23.791
In case anyone is interested.

0:19:24.958,0:19:27.458
And now I’m going to pass it off
to my colleague, Dr.

0:19:27.458,0:19:28.750
Kim Ritchie, who’s going to explore

0:19:28.750,0:19:31.291
the qualitative bit of this study
a bit more with you.

0:19:32.958,0:19:34.416
Thank you, Mina.

0:19:34.416,0:19:38.708
And as Mina mentioned, my name is Kim
Richey, and today I’m going to present

0:19:38.708,0:19:42.750
some of our preliminary findings
from the qualitative part of our research.

0:19:43.208,0:19:48.333
And in this part, we took a deeper look
at some of the work and personal factors.

0:19:48.333,0:19:52.416
Associate with resiliency of health
care providers during the pandemic.

0:19:53.250,0:19:56.541
For this part of our study,
we included health care providers

0:19:56.833,0:19:58.291
who completed an interview.

0:19:58.291,0:20:02.000
In addition to the survey,
and we included those participants

0:20:02.000,0:20:05.541
who scored either in the lower
or the higher ranges

0:20:05.541,0:20:09.583
on the brief resilience scale,
which was part of the online survey.

0:20:10.291,0:20:13.500
We then analyzed their interview data
in two groups

0:20:13.958,0:20:17.958
the health care providers who had lower
scores on the brief resilience scale

0:20:18.333,0:20:21.375
and those who scored in the higher score
higher range.

0:20:21.375,0:20:23.375
On the brief Resilience scale.

0:20:23.375,0:20:27.541
This analysis included
23 participants in total

0:20:28.041,0:20:31.916
and they represented
several different health care occupations,

0:20:31.916,0:20:36.750
including nursing, occupational therapy,
respiratory therapy and so on.

0:20:37.625,0:20:41.250
In our analysis,
we found three themes that cross-cut

0:20:41.583,0:20:44.625
the lower
and higher resiliency group today.

0:20:44.625,0:20:45.125
All share

0:20:45.125,0:20:49.416
those three themes, along with a quote
from each group to describe that theme.

0:20:49.958,0:20:53.958
In the first theme, participants in
both groups described many similarities

0:20:53.958,0:20:57.416
in the type of coping strategies, say,
utilized during the pandemic.

0:20:58.000,0:21:01.208
Overall, many participants reported
the pandemic

0:21:01.208,0:21:05.583
had a drastic impact on their ability
to practice usual coping strategies

0:21:06.000,0:21:10.166
with the loss of going to the gym
or visiting friends and family

0:21:10.166,0:21:14.916
and so on, due to especially during
the during the periods of lockdown.

0:21:15.541,0:21:20.333
And because of that, they really had
to adapt and develop new ways of coping.

0:21:21.041,0:21:24.333
The most common coping strategies found in
both groups

0:21:24.708,0:21:28.916
was an increase
in their use of alcohol, use of marijuana.

0:21:28.916,0:21:34.000
Sometimes for the first time,
eating more increased use of social media,

0:21:34.333,0:21:38.791
going for long walks
and increased risk taking behavior.

0:21:38.791,0:21:41.041
And these were all ways to manage

0:21:41.041,0:21:44.416
the increased stress they were
experiencing during the pandemic.

0:21:45.208,0:21:47.916
So, for example, the quotes on this slide

0:21:48.291,0:21:52.625
four in both the higher and Lower
Resilience Group report, similar

0:21:52.625,0:21:56.625
use of increase are similar increased
use of alcohol

0:21:56.916,0:21:59.916
as a way to help them cope
with their stress after work.

0:22:00.875,0:22:01.333
Several

0:22:01.333,0:22:04.250
participants also reported
that they recognized

0:22:04.666,0:22:08.208
that they were struggling
and they had a lot of increased stress.

0:22:08.958,0:22:13.875
They were to the point of exhaustion
and they came to realize that they had

0:22:13.875,0:22:17.041
to really prioritize their own self-care

0:22:17.458,0:22:20.083
over their need to care for others.

0:22:20.583,0:22:23.625
And we heard also about this
from health care

0:22:23.625,0:22:27.000
providers in both the lower
and higher resilience groups.

0:22:27.000,0:22:32.208
And they also they talked about having
this real difficulty or even a tension

0:22:32.541,0:22:37.208
when it came to prioritizing their health
and well-being over others.

0:22:37.625,0:22:40.833
And the reason for this
was that health care providers

0:22:41.083,0:22:44.375
really see themselves
as individuals who care for others.

0:22:44.791,0:22:47.458
And it is a big part of their identity.

0:22:47.916,0:22:52.750
Therefore, it’s really hard for them
to turn that same care towards themselves

0:22:52.958,0:22:57.583
or even to balance care for themselves
with their care for others.

0:22:58.875,0:23:01.416
Some of the health care providers
we talked to reported

0:23:01.416,0:23:05.416
that they had to give themselves
permission to care for themselves.

0:23:05.416,0:23:09.875
And this was the word that they used over
and over again in the data.

0:23:10.833,0:23:15.208
Sometimes some health care
providers said that they were able

0:23:15.208,0:23:18.291
to give themselves permission
to care for themselves

0:23:18.291,0:23:21.041
or to balance caring for themselves
with others.

0:23:21.541,0:23:24.333
And others said that they
they really wanted

0:23:24.333,0:23:27.458
and needed this permission
to come from someone else,

0:23:27.791,0:23:32.041
such as a family member,
a colleague, or even a supervisor.

0:23:32.583,0:23:36.625
And having this permission
given to them really helped them

0:23:36.625,0:23:40.208
to resolve some of this tension or guilt
they were experiencing

0:23:40.583,0:23:45.750
when it came to turning
that care towards themselves.

0:23:45.750,0:23:50.708
And the last thing today
really focuses on the types of ways

0:23:50.708,0:23:54.916
organizations supported
health care providers during the pandemic.

0:23:54.916,0:23:58.000
Most of the health care providers
we spoke with talked

0:23:58.000,0:24:01.625
about long standing challenges
related to being short staffed,

0:24:02.041,0:24:05.583
which was, of course, amplified
during the pandemic and contributed

0:24:05.791,0:24:10.625
to their increased workload and stress
where there were differences in the data.

0:24:10.625,0:24:15.000
So between the two groups within
how their health care providers

0:24:15.000,0:24:19.458
perceive their organizations managed
some of these increased work challenges.

0:24:20.125,0:24:22.458
What we found
was that health care providers

0:24:22.458,0:24:26.541
in the Lower Resilience Group
reported that they didn’t feel supported

0:24:26.916,0:24:31.000
or their organization
wasn’t receptive to their opinions,

0:24:31.958,0:24:34.125
so it didn’t feel safe

0:24:34.125,0:24:38.375
to them or they didn’t have an opportunity
to voice their opinions

0:24:38.875,0:24:41.708
about some of these challenges
that they were experiencing.

0:24:42.291,0:24:46.291
Whereas health care providers
in the Higher Resilience Group talked

0:24:46.291,0:24:52.041
about having a more open environment
in their organization, which was flexible.

0:24:52.416,0:24:56.500
There were established channels
of communication through regular meetings

0:24:56.500,0:25:01.708
or even daily huddles,
and during these times they felt able

0:25:01.708,0:25:05.708
to give their thoughts and opinions
and they felt their voice was heard.

0:25:06.875,0:25:10.083
So in conclusion,
what we found from our research

0:25:10.083,0:25:13.750
was that health care providers
with higher levels of resilience

0:25:13.750,0:25:18.333
may experience less negative mental
health symptoms such as PTSD,

0:25:18.333,0:25:21.541
moral injury, depression,
anxiety and stress.

0:25:22.208,0:25:24.583
Higher resilience is also associated

0:25:24.583,0:25:27.791
with health care providers
who have more social support,

0:25:28.208,0:25:33.875
more self-compassion and perceived,
more supportive organizations.

0:25:33.875,0:25:36.416
Secondly, health care providers

0:25:37.625,0:25:38.833
with both higher and

0:25:38.833,0:25:43.250
lower levels of resilience
have similar types of coping strategies

0:25:43.708,0:25:47.875
and difficulty prioritizing
or balancing their own self-care.

0:25:49.291,0:25:51.750
But there’s differences
in their perception

0:25:51.750,0:25:56.708
of how their organizations were able
to support them during the pandemic.

0:25:57.708,0:26:03.541
Thank you very much.

0:26:03.541,0:26:05.916
Thank you very much.

0:26:05.916,0:26:09.125
That was a fascinating Dr.

0:26:09.125,0:26:12.708
Kim Ritchie and Mina pitch to cover.

0:26:14.375,0:26:17.708
I do have some questions for you,
and I’m sure the audience

0:26:17.708,0:26:21.000
will have questions as well,
those that are listening.

0:26:21.000,0:26:25.500
And just a reminder
that if you’d like to ask

0:26:26.125,0:26:28.208
Mina and Kim any questions,

0:26:28.583,0:26:31.333
you can put your questions in the Q&A

0:26:31.333,0:26:34.916
box as you see that running below there.

0:26:35.250,0:26:37.958
And and I would be happy to to pass

0:26:37.958,0:26:41.375
those questions
on to our panelists for you.

0:26:41.791,0:26:45.833
But for now, Mike, I have some questions
of my own, if that’s okay.

0:26:47.375,0:26:49.000
Now, you

0:26:49.000,0:26:51.875
talked you touched on the personal factors

0:26:52.500,0:26:55.500
that influence resilience.

0:26:55.500,0:27:00.375
And I’m wondering if we can unpack that
just a little bit for for individuals

0:27:01.041,0:27:03.708
when we go back and take this information
and think about

0:27:04.000,0:27:07.875
what are those personal factors
that can be shifted or can be that

0:27:07.875,0:27:12.416
we can think about
in terms of individual resilience?

0:27:12.416,0:27:14.875
What are those personal factors
that influence?

0:27:17.583,0:27:18.291
Hi, Garvia.

0:27:18.291,0:27:23.958
Thank you for having me and for this
opportunity and for the great question.

0:27:24.291,0:27:27.333
So like I mentioned earlier,
the good thing about resilience is that

0:27:27.375,0:27:31.500
it’s not something that’s set in stone
and it’s something that can be influenced

0:27:32.500,0:27:36.000
and something that we can change
at the individual or personal level

0:27:36.291,0:27:39.000
and also at the organizational level.

0:27:39.000,0:27:41.625
In some ways,
to build resilience on a personal

0:27:41.625,0:27:44.708
level is through connection, for instance.

0:27:44.708,0:27:48.583
So building connections
with those that support you because it’s

0:27:48.583,0:27:52.125
very easy to isolate yourself
during hard times,

0:27:52.916,0:27:57.208
but building a sense of community
and being around people that have a common

0:27:57.208,0:28:01.000
understanding can really allow you
to connect with others

0:28:01.000,0:28:02.791
and overcome challenges as a group

0:28:04.250,0:28:06.875
and really allow you to bounce back
from that stress.

0:28:07.750,0:28:10.541
And then another thing
is taking care of your personal wellness.

0:28:11.041,0:28:14.916
So stress is not something
that’s just felt psychologically,

0:28:14.916,0:28:17.833
but it’s also felt in the physical body.

0:28:18.875,0:28:23.291
So of course, self-care is often
easier said than it’s done,

0:28:24.000,0:28:27.416
but it’s important to make it a priority
and give yourself

0:28:27.416,0:28:31.500
that self-compassion
and that space to take care of yourself.

0:28:31.500,0:28:35.541
Like Kim was mentioning earlier.

0:28:35.541,0:28:38.666
Yeah, and take care of the stress,
not only emotionally but physically,

0:28:40.208,0:28:43.083
so that you kind of have

0:28:43.083,0:28:45.625
the ability to push through.

0:28:47.041,0:28:51.750
So this can be like little things
that people build into their wellness

0:28:51.750,0:28:55.958
routines,
getting enough sleep, exercising,

0:28:56.708,0:29:01.041
building healthier habits,
and even small changes can make really

0:29:02.125,0:29:05.333
kind of big effects down the road.

0:29:06.041,0:29:08.000
And another thing is healthy thinking.

0:29:08.000,0:29:11.916
So acknowledging and accepting
your thoughts and emotions during

0:29:11.916,0:29:15.750
stressful times, it’s very natural
for these thoughts and emotions to come up

0:29:17.791,0:29:20.500
and giving
yourself grace when they do come up.

0:29:20.500,0:29:26.416
So kind of reflecting on your thoughts,
are they positive or negative?

0:29:26.416,0:29:28.000
Are they realistic?

0:29:28.000,0:29:30.708
Are they grounded in fact

0:29:30.708,0:29:33.000
and identifying areas of hope

0:29:33.000,0:29:35.666
that you can lean on

0:29:36.666,0:29:38.208
as well as accepting

0:29:38.208,0:29:40.833
certain circumstances
that can’t be changed right now

0:29:41.875,0:29:44.041
and focusing on the things
that you can change?

0:29:44.708,0:29:46.833
And finally

0:29:46.916,0:29:49.291
finding meaning and purpose
in what you’re doing.

0:29:49.291,0:29:55.750
Of course, health care is an incredibly
meaningful and purposeful profession,

0:29:55.750,0:30:02.041
but kind of celebrating your own strengths
and goals and moving towards your values

0:30:02.041,0:30:06.750
or something that can kind of help
foster that resilience.

0:30:06.750,0:30:11.375
But yes, just as much as you know,
there’s these factors

0:30:11.375,0:30:13.958
that are individual
that influence resilience.

0:30:14.541,0:30:17.833
Like I said, there’s also
the organizational and societal factors

0:30:17.833,0:30:19.000
that play a huge role.

0:30:20.625,0:30:23.458
So it’s also important to

0:30:23.458,0:30:26.041
shift away from thinking about this

0:30:26.041,0:30:30.291
as just a personal responsibility
and also thinking about it

0:30:30.291,0:30:35.458
as a societal
and organizational responsibility as well.

0:30:35.458,0:30:37.125
Yeah, absolutely.

0:30:37.125,0:30:40.708
The B it’s interesting
because I feel like the the,

0:30:40.958,0:30:43.916
the personal part of it

0:30:43.916,0:30:47.375
has is a lot like working out
Like it’s a lot

0:30:47.375,0:30:50.750
like the things that you’re supposed to do
for your for your body.

0:30:50.750,0:30:53.958
You think to yourself,
I need to think in this way.

0:30:53.958,0:30:56.708
I need to do these things
and give myself permission

0:30:56.708,0:31:00.708
to feel these feelings
and then and build my resilience. But

0:31:02.083,0:31:04.791
there’s another part of you
that said, I’m just so tired.

0:31:05.083,0:31:09.000
Like, I’m too tired
to think about taking care of myself.

0:31:09.000,0:31:14.750
I’m too tired to think about going to
the gym or, you know, of my own self-care.

0:31:14.750,0:31:16.500
And as your research shows,

0:31:16.500,0:31:20.625
so many people are preoccupied as well
with taking care of others.

0:31:22.416,0:31:25.750
So so I wonder about those small

0:31:27.208,0:31:29.750
the way to perhaps implement

0:31:29.750,0:31:33.958
the smaller parts of building up
the strength, like when you go to the gym,

0:31:33.958,0:31:37.708
you build up the strength
to be able to do the heavier lifting,

0:31:39.208,0:31:42.500
how you want those small bits

0:31:42.500,0:31:46.416
of that personal part
and then the occupational part as well.

0:31:47.041,0:31:51.375
The small things that employers or
those around you communities can be doing.

0:31:52.041,0:31:54.500
Mhm. Yeah, that’s a great point.

0:31:54.500,0:31:56.958
And that’s kind of the catch 22
that we’re seeing

0:31:58.083,0:32:01.750
on one hand,
you know, self care, resilience, wellness,

0:32:02.041,0:32:07.000
it’s incredibly important
and it’s like a muscle that you build up,

0:32:07.708,0:32:12.333
but then when there’s not the space
and the time and people are so burnt out

0:32:12.333,0:32:16.500
that they don’t have the capacity
and it just feels like, yeah, another task

0:32:16.500,0:32:19.625
and yet another responsibility,
that’s kind of when we get trapped

0:32:19.625,0:32:24.250
in that vicious cycle and I think that’s
why it’s so important to highlight

0:32:25.291,0:32:26.375
the organizational

0:32:26.375,0:32:30.708
factors that can influence resilience
and to shift away

0:32:30.708,0:32:34.041
from considering resilience
as just just at the individual level

0:32:34.958,0:32:38.416
that’s fully solvable by people
making life changes.

0:32:38.750,0:32:42.125
But we’re seeing that that’s not the case

0:32:42.125,0:32:44.333
and we’re starting to shift away
from thinking it,

0:32:44.500,0:32:48.291
thinking about it in that way,
and kind of shifting

0:32:48.291,0:32:53.041
some of the responsibility
towards the workplace environment.

0:32:53.041,0:32:56.041
And that includes things
like creating realistic

0:32:57.125,0:32:59.583
and compassionate team culture

0:32:59.916,0:33:02.416
where people can have honest conversations

0:33:03.291,0:33:06.250
with one another.

0:33:06.250,0:33:11.375
You know, organizations
being vigilant about the risks associated

0:33:11.375,0:33:16.208
with the profession and monitoring
ongoing stressors for health care workers,

0:33:17.375,0:33:19.500
having proper staffing,

0:33:19.500,0:33:24.291
having opportunities to discuss
work life balance

0:33:24.291,0:33:30.208
without fear of repercussion,
having having a shared responsibility

0:33:30.541,0:33:35.166
to identify the sources of stress
and take the appropriate measures

0:33:37.333,0:33:39.208
in the workplace.

0:33:39.541,0:33:40.666
Yeah, yeah.

0:33:40.666,0:33:44.208
And I think a lot of this comes down
to also just having

0:33:44.500,0:33:49.291
really clear organizational support
and having policies

0:33:49.291,0:33:52.541
that protect health care providers as well

0:33:54.000,0:33:57.333
so that there isn’t fear of repercussion

0:33:58.291,0:34:02.041
if individuals are bringing up
any sort of organizational concerns.

0:34:03.000,0:34:05.250
So yeah, I think it’s

0:34:05.250,0:34:07.750
definitely a delicate dance
between the two.

0:34:09.166,0:34:12.833
And there are things
at the individual level that, you know,

0:34:13.083,0:34:16.500
can allow people
to build up a resilience toolkit.

0:34:17.500,0:34:22.791
And then there’s also responsibilities
that are more

0:34:22.791,0:34:26.541
so on
the workplace, are more so organizational.

0:34:28.000,0:34:30.041
Now on the on the level

0:34:30.208,0:34:33.500
of the research itself,
there’s a question for me

0:34:34.000,0:34:37.625
from those listening here
about the physicians that did the survey.

0:34:37.625,0:34:41.708
Were there many physicians
that that did the survey or what?

0:34:41.708,0:34:43.791
What sorts of people did you hear from?

0:34:43.791,0:34:44.333
Yeah.

0:34:44.333,0:34:47.833
So in terms of our demographic breakdown,

0:34:48.791,0:34:50.166
the majority

0:34:50.166,0:34:54.583
of the individuals that responded
to this particular phase of our study

0:34:55.416,0:35:01.708
were nurses, physicians
and personal support workers.

0:35:01.708,0:35:04.458
So that was generally
the biggest breakdown

0:35:05.583,0:35:07.958
with about 4% being physicians.

0:35:08.916,0:35:09.750
Okay.

0:35:09.750,0:35:11.833
And 51% being nurses.

0:35:13.000,0:35:14.000
Right.

0:35:14.916,0:35:18.750
This is an excellent question
that comes from our audience as well.

0:35:18.750,0:35:24.125
What is the role of education
in clinical ethics to build resilience?

0:35:24.750,0:35:25.875
Big question.

0:35:25.875,0:35:31.541
We don’t have a half an hour or an hour
or another symposium to answer it,

0:35:31.541,0:35:37.458
but what is the role of education
in clinical ethics in building resilience?

0:35:38.041,0:35:39.125
Mm hmm.

0:35:39.125,0:35:41.500
I think that’s such a great question.

0:35:41.500,0:35:44.583
And, you know, we’ve
we’ve had lots of discussions about that

0:35:44.583,0:35:46.958
in our our own team.

0:35:46.958,0:35:50.166
I think the one of the questions

0:35:50.166,0:35:52.750
that we asked in our interviews was,

0:35:53.166,0:35:58.458
have you ever received
education on mental health issues

0:35:58.458,0:36:02.208
for yourself as part of your training
as a health care provider?

0:36:02.208,0:36:07.125
And we’ve only had a very small handful
of people who’ve responded that they had.

0:36:07.125,0:36:10.958
So I think that speaks to the
broader need for education,

0:36:11.916,0:36:12.666
for health care

0:36:12.666,0:36:15.041
providers, about mental health period,

0:36:15.708,0:36:19.125
about taking care of their own mental
health, about the types of exposures

0:36:19.125,0:36:22.500
that they’re going to face
as a health care provider,

0:36:23.333,0:36:27.250
and how to help build some of those skills

0:36:28.083,0:36:32.375
to actually take care of themselves,
how to balance that

0:36:32.375,0:36:36.541
with the need to patient care
with their own self care.

0:36:36.833,0:36:41.291
And then just to learn about mental health
for themselves overall.

0:36:41.875,0:36:44.916
And in terms of ethics,

0:36:44.916,0:36:49.375
what we’ve heard a lot about is health
care providers have talked about

0:36:49.833,0:36:53.291
really wanting
a debriefing in the workplace.

0:36:53.791,0:36:56.958
So this would be
where there’s an opportunity.

0:36:57.250,0:37:01.958
Maybe there’s been a specific issue
or challenge in the workplace

0:37:02.375,0:37:08.166
that is causing you some tension
or feeling that moral sort of distress

0:37:08.166,0:37:13.083
in some way and that you have the ability
to come together as a group or a team,

0:37:13.208,0:37:16.541
you know, with your own team
or even bringing in some outside

0:37:16.750,0:37:20.000
supports into really sort of unpack that.

0:37:20.375,0:37:24.875
And the purpose of it is to kind of share
your own thoughts

0:37:24.875,0:37:29.208
and feelings about that issue
and how it impacted you personally

0:37:30.958,0:37:32.125
beyond sort of the

0:37:32.125,0:37:38.166
broader sort of,
I guess, patient care issues.

0:37:38.166,0:37:39.875
But it’s about turning that inward

0:37:39.875,0:37:43.416
to look at
how did that issue impact me specifically?

0:37:43.958,0:37:47.166
So that’s one of the things we’ve heard
quite a bit about, is that request

0:37:47.416,0:37:51.291
in all types of health care
settings, acute care, community

0:37:51.291,0:37:54.791
care, long term care, overall demeanor.

0:37:55.333,0:37:55.791
Yeah,

0:37:55.791,0:37:59.625
I just think that’s such a good point
about the debriefing and the connection,

0:38:00.541,0:38:03.458
because when I was talking
about resilience on a personal level,

0:38:03.750,0:38:04.916
I mentioned connection

0:38:04.916,0:38:07.750
going out and seeking it
and this is a perfect example of how

0:38:07.958,0:38:11.625
the distinctions
between organizational and personal

0:38:11.958,0:38:14.791
aren’t always very clear cut

0:38:14.791,0:38:17.708
because connection does help
build personal resilience,

0:38:17.708,0:38:21.625
but it’s also something
that the organization can support by

0:38:21.875,0:38:22.708
essentially building it

0:38:22.708,0:38:26.541
into the programing, building into the
culture, into the protocols.

0:38:27.500,0:38:30.208
So I think that was a great point
and a great response.

0:38:30.208,0:38:31.625
Ken, thank you.

0:38:31.625,0:38:32.375
Yeah, thank you.

0:38:32.375,0:38:32.958
Thank you.

0:38:32.958,0:38:35.583
Thank you. To the both of you
for this presentation.

0:38:35.583,0:38:39.541
It really is it’s impossible
to measure the importance of

0:38:40.500,0:38:44.916
of having not just the research,
but now as we move into this

0:38:45.208,0:38:49.625
this this next portion of the symposium
of attaching real faces to it.

0:38:49.625,0:38:51.875
But thank you, Mina and Kim, for this.

0:38:51.875,0:38:55.666
This has been fantastic stick
and I’m sure we’ll be going back to this

0:38:55.666,0:38:59.791
as we continue this symposium today.

0:38:59.791,0:39:03.958
As I said, names and stories adding
the names and stories to the research

0:39:03.958,0:39:06.541
we are exploring today. Very important.

0:39:06.875,0:39:10.833
So right now we are so fortunate
to have three health care professionals

0:39:10.833,0:39:14.375
with us to not only share
their experiences, but to also tell us

0:39:14.375,0:39:19.208
about what has helped and or hindered
their ability to care for themselves.

0:39:20.166,0:39:21.666
Aram Chagall.

0:39:21.666,0:39:24.958
Chagall is an emergency, and trauma nurse.

0:39:25.458,0:39:29.916
David Tabb is a physical therapist
in general and thoracic surgery,

0:39:30.208,0:39:33.750
and Todd
Tran is an occupational therapist.

0:39:33.750,0:39:37.916
I welcome
all three of you to the symposium today.

0:39:37.916,0:39:40.416
Hello.

0:39:40.416,0:39:42.333
Hello. Hi.

0:39:42.333,0:39:44.416
Thank you so much for having me here.

0:39:44.416,0:39:46.500
Thank you, Aaron. Thank you, Todd.

0:39:46.875,0:39:47.833
I agree with you.

0:39:47.833,0:39:49.125
I know you are.

0:39:49.125,0:39:51.625
David, great to see you as well.

0:39:53.291,0:39:53.708
Can I?

0:39:53.708,0:39:57.708
I think it’s always
the origin story is just so important

0:39:57.708,0:40:02.375
because it kind of sets the table
as to why you’re

0:40:02.583,0:40:06.583
why you’re here today speaking
and why are do why you do what you do.

0:40:06.583,0:40:09.666
So can you, each of you
briefly give us kind of like the Coles

0:40:09.666,0:40:12.958
notes of what drew you to your profession?

0:40:12.958,0:40:17.791
And I will start with you, Arab. So

0:40:18.875,0:40:20.083
I had actually been through

0:40:20.083,0:40:22.208
a lot in my life previously,

0:40:23.166,0:40:25.625
and I would say that

0:40:25.625,0:40:30.583
going into nursing was something
I wanted to do to help others.

0:40:30.583,0:40:34.833
But I would also say it
was the heavy influence of my late father

0:40:35.708,0:40:38.250
because he thought that I could

0:40:38.250,0:40:40.958
and thought that I had the potential
to help people in need.

0:40:41.833,0:40:44.041
Yeah, Yeah.

0:40:44.041,0:40:46.291
Todd, what about you? Hmm?

0:40:48.583,0:40:51.750
My story is more about going into
the health care field

0:40:51.750,0:40:56.458
because I was really interested
in the biological sciences in high school,

0:40:57.041,0:41:00.541
and not to date myself,
but in high school.

0:41:00.541,0:41:06.000
Back then we had a great 13,
and those 15 was called OEC,

0:41:06.000,0:41:09.000
and I took biology and really enjoyed it.

0:41:09.000,0:41:13.541
And physical education,
which I really loved about the health

0:41:14.583,0:41:17.000
perspective and chemistry was so-so.

0:41:17.000,0:41:18.708
But then comes physics. Not so.

0:41:18.708,0:41:24.958
So I, I fell in love with nursing
and which I did my first degree in.

0:41:24.958,0:41:29.041
But Then I switched over to occupational
therapy because I love rehab so much so.

0:41:29.375,0:41:35.375
And in a similar vein of helping
and contributing to society.

0:41:35.375,0:41:37.291
Yeah. Yeah.

0:41:37.291,0:41:39.500
And you, David?

0:41:39.500,0:41:42.291
Well,
I grew up in a in a health care family,

0:41:42.333,0:41:45.375
so my mother worked in health care
as a nurse and hospital administrator.

0:41:45.375,0:41:49.708
So I grew up around in that environment
and certainly spent quite a bit of time

0:41:49.708,0:41:50.916
volunteering at hospitals

0:41:50.916,0:41:55.000
when I was young with, you know, physios
and occupational therapists.

0:41:55.000,0:41:59.750
And I had to take a big role
in caring for my grandmother post-stroke.

0:41:59.958,0:42:03.250
So my or certainly my early experiences
really

0:42:03.666,0:42:06.833
kind of pushed me towards
physio as a career and I just wanted to,

0:42:07.208,0:42:11.125
you know, have a job that had a positive
impact on people’s lives. MM

0:42:13.708,0:42:16.125
So I want you all to take me back

0:42:16.291,0:42:19.416
to the early days of the pandemic

0:42:19.958,0:42:23.125
and what you were experiencing

0:42:23.125,0:42:27.375
at your place of work
as the pandemic began

0:42:27.375,0:42:29.791
to unfold

0:42:30.625,0:42:34.958
as really frontline workers,
you saw what was happening.

0:42:35.291,0:42:38.125
Can you just take me back to that
and what you were seeing

0:42:38.125,0:42:42.125
and what what might have been going
through your mind at the time?

0:42:43.166,0:42:45.083
I’ll start with you, Todd.

0:42:45.083,0:42:47.791
Sure.

0:42:47.791,0:42:53.166
As your bring me back to the early phase
of the pandemic, it was a lot of chaos.

0:42:53.166,0:42:55.416
That’s the word
that comes to mind right now.

0:42:55.416,0:43:00.750
And I laugh at it, but it became more
organized throughout the week, the waves.

0:43:01.333,0:43:04.833
But it was quite chaotic
because we were redeployed

0:43:05.250,0:43:08.916
from where I work in primary
care to a variety of roles,

0:43:08.916,0:43:12.875
from screening to working in the pharma,
in the pharmacy,

0:43:12.875,0:43:16.833
of drawing of the vaccinations,
to giving out the vaccines.

0:43:16.833,0:43:20.041
So it was chaotic in terms of

0:43:20.041,0:43:23.125
we don’t know where we were deployed.

0:43:24.458,0:43:27.833
We didn’t get a sense of autonomy
either in terms of people

0:43:27.833,0:43:31.750
asking in the leadership team
of like Todd, there’s a variety of rules.

0:43:31.750,0:43:34.916
Which one
would you like to give options or choice?

0:43:34.916,0:43:36.000
There was a lack of that.

0:43:36.000,0:43:40.000
It was more, you’re doing this
and you’re going to do this next.

0:43:40.583,0:43:45.375
And even when I was wanting to contribute
and be in a vaccine clinic

0:43:46.083,0:43:50.708
going the hotspots of Toronto,
we didn’t know

0:43:51.541,0:43:55.625
from week to week where we were going
in terms of hotspots and it wasn’t shared.

0:43:55.625,0:43:58.125
And our roles wasn’t given.

0:43:58.125,0:44:01.541
So it was really chaotic.

0:44:01.541,0:44:04.625
But again,
it became more organized along the way.

0:44:04.625,0:44:09.833
But initially I just wish
that people had more choice in the matter

0:44:09.833,0:44:14.708
and also to ask a variety of health care
workers, is it okay if we do this?

0:44:14.916,0:44:18.416
Are you immunocompromised because
we didn’t have any vaccines at the time?

0:44:18.875,0:44:22.583
Are you okay to be in the front line
to screen or to do such and such?

0:44:22.625,0:44:24.333
Or another question would be,

0:44:24.333,0:44:28.000
Are you living with anyone else
in your family that’s immunocompromised?

0:44:28.416,0:44:32.958
That conversation would have been lovely
at the initial phase versus not.

0:44:33.666,0:44:35.041
Yeah, yeah.

0:44:35.041,0:44:40.125
We will hear a little bit more about that
and what was what was happening

0:44:40.125,0:44:45.291
with you in the emergency room,
in the trauma centers.

0:44:45.541,0:44:53.708
What did it the those early days
of the pandemic look like?

0:44:53.708,0:44:54.875
I would say crazy.

0:44:56.125,0:44:58.208
You didn’t really have time to think.

0:44:59.583,0:45:02.041
You people being rolled in by EMS

0:45:02.041,0:45:07.000
stretchers one by one, one by one,
you would get calls in advance

0:45:07.000,0:45:09.958
saying that we have a cardiac arrest
because they were short of breath.

0:45:11.333,0:45:14.250
We had to get people on life support.

0:45:14.250,0:45:17.916
Within 5 minutes of arriving.

0:45:17.916,0:45:20.958
We barely had bed accommodation space.

0:45:20.958,0:45:23.041
We had to make some very hard decisions.

0:45:24.000,0:45:26.458
ICU was became jam packed.

0:45:26.458,0:45:29.250
We were outsourcing or

0:45:30.333,0:45:33.375
sending patients off
to other hospitals in different regions.

0:45:34.625,0:45:38.291
It was heartbreaking
to speak with families on the phone

0:45:38.791,0:45:41.791
who couldn’t be there
physically in the presence of their family

0:45:41.791,0:45:44.500
or their loved one who was dying

0:45:46.083,0:45:48.958
to hear them on the phone, to see them on
face time

0:45:49.208,0:45:52.500
was probably the only way that they could
communicate with their families.

0:45:54.291,0:45:55.083
We saw all

0:45:55.083,0:45:59.208
age groups get very ill,
and I would say that

0:45:59.208,0:46:03.416
there was absolutely no time
to think information was so ever evolving.

0:46:03.416,0:46:07.583
When you were triaging, it was like
you were trying to update yourself

0:46:07.791,0:46:11.833
day to day basis, hour to hour basis
in terms of what we were screening for.

0:46:12.458,0:46:16.791
At times, we were even to deploy from the
emergency department to screening centers

0:46:17.166,0:46:21.500
and we were triaging up to maybe
5 to 600 people in a day

0:46:22.041,0:46:27.583
that may have been exposed or had symptoms
that may have not even been covered.

0:46:27.583,0:46:32.041
But just because it was such it’s
such a novel disease that you had no idea

0:46:32.666,0:46:35.041
what symptoms could arise.

0:46:35.041,0:46:37.000
And I would say

0:46:38.583,0:46:41.500
The Unforgettable was also

0:46:41.500,0:46:43.375
how many bodies we had to beg

0:46:43.375,0:46:47.333
and sent down to the morgue.

0:46:47.333,0:46:51.875
That was that was what COVID
started as and continue does.

0:46:53.250,0:46:54.125
Yeah.

0:46:54.833,0:46:59.583
And you know, Todd spoke
about being redeployed and and folks

0:46:59.625,0:47:03.500
in different jobs found themselves

0:47:04.500,0:47:07.541
doing things
that they would never have imagined.

0:47:08.166,0:47:13.000
Like,
you know, taking care of the deceased.

0:47:14.041,0:47:17.583
David, you were also redeployed

0:47:17.583,0:47:21.666
during during the pandemic
in those early days.

0:47:21.666,0:47:23.583
What was going on for you?

0:47:23.583,0:47:26.250
Like, how were you

0:47:27.208,0:47:29.166
how were you processing,

0:47:29.166,0:47:33.750
what was happening,
the chaos that Todd and Aram talk about

0:47:33.750,0:47:37.291
and being redeployed, all of those things?

0:47:37.291,0:47:37.958
Well, it was

0:47:37.958,0:47:40.791
it was certainly very challenging
within the health center itself.

0:47:40.791,0:47:45.458
It was like Todd was saying,
just a very chaotic novel virus.

0:47:45.458,0:47:47.708
We didn’t have much information about it.

0:47:47.708,0:47:50.708
Even being able to judge
like my own personal risk

0:47:50.916,0:47:53.666
to the virus just with other
kind of health care factors,

0:47:54.500,0:47:57.666
with my regular job
being in orthopedic and general surgery,

0:47:58.625,0:48:01.750
Like we stopped
a lot of a lot of the elective surgeries.

0:48:02.041,0:48:06.083
So I was seconded to work in the ICU
for for quite a while.

0:48:06.541,0:48:09.916
And, you know, I do have ICU experience
and I’m used to working

0:48:09.916,0:48:13.333
with those level of patients,
but kind of being able to prepare myself

0:48:13.333,0:48:16.958
for the symptoms
and just the unique level of care that

0:48:17.166,0:48:19.750
those patients
with severe COVID pneumonia required

0:48:20.500,0:48:23.250
was challenging and there was really
no preparation for that.

0:48:23.250,0:48:26.416
I mean, you just had to know
you’re working with a novel virus.

0:48:26.416,0:48:27.875
It’s hard to kind of do

0:48:27.875,0:48:31.583
the best of your ability
and using good, sound clinical judgment,

0:48:32.875,0:48:36.000
it was certainly
it was even more challenging for myself

0:48:36.000,0:48:39.125
when we went to the ICU was
we weren’t just doing day shifts.

0:48:39.125,0:48:42.416
So we were kind of just because
of a lack of staff in general.

0:48:43.250,0:48:47.208
So we had to do 24 hour shifts
like 24 hour coverage

0:48:47.708,0:48:51.958
with very little of time
to to really accommodate to the

0:48:53.125,0:48:53.291
well,

0:48:53.583,0:48:57.541
just going from day nights and actually
little like maybe having one day

0:48:57.541,0:49:01.833
in between to accommodate from from night
to from night to day and so forth.

0:49:02.291,0:49:03.833
And that was certainly challenging.

0:49:03.833,0:49:07.125
I have a lot of newfound respect
for our colleagues

0:49:07.291,0:49:10.125
that they do that on a on on, on a normal.

0:49:10.625,0:49:12.791
But that certainly left me
in the situation.

0:49:12.791,0:49:14.666
I was say, you know, trying to cope with

0:49:14.666,0:49:18.250
just a stressful situation
of change, a job, a job, but then also

0:49:18.250,0:49:22.041
having to do it without with, you know,
like sleep deprivation and

0:49:22.625,0:49:26.875
and certainly not having my other avenues
for for health care.

0:49:27.791,0:49:28.583
You know, a lot of the care

0:49:28.583,0:49:32.458
I was having to provide was, you know,
a little out of scope of practice.

0:49:32.583,0:49:34.000
You know, there is limited things.

0:49:34.000,0:49:37.500
A lot we could do from a mobilization
standpoint with with patients.

0:49:37.958,0:49:41.791
But, you know, having to,
you know, help bag bodies,

0:49:42.125,0:49:45.375
you know, speaking to families bringing
them in in the middle of the night

0:49:45.666,0:49:48.458
to be able
to kind of say goodbye to their loved ones

0:49:48.458,0:49:51.291
with us was certainly challenging.

0:49:51.708,0:49:53.041
And a little another thing

0:49:53.041,0:49:57.250
that also made it tougher was,
you know, a lot of different professions.

0:49:57.250,0:50:01.541
Certainly received some, you know,
kind of, you know, acknowledgment

0:50:01.541,0:50:05.333
from the government and monetary supports
through pandemic pays.

0:50:05.708,0:50:10.000
But, you know, physiotherapists were
one of the one of the groups that didn’t.

0:50:10.000,0:50:14.416
So now there we are,
six of us, around a patient Proning,

0:50:14.416,0:50:18.833
a intubated patient,
and only one of the only one of us was not

0:50:18.833,0:50:24.291
getting kind of any monetary support saw
or through that with the pandemic pay.

0:50:24.791,0:50:28.791
So that was that was just kind of
knocked it down a little bit further.

0:50:29.375,0:50:30.958
Mm hmm. Mm hmm.

0:50:30.958,0:50:35.083
It speaks to the the moral injury
that that we’ve that we’ve

0:50:36.916,0:50:38.791
alluded to.

0:50:39.541,0:50:41.041
Was there a moment for

0:50:41.041,0:50:44.791
for each of you
when you started to feel that

0:50:45.125,0:50:51.333
that feeling of we’re in a place
now that we’ve never been to and

0:50:51.333,0:50:57.041
and you start to feel the personal risk of
of where

0:50:57.041,0:51:01.208
we were in the pandemic, where you were
in the work that you were doing.

0:51:01.458,0:51:05.250
Was there a moment
that that you can think of,

0:51:05.250,0:51:09.083
but were that sort of the tides turned?

0:51:09.125,0:51:10.833
Let’s call it that.

0:51:10.833,0:51:13.458
I’ll start with you, Todd.

0:51:13.458,0:51:15.875
And I think that’s a great question.

0:51:15.875,0:51:19.916
It’s a great question because there’s
multiple times that I felt that way.

0:51:20.958,0:51:23.250
But I think it to me

0:51:23.250,0:51:27.750
is the tide that turned
was the convoy freedom protest

0:51:28.291,0:51:31.583
that really threw me off guard because

0:51:33.708,0:51:35.916
it because speaking from my experience

0:51:35.916,0:51:42.833
as a double minority, as a Asian man,
but also as a gay man,

0:51:42.833,0:51:46.125
two of those narrative that I have

0:51:46.125,0:51:50.791
is going down to to psychological safety
because of COVID

0:51:50.791,0:51:55.000
being Asian,
it’s not a good time to be Asian.

0:51:56.666,0:51:58.458
And then on top of that, being a gay man.

0:51:58.458,0:52:00.625
But then the third thing
that really came on

0:52:00.625,0:52:04.625
board was the convoy freedom protest,
that they were coming to Toronto

0:52:04.625,0:52:08.500
on a particular weekend,
and the messaging from my organization

0:52:08.500,0:52:13.166
was do not wear identify yourself

0:52:13.166,0:52:17.541
as a healthcare worker
just because you might be targeted.

0:52:18.041,0:52:21.333
So that was a really turning point
where it’s like

0:52:21.333,0:52:25.500
what is going on in the state of the world
where there’s three hats

0:52:25.791,0:52:29.208
that that I have three identities,
three identities, and

0:52:29.208,0:52:33.500
I can’t show all three perhaps, or it’s
not safe to have those three identities.

0:52:33.500,0:52:36.875
So psychological safety was really

0:52:38.375,0:52:42.291
at the foreground for me
in my experience during that time.

0:52:42.833,0:52:45.416
And that’s a new social phenomenon.

0:52:45.458,0:52:48.250
That’s it’s
a triple minority. Right. Where

0:52:49.583,0:52:50.625
do you feel safe?

0:52:50.625,0:52:52.250
Can you be yourself?

0:52:52.250,0:52:55.625
It’s a feeling of hiding oneself during

0:52:55.625,0:53:00.000
this pandemic was really interesting,
which highlighted that.

0:53:00.000,0:53:03.125
So that was a really take away
where it’s like

0:53:03.125,0:53:05.250
what is going on
in the state of the world.

0:53:06.333,0:53:09.958
I think that was just from a layperson’s
perspective.

0:53:09.958,0:53:12.875
That was a real turning point
for many people watching

0:53:13.791,0:53:18.291
The fact that you were unable to
when when those messages were going out

0:53:18.291,0:53:22.000
that don’t identify yourself
as a health care worker,

0:53:22.208,0:53:26.458
when, you know, four months
prior to that were standing out

0:53:26.458,0:53:30.458
and banging pots and pans for health care
workers.

0:53:30.458,0:53:32.708
So, Erin, what about you?

0:53:32.708,0:53:36.958
Was there a
I know that you experienced something

0:53:37.750,0:53:40.625
very traumatic during a

0:53:41.500,0:53:44.833
during the pandemic
and having your father being hospitalized

0:53:44.833,0:53:48.083
and coming into the same hospital
that you worked

0:53:48.083,0:53:51.666
at as a COVID patient?

0:53:51.666,0:53:54.333
I mean, I can’t even call that
a turning point.

0:53:54.333,0:53:58.000
Can you tell us just a little bit
about that and how you were

0:53:59.791,0:54:03.250
processing that situation?

0:54:07.833,0:54:08.791
My heart dropped

0:54:08.791,0:54:16.083
into my stomach.

0:54:16.083,0:54:20.291
Watching people struggle to breathe
and die is a very difficult thing

0:54:21.750,0:54:24.666
when you see it happen
to someone that you know and love

0:54:25.416,0:54:31.833
makes it much more difficult.

0:54:31.833,0:54:35.708
I would say continuing
to work on the front line while my father

0:54:35.708,0:54:40.291
was hospitalized in the ICU was a way
for me to be connected with him

0:54:40.291,0:54:44.666
physically and spiritually
at every point in my life at that time,

0:54:45.500,0:54:48.541
because I really believe
that was his journey.

0:54:48.541,0:54:51.708
But it was also part of my

0:54:52.416,0:54:55.000
it was me working 12 hour

0:54:55.000,0:54:58.750
shifts or more
and then walking over to the ICU

0:54:58.750,0:55:02.583
just to see what was going on, getting

0:55:03.000,0:55:05.125
feeling frantic, getting phone calls.

0:55:05.875,0:55:09.250
I think it was
also very difficult at times

0:55:10.916,0:55:13.625
hearing a code blue alarm go off up
above in the

0:55:13.625,0:55:16.125
and the announcement in the hospital,

0:55:16.125,0:55:18.666
because naturally you would wonder
and think,

0:55:19.291,0:55:23.916
is that someone that, you know,

0:55:23.916,0:55:26.875
watching the news and really stressed out,

0:55:27.791,0:55:30.833
hearing about things such as you know,

0:55:30.875,0:55:34.916
new new laws and new decisions

0:55:34.916,0:55:38.708
that were being made about certain age
groups being taken off of life support

0:55:40.083,0:55:45.166
was very, very difficult for me.

0:55:45.166,0:55:47.333
But also to to add on to,

0:55:48.708,0:55:51.000
you know, what was mentioned

0:55:51.000,0:55:56.583
just now about the convoy protest
and then having patients come in and

0:55:56.583,0:56:02.291
and become irate and and physically
and verbally assaulting you in the E.R.

0:56:02.750,0:56:06.250
and to the point
where a lot of them did not want to mask

0:56:06.458,0:56:10.125
because they didn’t
really believe this disease was real

0:56:11.250,0:56:14.583
or refusing to get vaccinated

0:56:14.583,0:56:18.000
was something that really affected myself.

0:56:18.208,0:56:21.541
But I think it also impacted
a lot of my colleagues that worked with me

0:56:21.541,0:56:24.875
alongside with me,
because there were so many people

0:56:25.916,0:56:28.083
that would have really
wanted that vaccine.

0:56:29.416,0:56:33.375
But my father was one of them.

0:56:33.375,0:56:34.333
He was

0:56:35.833,0:56:40.000
he was to wait by one week.

0:56:40.000,0:56:41.583
And so

0:56:44.708,0:56:47.666
he then became ill

0:56:47.916,0:56:50.958
and ended up on life support

0:56:50.958,0:56:54.041
where he fought for his life

0:56:54.041,0:56:56.166
for the hardest month.

0:56:56.791,0:56:58.083
That was one hard month.

0:56:58.083,0:57:01.333
That was a very hard month.

0:57:01.333,0:57:03.625
So I would say that

0:57:03.625,0:57:07.458
there are there were so many people
that would have really wanted that vaccine

0:57:08.083,0:57:10.416
so that they could just have that chance
to live

0:57:12.541,0:57:14.458
and be alive.

0:57:14.458,0:57:18.458
And so many people that I’ve seen sick
just because they couldn’t get a vaccine.

0:57:19.625,0:57:22.625
And I think that’s what had angered me.

0:57:22.625,0:57:26.416
And and a lot of us felt
so angered about those who were.

0:57:26.416,0:57:29.708
And we do understand that
there’s questions that people have because

0:57:29.708,0:57:32.791
it’s such a new disease.

0:57:32.791,0:57:35.250
But can you imagine,
is that really worth your life

0:57:35.708,0:57:40.166
because so many people died
from not having that?

0:57:40.166,0:57:41.000
Yeah,

0:57:42.250,0:57:43.916
thank you for sharing that.

0:57:43.916,0:57:46.958
I know that this is not an easy topic.

0:57:46.958,0:57:51.208
And, you know, as we talk about risk
and resilience, this is still so fresh.

0:57:51.208,0:57:56.625
This is this these are not conversations
that are in the past.

0:57:56.625,0:57:59.583
They’re still happening now.

0:57:59.583,0:58:01.500
So thank you for that.

0:58:01.500,0:58:01.875
David.

0:58:01.875,0:58:05.791
I know that you’ve yourself had

0:58:07.083,0:58:09.083
some turning points and some questions

0:58:09.083,0:58:10.625
around

0:58:12.125,0:58:15.166
around what your role would be as

0:58:15.166,0:58:18.000
you were thinking about your family,

0:58:18.166,0:58:21.875
those outside
leaving the hospital, going back home.

0:58:21.875,0:58:28.416
I know that you and I spoke a little bit
about the difficulties of home life and

0:58:29.625,0:58:32.541
and all
of those those things that come with

0:58:33.625,0:58:34.833
the work that you do.

0:58:34.833,0:58:38.458
Can can you just get into that
just a little bit

0:58:38.458,0:58:41.916
of how how

0:58:42.125,0:58:43.833
your work kind of filtered

0:58:43.833,0:58:46.250
into into the rest of your life?

0:58:47.875,0:58:48.333
Certainly.

0:58:48.333,0:58:52.875
I mean, it was very challenging,
just not having or I think as I mentioned

0:58:52.875,0:58:58.375
before, or just the strategies
I would normally use for for self-care.

0:58:58.458,0:59:01.500
You know, we talked about friends
and family, you know,

0:59:01.500,0:59:03.833
being able to go out for dinners, travel,

0:59:04.625,0:59:08.708
you know, going to the gym, all regular
things that I would would certainly do.

0:59:08.708,0:59:10.458
So we’re dealing with a

0:59:10.458,0:59:13.083
very stressful situation
and having to cope with it

0:59:13.083,0:59:16.000
and isolation
and the sense that, you know,

0:59:17.166,0:59:20.166
the general public was told to,
you know, kind of stay with their family

0:59:20.166,0:59:21.083
is, you know, bubble

0:59:21.083,0:59:24.916
have that around you and then then isolate
if you had a potential exposure.

0:59:25.291,0:59:28.958
But when you’re dealing
with potential exposures on the daily

0:59:29.083,0:59:33.333
you know, certainly
no one wants to wants to be around you.

0:59:33.333,0:59:36.541
So you’re looked at as a hero and one
and then kind of one vain

0:59:36.541,0:59:40.000
and then certainly looked at as like
the virus when you’re out in the community

0:59:40.000,0:59:42.750
and know
just people being generally scared,

0:59:43.625,0:59:47.041
I really had to kind of shut down,
you know, and compartmentalize

0:59:47.041,0:59:48.708
any worrying thoughts that I that I had

0:59:48.708,0:59:52.583
for myself to be able to continue
to show up for work and

0:59:53.041,0:59:56.666
and to be able to to continue to advocate,
to help the public.

0:59:56.875,1:00:00.666
And also, I mentioned before,
just having that fatigue,

1:00:00.666,1:00:04.500
that of dealing with that on the daily
that when you come home not being

1:00:04.500,1:00:08.583
fully there for your for your spouse
or your significant other and

1:00:08.791,1:00:12.708
and also to help in
and there I’m mean not needs

1:00:13.291,1:00:14.583
and one thing that was also

1:00:14.583,1:00:18.583
was just having the responsibility
of you know working in the ICU with

1:00:18.875,1:00:22.083
you know patients you know on 200% oxygen,
you know, prior to,

1:00:22.750,1:00:26.375
you know, potentially being intubated,
you know, being one of the last

1:00:27.458,1:00:29.916
physical contacts that they might have.

1:00:29.916,1:00:33.375
I mean, family weren’t allowed to come in
and they weren’t allowed to do that

1:00:33.875,1:00:37.583
to see their loved ones
unless it was close to close to death.

1:00:37.583,1:00:40.291
And they were having to view them
through through an iPad.

1:00:40.416,1:00:44.791
So having that responsibility of,
you know, being actual human connection

1:00:44.791,1:00:48.166
to someone as they’re potentially
going through there, you know,

1:00:48.625,1:00:51.375
ending stages of life and,
you know, having to tell them,

1:00:51.875,1:00:55.416
you know, try to calm their anxiety that,
you know, things were going to be okay

1:00:55.416,1:00:57.916
when you really know that
that they’re not.

1:00:57.916,1:01:02.708
That’s an incredible and very weighing
responsibility to have had.

1:01:03.083,1:01:05.708
So yeah yeah

1:01:05.708,1:01:10.416
I wonder if the three of you have

1:01:10.416,1:01:13.000
had you know we just listened to the

1:01:13.750,1:01:18.416
the research on on resilience
and being able to kind of take the time

1:01:18.416,1:01:24.708
to build your resilience and to do
the things that are important for that.

1:01:24.708,1:01:28.833
And David, I think you, you outlined
many of those things very well.

1:01:28.833,1:01:32.791
You know, being able to work out
and see friends and family

1:01:32.875,1:01:35.750
be those things
that builds up your resilience,

1:01:36.541,1:01:39.166
have you all had the time

1:01:39.166,1:01:42.625
or the capacity
to be able to care for yourselves

1:01:43.750,1:01:44.833
during this time?

1:01:44.833,1:01:48.625
And and what are those things
that are your you’re holding on to?

1:01:48.625,1:01:51.708
Are those moments that you can hold on to

1:01:51.708,1:01:54.833
to keep you you going?

1:01:55.083,1:01:57.125
Aram, can I start with you? Is that okay?

1:01:57.875,1:02:00.750
Yes, that’s fine.

1:02:00.750,1:02:04.833
I would say for me, I’m
a very spiritually inclined person.

1:02:05.708,1:02:09.500
I really believe in a lot of power
and strength and meditation and prayer

1:02:09.666,1:02:12.166
and I really believe that is what

1:02:12.666,1:02:15.541
kept me going
through my very difficult times

1:02:16.000,1:02:19.500
while my father was hospitalized
when the pandemic

1:02:19.500,1:02:23.916
had even started,

1:02:23.916,1:02:26.291
I would say
that was something that kept me going

1:02:28.333,1:02:32.041
while my father was hospitalized
and I was working alongside with

1:02:32.041,1:02:36.333
other patients that were simultaneously
on life support as well.

1:02:36.958,1:02:41.250
And, you know, for me,

1:02:41.250,1:02:45.125
I feel like
that is a great resource of strength.

1:02:46.083,1:02:46.666
And that is

1:02:46.666,1:02:50.416
something that that kept me going.

1:02:50.416,1:02:54.000
The pandemic did have
a lot of restrictions in terms of

1:02:54.875,1:02:58.000
having to physically meet people,

1:02:58.125,1:03:01.250
speaking with people on the phone
or having anything virtual.

1:03:01.250,1:03:04.250
It was was,
I would say, a bit of a challenging issue.

1:03:05.166,1:03:07.250
And I would say that

1:03:07.416,1:03:11.833
on behalf of my colleagues, for instance,
because I think a lot of them

1:03:11.833,1:03:14.083
have been going through
so much personally,

1:03:15.708,1:03:18.083
each individual copes differently.

1:03:18.250,1:03:20.833
So the way that they

1:03:20.833,1:03:22.750
respond or react to stress

1:03:22.750,1:03:25.916
is going to be very vastly different
from each person.

1:03:27.083,1:03:30.541
I would also say a lot of other things
that kind of helped me

1:03:30.541,1:03:35.916
with coping were,
I would say, a lot of writing.

1:03:36.458,1:03:39.583
I’m very much into writing and to music

1:03:41.375,1:03:43.500
I like, you know, I

1:03:44.208,1:03:48.375
I’ve played a lot of musical instruments
and I would really feel like that was my

1:03:48.958,1:03:50.958
my circle or a space of Zen

1:03:51.875,1:03:55.500
for me too, to have that moment for myself
to really indulge

1:03:55.500,1:03:59.833
and just have that inner peace, to try
to align that inner peace within me.

1:04:00.833,1:04:01.750
Yeah.

1:04:02.458,1:04:04.416
How about you, Todd?

1:04:04.416,1:04:08.750
Have you had the the time,
the capacity to care for yourself?

1:04:08.750,1:04:11.416
And what have you been doing

1:04:11.416,1:04:12.666
for such a good question.

1:04:12.666,1:04:17.000
And when I reflect on that,
I really have to say I’m unsure

1:04:18.333,1:04:23.333
and sure, because being in the health care
system very I saw and witnessed

1:04:23.333,1:04:27.708
so many inequities that it’s just
it still sits with me, right?

1:04:27.708,1:04:31.208
You see it and you don’t know what to do.

1:04:31.208,1:04:34.750
And you’re experiencing
this moral distress or moral injury.

1:04:35.166,1:04:37.500
How do you heal from that?

1:04:38.583,1:04:40.541
Sure, sleep helps.

1:04:40.541,1:04:43.625
Taking time away helps,
but being in the health care system,

1:04:43.625,1:04:47.083
you’re kind of reminded, okay,
we need to make some change.

1:04:47.083,1:04:51.166
So I think that self-care is one thing.

1:04:51.166,1:04:54.791
But I also I would say it’s
the responsibility of the organization

1:04:54.791,1:04:59.916
as well to support us
after this experience because they did

1:04:59.916,1:05:04.833
such a great job as just putting people
together organized for deployment.

1:05:04.833,1:05:06.250
You cannot do this, do that.

1:05:06.250,1:05:11.333
But I think that same energy
needs to be deployed for management of

1:05:11.791,1:05:16.416
of such of how to take care of your team,
how to build back better,

1:05:16.791,1:05:22.750
how to promote a sense of mental
well-being in your team.

1:05:23.333,1:05:28.416
And just going back to the presentation
that we did was the organizational level

1:05:28.791,1:05:34.166
of perhaps being more transformative
leadership, promoting more sense of mental

1:05:34.166,1:05:40.375
well-being and supports
and really making that a priority somehow.

1:05:40.375,1:05:44.708
So I think it comes from within our self
to take care of yourself for sure,

1:05:44.708,1:05:50.833
but also coming from our organization
as well.

1:05:50.833,1:05:52.375
David do you feel like like

1:05:54.000,1:05:56.791
your supports, your organization is

1:05:56.791,1:06:00.958
is helping you along that that journey to,

1:06:02.583,1:06:07.000
you know, to give you back the capacity
to kind of take care of yourself or to,

1:06:07.333,1:06:10.791
you know,
are those systems in place for you?

1:06:11.791,1:06:14.208
Well, that’s that’s it’s it’s challenging.

1:06:14.375,1:06:17.750
I mean, although I’ve been able
to, you know, do some personal stuff

1:06:17.791,1:06:21.000
with regards to self-care, you know,
going back to, you know, being active,

1:06:21.000,1:06:24.916
working out,
I really certainly went to education

1:06:24.916,1:06:26.958
and to to really

1:06:26.958,1:06:30.333
to give myself some control,
like going to literature, learning about

1:06:31.000,1:06:34.750
the virus and with each and with each
new strand that was coming out.

1:06:35.083,1:06:37.916
And to give myself
a little bit of control in a

1:06:38.291,1:06:41.083
in an environment,
whether that were there was little.

1:06:41.083,1:06:43.625
It’s been challenging, though,
because, I mean, the state of our health

1:06:43.625,1:06:44.791
care system has gone.

1:06:44.791,1:06:46.333
We’ve gone from a COVID pandemic

1:06:46.333,1:06:50.541
to a pandemic staffing,
and that’s been challenging for us.

1:06:50.541,1:06:52.041
I certainly know that.

1:06:52.041,1:06:55.000
I know organizations,
you know, have job postings out

1:06:55.000,1:06:57.458
and have had them up for months and
and years.

1:06:57.875,1:07:02.625
But there’s very that, you know, we can do
when there’s just no people that that

1:07:02.666,1:07:03.666
that want to do the job.

1:07:03.666,1:07:07.875
And so now we’re moving from
you know, the our secondments

1:07:07.875,1:07:11.416
and dealing
with the severity of COVID itself.

1:07:11.416,1:07:16.750
And now we’re going into just an onslaught
of trying to clear the surgical backlogs

1:07:16.750,1:07:19.833
and the constant push to,
you know, try to move through quicker.

1:07:19.833,1:07:23.500
And, you know, and you’re also working
with more challenging,

1:07:23.500,1:07:24.666
you know, patients and families

1:07:24.666,1:07:28.000
who haven’t had the appropriate
level of care for the last 2 to 3 years.

1:07:28.000,1:07:31.291
And and doing that with the same,
you know, very same

1:07:31.291,1:07:34.416
level of staffing
that was that was there prior prior,

1:07:34.416,1:07:38.583
which has been limited
as certainly has been challenging.

1:07:38.583,1:07:39.500
And I know it’s something

1:07:39.500,1:07:43.500
that all organizations, you know,
are trying to are trying to correct.

1:07:43.500,1:07:44.166
It’s just,

1:07:44.166,1:07:47.583
you know, certainly difficult when there’s
just not enough of the skilled people

1:07:47.875,1:07:52.166
wanting to wanting to take the positions.

1:07:52.166,1:07:57.541
I have no doubt that this has been the most challenging period in your work lives,

1:07:59.083,1:08:01.375
but you’re still all still

1:08:02.791,1:08:06.500
you are still working, you’re
still getting up and going to your jobs.

1:08:06.500,1:08:08.416
And I wonder about

1:08:08.708,1:08:12.625
where Hope lies in all of this for you
and and

1:08:12.958,1:08:15.375
and why it’s important to just keep

1:08:15.666,1:08:18.083
on keeping on as you’re going

1:08:19.541,1:08:20.791
to. I

1:08:24.291,1:08:27.333
what keeps me going
is the connections that I make

1:08:27.333,1:08:32.041
with the people that I work with,
the clients, the patients

1:08:32.458,1:08:36.375
and my colleagues, because I realize that
that’s my second family.

1:08:36.666,1:08:40.791
I have my own family,
but it’s the work family.

1:08:41.250,1:08:46.208
And just going back to the first question
of why I went to the field, I loved the

1:08:46.500,1:08:51.250
the contribution
that I make to people’s lives,

1:08:51.250,1:08:53.750
and that keeps me going.

1:08:54.333,1:08:57.416
And also being curious
and being in the health care system.

1:08:57.416,1:09:00.291
How can I contribute
to make it more equitable?

1:09:00.291,1:09:03.250
Because I think it’s everybody’s
responsibility now,

1:09:03.291,1:09:07.000
not just the leadership team, but for me
now, after speaking COVID

1:09:07.500,1:09:13.500
I, the pandemic is I need to voice biases.

1:09:13.500,1:09:18.000
I need to communicate from
a bystander if things are

1:09:20.041,1:09:23.166
not ethical,
not equitable, that sort of thing.

1:09:23.166,1:09:26.875
So I think now
I have a different lens of going into this

1:09:27.750,1:09:31.041
from the next chapter of my life
and my career to

1:09:31.083,1:09:34.750
how can I make a positive influence
in a different way this time

1:09:35.250,1:09:40.583
so that we can learn from the endemic,
not make the same mistakes.

1:09:40.583,1:09:44.375
So coming from that angle is a strength
based focus

1:09:44.791,1:09:47.166
versus from a pessimistic
point of view of health care.

1:09:47.166,1:09:48.833
Because we can go there.

1:09:48.833,1:09:52.208
But I think I’m focusing more
on the strength of health care.

1:09:53.041,1:09:55.041
Yeah, with the.

1:09:55.916,1:09:56.708
Thank you for that.

1:09:56.708,1:09:58.000
What the few minutes we have.

1:09:58.000,1:10:00.000
What about you, David?

1:10:00.666,1:10:03.708
A what is what is keeping you in it

1:10:03.708,1:10:07.166
and giving you hope these days?

1:10:07.166,1:10:09.666
Well, as interestingly listening
to the talk about resiliency.

1:10:09.666,1:10:10.541
So I am getting older.

1:10:10.541,1:10:14.500
So my resiliency builds
certainly builds with age but

1:10:16.041,1:10:19.083
but no, it’s still coming back
to, you know, why

1:10:19.083,1:10:22.041
I went into the profession
in the first place and having that ability

1:10:22.416,1:10:25.833
to certainly help other people
and and and family.

1:10:25.875,1:10:28.750
I mean, my secondary job
that’s kind of popped up

1:10:28.750,1:10:31.750
has been a health care navigator
for friends and family in this time.

1:10:31.750,1:10:35.500
Just because our health care system is
certainly is very fractured

1:10:35.500,1:10:38.166
from from where it was before
and just trying to get to appropriate

1:10:38.166,1:10:41.083
levels of care
afterwards has certainly been challenging.

1:10:42.125,1:10:44.500
And I just really hope that, you know,

1:10:45.083,1:10:48.291
from a higher levels of government
that would that we learn from this,

1:10:48.291,1:10:49.833
you know, whether,

1:10:49.833,1:10:53.750
you know, everything was truly heated
after or after this virus pandemic.

1:10:53.750,1:10:57.125
And and in 2003 was was really carry
forward.

1:10:57.125,1:11:00.041
And, you know, there was a lot of a lot of
talk and a lot of questions about that.

1:11:00.750,1:11:03.625
So I really hope that, you know,
I hope that, you know,

1:11:03.625,1:11:08.083
we have good people in place
that can really push forward

1:11:08.083,1:11:12.125
and and really learn from this, you know,
try to support that on the front lines.

1:11:12.208,1:11:15.875
Certainly looking at staffing models,
not trying to do not trying

1:11:15.875,1:11:17.791
to do more with less. And I

1:11:19.291,1:11:20.500
have hopes that that will happen.

1:11:20.500,1:11:23.583
And we’ll just have to
just have to keep soldiering on.

1:11:24.500,1:11:26.500
Yeah for sure.

1:11:26.500,1:11:30.125
And you, Aram, what is giving you hope?

1:11:30.125,1:11:35.041
What’s keeping
you getting up and doing the work?

1:11:35.041,1:11:38.416
I would probably say that

1:11:38.500,1:11:40.625
we’ve all been
through such a difficult battle.

1:11:40.625,1:11:42.083
So why stop now?

1:11:42.083,1:11:42.875
Why what?

1:11:42.875,1:11:46.416
Why? Why would I stop now?

1:11:47.333,1:11:49.625
I would also say

1:11:49.625,1:11:53.916
that it is to continue the legacy
of my late father, because I know

1:11:53.916,1:11:56.541
it’s something that he really wanted me
to do and continue.

1:11:57.333,1:11:59.958
And I know that he wanted me.

1:11:59.958,1:12:02.458
And I know he always would say that.

1:12:02.458,1:12:04.875
I know that you will

1:12:04.875,1:12:07.750
shape
and change the world for a better place.

1:12:08.958,1:12:11.708
And I think lastly,
what I’d like to add on to

1:12:11.708,1:12:14.958
that is given this experience.

1:12:16.291,1:12:17.125
You know,

1:12:17.125,1:12:20.125
SaaS and Ebola, for example,
those were like our

1:12:21.875,1:12:23.250
our wake up calls.

1:12:23.250,1:12:27.833
And I think getting input from individuals
such as ourselves is what mistake

1:12:27.875,1:12:30.208
are we going to avoid for the future

1:12:30.208,1:12:33.208
and and try to implement programs,
for example,

1:12:33.208,1:12:37.083
such as emergency preparedness programs,
of what mistakes we made

1:12:37.083,1:12:40.333
and what things could be done
better, implementing

1:12:41.458,1:12:44.375
programs and mental health
awareness programs and support

1:12:44.375,1:12:47.083
groups for health care
workers at the start of the pandemic.

1:12:47.458,1:12:49.208
It’s long overdue.

1:12:49.208,1:12:51.416
And you know, things like that.

1:12:51.416,1:12:55.000
For example,
because so many lives have been lost.

1:12:55.000,1:12:57.541
And I just think that it could
just have been managed so much better.

1:12:59.125,1:13:01.333
But I would say that

1:13:01.333,1:13:03.666
to implement more, to implement

1:13:05.041,1:13:07.708
and shape the world into a better place

1:13:07.708,1:13:10.416
and just that change for a better
tomorrow.

1:13:11.041,1:13:12.500
Yeah.

1:13:12.500,1:13:14.916
Thank you all so, so much.

1:13:14.916,1:13:19.000
Aram and Todd and David
and I wish you the best

1:13:19.000,1:13:22.291
as you push forward and in care of us.

1:13:22.291,1:13:26.666
And I thank you for not just taking
this time and a symposium here, but

1:13:27.666,1:13:29.041
for the work that you do.

1:13:29.041,1:13:31.541
Thank you for being here today.

1:13:31.541,1:13:34.416
Much appreciated.

1:13:35.291,1:13:37.875
Hello. Welcome back, everyone.

1:13:37.875,1:13:39.333
I hope that

1:13:39.916,1:13:42.625
you had a short break
and you put it to good use.

1:13:43.333,1:13:46.750
We have learned
so in this in our morning session

1:13:46.958,1:13:50.708
in the in the early parts of the symposium
about risk and resilience through

1:13:50.708,1:13:53.791
the personal lens of our generous health

1:13:53.791,1:13:57.916
care and the panelists and
and through the data

1:13:57.916,1:14:01.500
and recommendations
coming out of the research,

1:14:02.708,1:14:06.375
I have to say that, you know,
I am learning so much about PTSD,

1:14:06.375,1:14:10.500
about moral injury
and risk and my own resilience.

1:14:11.875,1:14:17.583
But you I’d say that we do lean on on

1:14:17.708,1:14:22.208
you all the most
and at our most vulnerable times.

1:14:22.625,1:14:26.791
And so it’s good
to really take a step back and look at

1:14:27.250,1:14:30.250
what what we can do to help

1:14:30.541,1:14:34.208
to alleviate some of this this burden
and this this stress.

1:14:34.583,1:14:36.666
We’re going to continue this conversation
with colleagues

1:14:36.666,1:14:41.375
from the University of Alberta
who will present a tool called The Matrix

1:14:42.000,1:14:46.375
that aims to impart mood individuals
from NEG negative

1:14:46.375,1:14:50.458
psychological distress
or behaviors to more positive behaviors.

1:14:50.958,1:14:54.000
Dr. Suzette Brémault-Phillips and Dr.

1:14:54.250,1:14:55.083
Lorraine Smith.

1:14:55.083,1:14:58.833
McDonald can give you and give us

1:14:58.833,1:15:01.708
a bit of background on the Matrix.

1:15:01.916,1:15:03.000
I’ll turn it over to them

1:15:08.166,1:15:18.208
to then we go, Can everyone hear me?

1:15:18.208,1:15:19.625
Is it okay now?

1:15:19.625,1:15:21.625
Okay, wonderful. Sorry about that.

1:15:22.000,1:15:25.083
So I just wanted to say thank you
so much for that introduction

1:15:25.500,1:15:27.541
and we’re very to be here

1:15:28.083,1:15:30.666
and as already has been mentioned
in the symposium

1:15:30.666,1:15:34.000
many times, we just want to acknowledge
both the risk and the harm

1:15:34.000,1:15:38.125
that has come out of the pandemic,
whether that’s PTSD or moral injury

1:15:38.666,1:15:42.458
or just any of those other components
that people have had to experience.

1:15:43.625,1:15:47.375
But I think we also just want to honor
the moments, resilience that we just heard

1:15:47.375,1:15:51.500
about in the last presentation
and to just really speak to the fact

1:15:51.500,1:15:56.708
that as much as we know that risk comes,
so too can resilience come.

1:15:57.250,1:15:59.875
And we want to share a little bit
about our definition

1:15:59.875,1:16:04.166
of risk and resilience
and how we we believe you can build it.

1:16:05.416,1:16:08.041
And so I will turn it over to Dr.

1:16:08.041,1:16:09.708
Suzette Brémault-Phillips

1:16:09.708,1:16:13.541
to just give us a little bit
of an introduction about our understanding

1:16:13.875,1:16:17.166
of risk and resilience
before we move into the Matrix.

1:16:18.000,1:16:18.958
Thank you. Dr.

1:16:18.958,1:16:20.875
Seth McDonald It’s a pleasure being here.

1:16:20.875,1:16:23.041
Thank you everyone for the opportunity.

1:16:23.916,1:16:27.083
Yeah, well, there’s a lot of different
of models of resilience.

1:16:27.083,1:16:28.250
One way that we can look at it

1:16:28.250,1:16:31.666
is to think of resilience
and risk as two sides of the same coin.

1:16:32.250,1:16:35.083
On the one hand, harm
is anything that can challenge

1:16:35.083,1:16:38.375
our values external threat to us.

1:16:38.375,1:16:42.333
Yet at the same time, despite that threat,
we have the innate desire

1:16:42.333,1:16:45.500
in our hearts
to continue to move forward early on.

1:16:46.291,1:16:50.791
We hope, even if the glimmer of hope is
extremely small or hard to find sometimes.

1:16:51.458,1:16:54.875
But with time,
this harm can sometimes overcome our hope.

1:16:54.875,1:16:57.791
And so there’s a need to go deeper
to find a way to get through.

1:16:58.666,1:17:02.458
We posit that resilience
is about our values as well.

1:17:02.500,1:17:06.583
To be resilient, we need to know
what matters to us the most, i.e.

1:17:06.666,1:17:10.625
what our core values are and how we want
to live out those values in our lives.

1:17:11.416,1:17:15.125
If we don’t care about something,
it doesn’t align with our values or who

1:17:15.125,1:17:19.833
we want to be, then it’s going to be
very difficult to care or to carry on.

1:17:20.583,1:17:23.166
Knowing what matters to us
helps us to clarify

1:17:23.166,1:17:25.875
where we put our energies or what
things are worth fighting for,

1:17:25.875,1:17:29.166
and equally importantly,
what things we should let go of.

1:17:29.875,1:17:34.625
Resilience is about trying to, in small
steps, be able to realign with our values.

1:17:35.125,1:17:37.791
In difficult times, we often lose sight

1:17:37.958,1:17:42.583
of what we are trying to achieve
or why we’re doing things Left unchecked.

1:17:42.750,1:17:46.291
This can lead to helplessness,
feelings of hopelessness

1:17:46.625,1:17:49.875
which further compound
or can compound our sense of harm.

1:17:51.000,1:17:51.708
Taking small

1:17:51.708,1:17:54.125
steps to clarify what matters to us most,

1:17:54.750,1:17:58.125
However, it can provide us with greater
understanding and a clearer sense

1:17:58.125,1:17:59.666
of meaning and purpose

1:17:59.666,1:18:03.541
and a pathway to get through the harm
that we’re experiencing.

1:18:03.541,1:18:05.875
And that’s where resilience shines
the most.

1:18:06.250,1:18:09.000
So again, resilience is about our values.

1:18:09.208,1:18:11.458
What matters to us the most?

1:18:11.458,1:18:13.250
Act Hillary Great.

1:18:13.250,1:18:14.791
Thank you so much.

1:18:15.041,1:18:18.583
We also just want to acknowledge,
as has been discussed in this symposium,

1:18:18.583,1:18:22.125
that resilience is something
that is a joint responsibility

1:18:22.125,1:18:26.791
between ourselves and other people,
specifically employers and employees.

1:18:27.375,1:18:31.458
And employers need to make those changes
to be able to improve

1:18:31.791,1:18:35.291
workplace factors that reduce
mental health and promote resilience.

1:18:35.458,1:18:38.916
So we want to just acknowledge
before we get into the matrix specifically

1:18:39.291,1:18:43.750
that this tool, while being specific to
individuals, can be used on a team level

1:18:44.083,1:18:48.125
and can also be used in ways
to support this more global and more

1:18:49.333,1:18:51.375
societal approach to resilience.

1:18:52.625,1:18:55.250
So before anything else,

1:18:55.250,1:18:58.125
why don’t we jump right into the matrix?

1:18:58.333,1:19:01.750
This is a tool that was developed
by acceptance and commitment therapy,

1:19:02.000,1:19:05.666
and it’s an evidence based tool to try
and support people to move from risk

1:19:05.958,1:19:14.958
to resiliency.

1:19:16.333,1:19:19.333
Hi, We’re going to introduce you
to a tool called The Matrix.

1:19:19.750,1:19:21.375
The Matrix is a perspective.

1:19:21.375,1:19:25.291
It’s a way that we can look at things
and we can use the matrix, understand our

1:19:25.291,1:19:29.541
experiences and help guide our choices,
especially when we’re feeling stuck.

1:19:29.541,1:19:31.791
It can help us
figure out how to get unstuck.

1:19:32.083,1:19:34.166
So the Matrix has two axes.

1:19:34.166,1:19:38.500
The first is towards in a way,
and this means towards

1:19:38.500,1:19:41.708
what matters to you, towards
who’s important to you, towards

1:19:41.708,1:19:45.208
your values, what’s important
and matters to you or away from

1:19:46.208,1:19:48.333
the other axes is inside and outside.

1:19:48.583,1:19:52.083
Inside is our internal
thoughts, feelings and sensations

1:19:52.083,1:19:54.750
and outside
is anything you can notice with your five

1:19:55.583,1:19:58.166
or your own behavior,
which is what other people can see.

1:19:58.166,1:19:59.166
You two

1:19:59.708,1:20:01.750
in the middle is us noticing,

1:20:01.750,1:20:04.791
hopefully
with some kindness and curiosity.

1:20:04.791,1:20:08.166
And so it’s important
because it also helps us notice

1:20:08.166,1:20:11.625
what’s happening and to take a different
perspective of thinking about things,

1:20:11.708,1:20:15.375
not in terms of good,
bad, right, wrong, true or false,

1:20:15.666,1:20:18.958
but in terms of towards
what matters or away from what matters.

1:20:19.416,1:20:22.750
We can also use a matrix
to understand risk and resiliency.

1:20:23.333,1:20:27.458
So in a sense, risk is when we get stuck
on the away side of the matrix.

1:20:27.708,1:20:31.083
As humans, we often do things
that are short term solutions

1:20:31.291,1:20:33.458
but end up costing us in the long term

1:20:34.625,1:20:38.458
resiliency is then getting to the towards
side of the matrix.

1:20:38.458,1:20:41.833
It means that we’re doing things
that are important to us,

1:20:42.000,1:20:45.000
that matter to us
even when things are difficult.

1:20:46.291,1:20:49.708
And our goal is simply to move
a little bit more towards than away.

1:20:50.041,1:20:53.875
Nobody can spend all their time
on the towards side of the matrix.

1:20:53.875,1:20:56.291
So now we’re going to use the Matrix.

1:20:56.291,1:20:58.583
And to give you an example
of how you can use it,

1:20:59.625,1:21:03.083
the now we’re going to go through
an example of how we can use the matrix.

1:21:03.083,1:21:04.583
In this example, Dr.

1:21:04.583,1:21:07.208
Jaimie and I are going to use the Matrix.

1:21:07.625,1:21:10.958
I’m going to be using an example
from my own personal experience.

1:21:10.958,1:21:14.125
I spent almost 15 years
on the medical surgical and cancer

1:21:14.125,1:21:18.041
care units at the hospital,
and I was there for part of the pandemic.

1:21:18.458,1:21:22.083
And so as a frontline worker working
in the cancer center during the pandemic,

1:21:22.125,1:21:23.083
I’m going to use my own

1:21:23.083,1:21:27.083
personal experiences to help us understand
how we can use the Matrix.

1:21:27.250,1:21:29.250
So let’s
see how we can make use of this tool.

1:21:31.041,1:21:31.625
Hey, Dr.

1:21:31.625,1:21:33.916
Dayna. Hey, Dr. Jaimie.

1:21:35.250,1:21:38.791
Let’s talk about something related
to your experiences as a health care

1:21:38.791,1:21:43.291
worker, especially the ways that you felt
stuck as a health care worker.

1:21:44.500,1:21:48.791
Yes. So I would say one of the parts
that was the most difficult

1:21:48.791,1:21:51.916
and I get the most stuck on where
some of the rules that really

1:21:51.916,1:21:55.041
it felt like they were putting patients
and health care providers at risk.

1:21:55.166,1:21:58.583
Sometimes those were government rules,
sometimes were institution rules

1:21:59.041,1:22:00.166
during the pandemic.

1:22:00.166,1:22:02.083
Sometimes it was about me.

1:22:02.083,1:22:04.875
And when you could get it
or how you should use it, other times

1:22:04.875,1:22:08.166
it was about when and where
and who was allowed to go

1:22:08.166,1:22:11.500
in and out of the hospital
and where you had to work.

1:22:11.500,1:22:15.000
And there was just constant worry
about bringing the virus either

1:22:15.000,1:22:18.791
in or out of the hospital, especially
at early stages of the pandemic.

1:22:19.375,1:22:21.000
Yeah.

1:22:21.000,1:22:23.208
So pain painful.

1:22:23.916,1:22:26.791
So I’m not I’m going to put this
on the matrix, Dr.

1:22:26.791,1:22:29.916
Dayna, away from what matters
because this pain was

1:22:29.916,1:22:33.375
really, really taking you away
from the things that mattered

1:22:34.083,1:22:37.000
and in the internal world. So

1:22:38.041,1:22:41.000
could you tell us a little bit
about those painful thoughts

1:22:41.166,1:22:44.916
and feelings and memories
that you had during that time?

1:22:46.041,1:22:48.791
Yeah,
there was a lot of anger and frustration.

1:22:48.791,1:22:51.500
And I would say
also really feeling helpless

1:22:51.500,1:22:54.250
and sometimes hopeless
that things weren’t going to change.

1:22:54.541,1:22:57.458
Sometimes we tried so hard
to get those roles to change

1:22:57.458,1:23:00.541
and sometimes we made no progress at all.

1:23:00.541,1:23:02.000
And I also heard you say

1:23:02.000,1:23:05.333
just memories of people, patients
and coworkers being harmed.

1:23:05.916,1:23:08.208
Yeah, it was really upsetting too.

1:23:08.208,1:23:11.375
You know, we all get into profession
because we want to help people.

1:23:11.375,1:23:12.875
And here there are these roles

1:23:12.875,1:23:16.416
that feel like they’re harming
both patients and our coworkers.

1:23:16.833,1:23:18.333
So thoughts like what?

1:23:18.333,1:23:21.333
What was going through your head like,
this is unfair.

1:23:21.333,1:23:23.916
I need to fix this. Why is this happening?

1:23:24.791,1:23:27.791
Any any body sensations
with all this pain?

1:23:28.416,1:23:32.458
Oh, well, like constant tension
just all the time.

1:23:32.875,1:23:33.666
Mm hmm.

1:23:33.875,1:23:37.625
Okay, so lots of anger,
lots of frustration.

1:23:37.625,1:23:40.583
Helpless, hopeless Great noticing.

1:23:42.125,1:23:44.583
All right, so we’re going to move up here.

1:23:44.583,1:23:49.083
So this is away from what matters
and what people see in the outside world.

1:23:49.083,1:23:52.541
What what did you do to move away
from this pain?

1:23:54.083,1:23:58.291
Well, I would say we often
got into arguments with management

1:23:58.291,1:24:01.458
trying to get people to change
or to convince people,

1:24:01.458,1:24:04.875
you know, of the importance
of how things needed to be different.

1:24:05.541,1:24:07.166
That was a big thing.

1:24:07.166,1:24:11.750
So what else did you do when you felt
frustrated, hopeless, helpless?

1:24:12.625,1:24:13.125
Yeah. I mean,

1:24:13.125,1:24:17.166
we often didn’t get anywhere with that,
so we did feel like super hopeless.

1:24:17.166,1:24:21.250
I’m I’m pretty I was like pretty snappy
with my family members.

1:24:22.416,1:24:27.000
And I probably started to, like,
avoid some of my friends because they just

1:24:27.000,1:24:31.375
didn’t want to keep hearing about
all of our stressors at the hospital.

1:24:32.250,1:24:33.083
Yeah.

1:24:33.250,1:24:37.291
So what happens
is this these thoughts and feelings

1:24:38.541,1:24:41.375
in their way Internal.

1:24:41.375,1:24:45.666
You started coping with them
with these away outside, right?

1:24:46.000,1:24:50.583
Is there anything that happened
as a result of these away outside moves

1:24:50.583,1:24:53.041
like so while you’re getting in arguments
with management,

1:24:53.416,1:24:57.000
trying to get people to change,
getting snappy, avoiding friends,

1:24:57.000,1:25:00.583
what painted that ad on the inside?

1:25:01.833,1:25:04.541
Well,
I end up just feeling even more frustrated

1:25:04.541,1:25:07.333
and angry
because you can’t get them to change

1:25:08.375,1:25:10.541
and then you start
to feel like a horrible person

1:25:10.541,1:25:13.500
because you’re not,
you know, hanging out with your friends

1:25:13.500,1:25:16.625
and you’re being snappy
and difficult with your family.

1:25:16.625,1:25:17.375
Like,

1:25:18.333,1:25:20.500
Yeah, okay, so

1:25:21.875,1:25:26.541
great noticing and notice
what’s starting to happen.

1:25:26.541,1:25:32.375
These away inside
experiences are contributing to these away

1:25:32.375,1:25:37.625
outside actions which are then
leading to more a way outside experiences.

1:25:37.833,1:25:42.875
So we start to spiral on this side
and when people come to us stuck,

1:25:43.250,1:25:44.583
they can be

1:25:44.583,1:25:48.875
in a in a high risk situation
where they’re spiraling on this away side.

1:25:49.708,1:25:53.000
So when we get fixated on this away

1:25:53.000,1:25:56.791
side of the matrix,
the pain and the ways managing the pain

1:25:58.541,1:26:00.916
and then trying to get rid of these

1:26:01.500,1:26:05.458
as if somehow if we worked hard enough,
we could get rid of them.

1:26:05.458,1:26:08.750
We can stay just in this spin.

1:26:09.541,1:26:13.208
So, so we’ve all been there
trying to get rid of these things

1:26:13.208,1:26:16.458
and we know what we’ve learned
can’t be unlearned.

1:26:17.041,1:26:19.625
And even if we could get rid
of all this stuff,

1:26:19.958,1:26:23.333
it still isn’t getting us over here
to the things that matter to us.

1:26:23.875,1:26:29.041
So where we’re really focusing
now is moving to this towards side where

1:26:29.333,1:26:34.125
we’re living a meaningful, purposeful
life, connecting with what matters to us.

1:26:34.125,1:26:38.291
So let’s move over to this toward
the inside world of yours

1:26:38.583,1:26:42.000
with who or what matters to you.

1:26:42.000,1:26:43.875
Well, I would say obviously

1:26:43.875,1:26:47.208
my family and my friends matter to me.

1:26:48.666,1:26:50.416
You know, my

1:26:50.500,1:26:54.250
colleagues and patients,
they were important as well.

1:26:54.250,1:26:54.958
Okay.

1:26:55.000,1:26:56.750
So that’s who matters to you.

1:26:56.750,1:26:58.833
How about what matters to you?

1:26:58.875,1:27:01.125
What are some of those values
that matter to you?

1:27:02.083,1:27:05.166
Well, again,
I really got into this profession to,

1:27:05.166,1:27:08.250
like, help reduce human suffering,
to make things better

1:27:08.250,1:27:13.333
for people,
to help them live healthier, better lives.

1:27:13.333,1:27:17.625
When we think about these values
and we move up to this towards outside

1:27:18.250,1:27:21.250
part of the matrix for looking at
what could you do

1:27:21.500,1:27:24.333
to live out these values
and care for these people.

1:27:24.666,1:27:29.291
And one of the things you said
you’re trying to do is change the system,

1:27:29.708,1:27:33.083
help the system be more responsive, help
the system take care of health care

1:27:33.125,1:27:34.583
workers, patients.

1:27:34.583,1:27:37.458
And you tried that
strategy, it sounds like,

1:27:38.666,1:27:41.416
to to the end degree.

1:27:41.833,1:27:44.125
So that matters.

1:27:44.166,1:27:45.375
That matters.

1:27:45.375,1:27:49.250
And we’re also trying
to find other things up here

1:27:49.875,1:27:51.458
that would help you live out these values.

1:27:51.458,1:27:54.750
So when you think about these people
and these things that matter to you,

1:27:54.791,1:27:59.375
what else could you do to live out
the inside towards quadrant?

1:28:00.250,1:28:03.000
Well, I mean,
I guess I could definitely spend more time

1:28:03.000,1:28:07.000
with friends and family
and not be so grumpy around them.

1:28:07.583,1:28:09.666
Yeah, what else?

1:28:09.833,1:28:12.541
How about taking care of your colleagues
and patients?

1:28:13.291,1:28:16.416
Well, I mean,
I think it was probably really helpful

1:28:16.416,1:28:21.291
when we supported each other as colleagues
and just recognized how hard it was.

1:28:21.291,1:28:23.125
Often people who weren’t in the hospital

1:28:23.125,1:28:26.166
just really didn’t understand
what it was like to be there.

1:28:26.166,1:28:30.500
And so probably supporting each other
about how hard it was,

1:28:30.500,1:28:34.083
what an important thing to do. Right.

1:28:35.166,1:28:37.291
So lots of ways that you are

1:28:37.291,1:28:40.125
showing up with compassion
that really made a difference.

1:28:40.541,1:28:40.833
Yeah.

1:28:40.833,1:28:45.083
And similar probably for patients to write
that everybody was scared

1:28:45.083,1:28:47.583
and things were so uncertain.

1:28:48.583,1:28:49.958
Yeah, so comforting.

1:28:49.958,1:28:52.083
Patients. Yeah.

1:28:52.083,1:28:52.416
Okay.

1:28:52.416,1:28:56.125
So notice you actually have some options

1:28:56.125,1:28:59.500
here.

1:28:59.500,1:29:01.458
It was super frustrating

1:29:01.458,1:29:05.583
that you didn’t get the support you needed
from management, from the hospital

1:29:05.583,1:29:10.291
and understandably caused you pain
because you want to make things better.

1:29:10.375,1:29:14.500
You wanted people to have healthier lives
and you just noticed

1:29:15.208,1:29:18.458
there’s a lot of flexible ways
that you can express your values.

1:29:18.833,1:29:23.500
So we want a lot of different options
up here because we find ourselves

1:29:23.833,1:29:28.041
in contexts and external situations
that limit our options.

1:29:28.041,1:29:31.416
So resiliency on
this side is really having

1:29:31.833,1:29:35.000
quite a few ways
to show up towards what matters to you.

1:29:35.958,1:29:38.000
I want you to notice two Dr.

1:29:38.000,1:29:41.791
Dayna down here, these things
that matter to you are the very things

1:29:42.541,1:29:44.625
that are connected to your pain.

1:29:44.625,1:29:48.250
So looking at anger, frustration
helpless, hopeless

1:29:48.250,1:29:52.791
because you cared about patients
and your colleagues, memories of people

1:29:52.791,1:29:55.583
being harmed because you want them
to be healthy and feel better.

1:29:56.666,1:30:00.541
And this is not fair because you want
things to be fair for these people.

1:30:01.041,1:30:05.416
So your pain is directly connected
to these values

1:30:05.958,1:30:10.416
and then that way risk and resiliency
are two sides of the same coin.

1:30:10.958,1:30:13.333
We hurt because we care.

1:30:13.541,1:30:16.958
So when you look at this whole matrix,
what’s it like to?

1:30:16.958,1:30:19.500
Notice with kindness and curiosity?

1:30:19.500,1:30:19.833
Yeah, it’s

1:30:19.833,1:30:24.625
actually it’s pretty clarifying too,
to see it like written out all that way.

1:30:24.625,1:30:27.958
And I can see that I was getting stuck,

1:30:28.208,1:30:31.541
you know, in
just one way of trying to do things.

1:30:31.541,1:30:32.708
And that maybe there are

1:30:32.708,1:30:37.416
some other things that I could do
that are still important and helpful.

1:30:38.708,1:30:41.583
Yes. And
here’s what’s important to notice.

1:30:41.583,1:30:44.583
We we don’t get to get rid of the away
side or side.

1:30:45.291,1:30:49.000
The uncertainty
the pain of life is is there for good.

1:30:49.833,1:30:54.625
And yet we do get to focus on continuing
to move towards a meaningful life.

1:30:54.625,1:30:59.541
Even with that, even with the ways
that we’re managing that pain.

1:30:59.708,1:31:02.083
So today you noticed

1:31:02.708,1:31:05.291
different ways to move to the towards side

1:31:05.791,1:31:10.541
and how we are resilient
even in the face of difficult situations.

1:31:11.291,1:31:16.000
So that was an example of how you can use
the matrix to understand what’s going on

1:31:16.000,1:31:19.958
for us and to take a new perspective
on how we can move forward.

1:31:20.583,1:31:21.458
As clinicians.

1:31:21.458,1:31:22.541
We use this all the time

1:31:22.541,1:31:26.250
to help our clients and patients,
but we also use this in our everyday life.

1:31:26.541,1:31:30.625
Whenever I’m feeling confused
or stuck or uncertain about how to behave,

1:31:30.625,1:31:32.500
I will take out a matrix and fill it out

1:31:32.500,1:31:36.000
to figure out what’s important to me
and how can I express that?

1:31:36.375,1:31:39.291
We can really see
how risk and resiliency are

1:31:39.875,1:31:44.750
part of two sides of the same coin
that we can get stuck on the away

1:31:44.750,1:31:47.791
side is part of the risk,
and it’s a normal human response.

1:31:48.041,1:31:52.041
And resiliency is figuring out ways
to make towards moves even when it’s hard.

1:31:53.583,1:31:54.791
Yeah, the Matrix has

1:31:54.791,1:31:58.583
me really listen to my pain
and find my values within my pain.

1:31:59.250,1:32:02.791
So when I am feeling angry, what

1:32:03.875,1:32:07.916
feels wrong to me that I could take
valued actions on when I’m sad?

1:32:07.916,1:32:11.166
What can I
what can I mourn that matters to me?

1:32:11.791,1:32:15.958
And if I’m scared,
what can I protect that I care about?

1:32:16.541,1:32:18.708
If I’m guilty, what can I repair?

1:32:18.708,1:32:23.375
So my pain then informs my values
and my valued actions

1:32:23.708,1:32:26.875
instead of being something
I need to react to and fix.

1:32:27.833,1:32:31.041
So we always take the approach
that wellness

1:32:31.041,1:32:35.041
is a joint responsibility
between employees and employers.

1:32:35.041,1:32:39.875
So although we don’t have time in today’s
presentation, there is also a team matrix

1:32:39.875,1:32:43.583
or a pro-social matrix, which is about
how groups can work together

1:32:43.833,1:32:46.666
and find their shared purpose
or their values

1:32:46.666,1:32:49.833
and move towards or away
from that and understand that better.

1:32:50.125,1:32:54.916
And so we want to empower individuals
to do what they can to be.

1:32:54.916,1:32:58.416
Well, while we also recognize that systems
also need to change

1:32:58.416,1:33:06.708
to help the individuals
be well, incredible stuff.

1:33:06.708,1:33:09.291
Thank you so much to Dr.

1:33:09.416,1:33:10.958
Jaimie Lusk and Dr.

1:33:10.958,1:33:14.541
Dayna Lee-Baggley. And Dr.

1:33:14.541,1:33:19.541
Dayna is is joining us today,
along with Dr.

1:33:19.541,1:33:21.916
Suzette and Dr. Lorraine are back.

1:33:22.750,1:33:24.125
Thank you all so much.

1:33:25.500,1:33:27.541
You know,
talking about the problem is so important,

1:33:27.541,1:33:32.875
but providing the tools to address
those problems is crucial

1:33:33.125,1:33:37.000
if we’re going to change
personal and institutional behaviors.

1:33:37.000,1:33:40.250
And thank you, Doctor.

1:33:40.250,1:33:41.291
What was it like, Dr.

1:33:41.291,1:33:46.083
Dayna, to go through the Matrix yourself?

1:33:46.083,1:33:49.333
You gave so much of yourself,
and I don’t think that those answers

1:33:49.333,1:33:50.458
were made up.

1:33:50.458,1:33:53.541
Like I’m not thinking that. Yeah.

1:33:53.583,1:33:58.250
So I really do actually use the Matrix
all the time in my everyday life.

1:33:58.250,1:34:01.958
So going through the Matrix
was a really common thing for me,

1:34:02.250,1:34:05.166
but I think it really demonstrates
how we can do it.

1:34:05.166,1:34:09.166
We were really glad to have some real,
you know, lived experience to be able

1:34:09.166,1:34:12.416
to share with the audience
and how we could use the Matrix

1:34:12.416,1:34:13.625
with that lived experience.

1:34:13.625,1:34:19.250
And so I think it’s a great example
with them, you know, real data

1:34:19.250,1:34:22.958
as to how you can make use of it
to handle the experiences of

1:34:23.625,1:34:25.375
frontline workers during a pandemic.

1:34:25.375,1:34:26.958
And hospital workers in general

1:34:28.166,1:34:29.875
are sure.

1:34:29.875,1:34:33.000
I want to just remind folks that the Q&A

1:34:34.333,1:34:37.333
box is open to you if you have questions

1:34:37.333,1:34:40.000
for the university of Alberta team here,

1:34:41.250,1:34:44.750
I’m happy to,

1:34:44.750,1:34:47.875
you know, express those questions for you
right here.

1:34:48.625,1:34:51.458
I do wonder about this.

1:34:51.458,1:34:54.583
There is a question that came up
about the group and team Matrix

1:34:54.583,1:34:58.375
that you did mention and how that works

1:34:58.375,1:35:00.458
and how can you just

1:35:02.916,1:35:05.791
either anyone of you can
can you tell me just a little bit

1:35:05.791,1:35:09.041
about how the team Matrix

1:35:09.041,1:35:12.500
would be applied in health care settings?

1:35:12.500,1:35:14.708
It how it might work?

1:35:15.041,1:35:17.583
So we visited in a number
of our interventions

1:35:17.583,1:35:21.250
with health care workers
and it’s really four kind of group.

1:35:21.250,1:35:22.708
So it could be a unit,

1:35:22.708,1:35:26.375
it could be a department,
it could be two people working together.

1:35:26.708,1:35:31.125
And what it allows groups of people to do
is to focus the conversation on values,

1:35:31.125,1:35:35.208
which in the group setting
we refer to as shared purpose in groups.

1:35:35.208,1:35:38.166
We, you know, and in work settings,
there is a shared purpose

1:35:38.166,1:35:40.291
that people are there
to do something together.

1:35:40.750,1:35:44.500
And so it allows us to have conversations
about shared purpose

1:35:44.500,1:35:49.208
and values instead of again,
like right, wrong, but bad, true, false.

1:35:49.750,1:35:52.250
We used it in work conflict

1:35:52.250,1:35:56.083
resolution to again change the perspective
instead of like who’s right

1:35:56.083,1:35:59.500
and who’s wrong in terms of
what’s going to move us towards.

1:35:59.500,1:36:03.000
In a way we use it in our diversity,
equity and inclusion

1:36:03.000,1:36:06.333
training to help people change
their behavior in their everyday lives.

1:36:06.333,1:36:10.500
Again, becoming more aware of the biases
that show up and choosing behaviors

1:36:10.500,1:36:13.250
that’s more consistent,
their values around inclusion.

1:36:13.833,1:36:16.416
So there’s a number of ways
that you can make use of it,

1:36:16.416,1:36:18.458
and it’s a really versatile tool.

1:36:18.458,1:36:20.625
Again, it’s really meaningful to us.

1:36:20.916,1:36:24.333
In addition to empowering individuals
is to help change the systems.

1:36:24.333,1:36:30.000
We know that the systems are also
contributing to burnout, contributing

1:36:30.041,1:36:34.125
to moral injury, and so we don’t want to
just rely on the individual changing.

1:36:34.125,1:36:36.125
We also want to help the system change.

1:36:36.125,1:36:39.458
And so we’ve made use of that tool,
for example, in leadership training,

1:36:39.458,1:36:41.708
which is one way that you change
the system is by helping

1:36:41.708,1:36:46.083
leaders have better skills
to manage people and to make decisions.

1:36:46.291,1:36:51.583
And so there’s a number of ways
that we’ve made use of it in teams.

1:36:51.583,1:36:58.166
Oh, you’re on meet.

1:36:58.166,1:37:00.208
It’s like I’m brand new at this.

1:37:00.750,1:37:02.458
I’m really not.

1:37:02.458,1:37:04.500
Can you just tell me
how it’s been received then?

1:37:04.500,1:37:09.083
In those in those settings you say that
it’s been that The Matrix has been applied

1:37:09.083,1:37:11.375
to so many different

1:37:12.166,1:37:16.333
scenarios and, and groups
how has it been received?

1:37:16.333,1:37:21.833
Has has there been uptake in the
in the way I know that you and Dr.

1:37:21.833,1:37:25.000
Jaimie have used use it in your own lives.

1:37:25.000,1:37:26.583
Tell me a little bit more about the uptake

1:37:27.875,1:37:29.458
and how it’s received.

1:37:29.458,1:37:31.958
Yeah. So I think it’s been very favorable.

1:37:31.958,1:37:36.458
We did a study on burnout
during the pandemic and again

1:37:36.458,1:37:39.666
we decided that we
we got grant funding to look at

1:37:40.750,1:37:44.416
burnout in frontline workers and we chose
to do a leadership training of,

1:37:44.666,1:37:48.083
you know, an employee training to again,
try to address some system level problems.

1:37:48.083,1:37:52.041
And that was the structure
of all of the intervention

1:37:52.041,1:37:54.791
was using the matrix
to help change behaviors of leaders.

1:37:54.791,1:37:57.458
And so it’s been really,
really well-received.

1:37:57.708,1:38:01.291
One of the things the Matrix does
is actually create psychological safety.

1:38:01.291,1:38:03.125
And so that’s sort of been mentioned

1:38:03.125,1:38:07.083
in some of the earlier talks as well
about lacking psychological safety.

1:38:07.083,1:38:11.625
And it’s actually a tool that teams
can use that builds psychological safety

1:38:11.625,1:38:12.708
because it allows people

1:38:12.708,1:38:16.250
to have conversation
about difficult topics in a safer way.

1:38:16.541,1:38:17.916
So we don’t have to point out

1:38:17.916,1:38:21.458
like, well, you did this or you did that
or this was bad or you shouldn’t do that.

1:38:21.708,1:38:23.291
We can simply say kind of that

1:38:23.291,1:38:26.291
felt like a towards move for me
or that felt like an away move for me.

1:38:26.500,1:38:30.333
And sometimes, you know,
people are trying to do towards moves

1:38:30.333,1:38:34.791
and they’re interpreted as a way moves
and so it gives a team a language that you

1:38:34.791,1:38:39.458
that is really more compassionate and
more flexible and more curious and open

1:38:39.833,1:38:43.833
and doesn’t have to get into like,
right, wrong true, false, good, bad.

1:38:44.541,1:38:47.083
Right.
And it started one of those earworms.

1:38:47.083,1:38:50.250
You know, once you hear towards in a way
like it’s hard to forget it.

1:38:51.083,1:38:53.000
Absolutely. Absolutely.

1:38:54.541,1:38:55.791
Dr. Lorraine and Dr.

1:38:55.791,1:39:01.708
Suzette, have you been applying the matrix
to your lives?

1:39:01.708,1:39:03.541
Yes, absolutely.

1:39:03.541,1:39:04.750
As Dr.

1:39:04.750,1:39:08.458
Dayna just said, it’s amazing how familiar
this idea

1:39:08.500,1:39:11.583
towards in a way becomes
and is documented.

1:39:11.583,1:39:14.250
I think it’s a really nice way
to sort of ask yourself,

1:39:15.833,1:39:18.333
why am I doing this behavior right?

1:39:18.333,1:39:21.500
And what does it mean to me
that I am doing this behavior?

1:39:22.000,1:39:25.708
And so for me personally,
that has been a great way to clarify

1:39:25.708,1:39:29.000
why am I doing certain things
and really to be able to look and say,

1:39:29.000,1:39:30.250
is this towards

1:39:30.250,1:39:33.958
what I care about, as Suzette said,
is this something that’s meaningful to me?

1:39:34.166,1:39:36.875
Does it move me
in the way that I want to move in my life,

1:39:37.250,1:39:41.958
or is it really taking me away from that,
even if it’s a short term experience?

1:39:41.958,1:39:45.791
So it really has helped me
to to really clarify

1:39:45.833,1:39:50.166
that meaning and purpose in my life
in really small ways, really tiny things

1:39:50.166,1:39:54.250
that I’ll ask myself, like, you know, work
decisions or personal decisions.

1:39:54.250,1:39:56.791
So yeah, definitely I’ve used it

1:39:57.833,1:39:58.250
and I

1:39:58.250,1:40:01.125
would just do, I would just echo
that if I could.

1:40:01.375,1:40:03.041
Yeah, yeah.

1:40:03.041,1:40:04.875
Of just being empowering.

1:40:04.875,1:40:08.750
So a tool that I use as well in terms
of making those choices.

1:40:08.750,1:40:11.166
So looking, do I go this way
or do I go that way?

1:40:11.166,1:40:13.125
It’s, it’s within my control.

1:40:13.125,1:40:16.750
And so giving people reminding people,
reminding me of my choice.

1:40:16.750,1:40:19.208
And so I find the tool very empowering.

1:40:19.208,1:40:23.458
Also, it challenges me to be more aware,

1:40:23.583,1:40:29.041
more self aware, and more collectively
aware of what choices we’re taking.

1:40:29.041,1:40:32.041
I choose to look at something,
what other options I have.

1:40:32.041,1:40:36.500
So for me it’s an awareness tool as well
as a choice tool and a team building.

1:40:36.500,1:40:37.083
And it’s Dr.

1:40:37.083,1:40:41.250
Dayna mentioned as, well,
a way for people to have a safe way

1:40:41.583,1:40:45.416
to not look at blacks and whites
or or blaming or otherwise,

1:40:45.416,1:40:49.416
but to really have an open mind about
seeing things in a broader perspective.

1:40:49.416,1:40:52.041
So empowering choice breadth

1:40:52.750,1:40:57.083
about me and about weight
and really keeping that focus on two sides

1:40:57.083,1:40:59.125
of the same coin
and looking at where those

1:40:59.500,1:41:02.416
where those pains are,
also the things that truly matter.

1:41:02.708,1:41:05.791
And how if I root into those,
I can be more resilient

1:41:06.416,1:41:08.666
in even the most difficult
of circumstance says.

1:41:09.125,1:41:11.750
So I think for me it’s
something it’s a lens through which

1:41:11.750,1:41:16.125
I look all the time
to be able to make the choices that I do.

1:41:16.125,1:41:20.291
So rather than a tool for me
it’s a way of life and a lens through

1:41:20.291,1:41:23.375
which I look at every moment
of every life about Do

1:41:23.375,1:41:26.791
I choose to move this way or that way? I’m

1:41:27.750,1:41:29.333
amazing.

1:41:29.375,1:41:34.250
I feel like The Matrix is something
that I’m going to take back to all of,

1:41:34.458,1:41:38.625
you know, my own teammates and my own life

1:41:38.625,1:41:42.250
and put it on the fridge
and all of you here where

1:41:43.500,1:41:46.041
it really is.

1:41:46.041,1:41:48.750
You know,
one thing that I find really fascinating

1:41:48.750,1:41:51.958
is the idea that The Matrix helps

1:41:51.958,1:41:54.750
to clarify your values

1:41:55.125,1:41:59.250
and and how values link with resilience.

1:41:59.250,1:41:59.791
So I’m wondering,

1:41:59.791,1:42:02.958
you just unpack that just again,
just a little bit more so that we can be

1:42:03.375,1:42:06.750
left with a clarity
in, in that how the values

1:42:09.250,1:42:11.416
are linked with resilience

1:42:11.416,1:42:16.416
and then how you can get to that
through the matrix DOT data.

1:42:16.416,1:42:19.208
So one of the great parts about the Matrix
is it is an evidence

1:42:19.208,1:42:23.000
based tool and it’s built on, you know, a
well-supported intervention known

1:42:23.000,1:42:26.208
as acceptance and commitment therapy
that’s been shown to address

1:42:26.208,1:42:29.208
that number of conditions
from things like depression and anxiety.

1:42:29.708,1:42:32.083
Our team used it for moral injury,

1:42:32.541,1:42:35.250
but also even things
like OCD and psychosis.

1:42:35.541,1:42:38.250
And then things like procrastination
and parenting.

1:42:38.500,1:42:41.916
And so it’s a very versatile therapy,
but well-established

1:42:42.291,1:42:43.416
that we know that it works.

1:42:43.416,1:42:46.166
And so values
as part of that model of therapy

1:42:46.416,1:42:50.125
and values has a very kind of specific
meaning in, in the therapy

1:42:50.125,1:42:53.250
is that it’s about
how you want to show up as a person.

1:42:53.583,1:42:56.291
And that’s really important
because it’s not sort of like,

1:42:56.291,1:42:58.375
what do I want to get out of life?

1:42:58.375,1:43:00.458
But it’s like,
what do I want to contribute to life?

1:43:00.458,1:43:02.041
How do I want to care about people?

1:43:02.041,1:43:03.750
How do I want to show up?

1:43:03.750,1:43:05.708
And that’s a much different thing
to think about

1:43:05.708,1:43:09.083
because then it’s about your own behavior
and you have much more control over that

1:43:09.333,1:43:12.875
than the environment or,
you know, the way the world is responding.

1:43:13.500,1:43:16.166
And so, you know, for example, sometimes,

1:43:16.166,1:43:19.291
you know, there was people who would say
freedom is a value.

1:43:19.291,1:43:22.333
And the question was, well,
what would you do with more freedom?

1:43:22.458,1:43:22.791
Right?

1:43:22.791,1:43:25.458
Because the values part is
how would you show up

1:43:25.791,1:43:28.916
if that’s important to you, how would
what would you do more of or less of

1:43:29.125,1:43:29.916
if you have that?

1:43:29.916,1:43:32.291
That’s
how we kind of talk about the values.

1:43:32.916,1:43:35.416
And so there’s a, you know, Dr.

1:43:35.416,1:43:37.750
Jaimie did a great example of that.

1:43:37.750,1:43:40.791
There’s this expression about where
there is pain, you’ll find your values.

1:43:40.958,1:43:43.750
And so that’s it’s
the two sides of the same coin

1:43:44.000,1:43:48.333
that when something is really painful,
it also tells you what’s important to you.

1:43:48.333,1:43:50.250
And it can give you clues

1:43:50.250,1:43:53.250
about, you know, what matters to you
and how you want to show up.

1:43:53.500,1:43:57.333
And then there’s the secret sauce is
then we want to find flexible

1:43:57.333,1:43:59.083
ways of expressing that. We often get

1:44:00.083,1:44:01.833
into very narrow definitions

1:44:01.833,1:44:05.166
of like, this is how I have to show up
to express value.

1:44:05.166,1:44:08.666
But we’re trying to find lots
of different ways to express our values.

1:44:08.666,1:44:12.541
And that, I think, is really important
in this world that this like

1:44:12.750,1:44:15.666
post-pandemic world
that is way more uncertain.

1:44:15.666,1:44:20.791
And there is a lot of things that are less
predictable than they were beforehand.

1:44:20.791,1:44:23.625
And so having that
psychological flexibility to show up

1:44:23.875,1:44:26.416
in a variety of different ways
to express your values

1:44:27.000,1:44:30.500
then gives us a lot of ways
to move forward in a meaningful way.

1:44:31.708,1:44:36.250
Yes. Thank you very much for this.

1:44:36.250,1:44:38.416
This has been

1:44:38.791,1:44:40.416
such a

1:44:41.750,1:44:43.958
paradigm shifting in your head.

1:44:43.958,1:44:45.958
You know that these shifts, something

1:44:46.958,1:44:51.250
this just this
the matrix is is really quite fascinating.

1:44:51.250,1:44:52.500
If anyone

1:44:52.500,1:44:56.916
wants to take a look at the template,
you can look at the chart right now.

1:44:57.125,1:44:58.958
There’s a French version.

1:44:58.958,1:45:01.291
It’s also in other languages.

1:45:01.291,1:45:03.750
There’s an English version
here in the chat.

1:45:04.416,1:45:07.041
You’ll see that
and you can just copy and paste that.

1:45:07.791,1:45:12.750
There’s also a question here about a link
to, the group and Team Matrix,

1:45:13.125,1:45:16.625
which we I’m sure
that we can provide as well.

1:45:17.250,1:45:18.625
But I want to thank Dr.

1:45:18.625,1:45:21.583
Suzette Brémault-Phillips, Dr.

1:45:21.583,1:45:23.833
Lorraine Smith-MacDonald, Dr.

1:45:24.125,1:45:28.000
Dayna Lee-Baggley and Dr.

1:45:28.000,1:45:30.250
Jaimie Lusk, who is not with us right.

1:45:30.250,1:45:31.791
But this has been fascinating.

1:45:31.791,1:45:37.583
Thank you so very much
for being part of the symposium day.

1:45:37.583,1:45:38.833
Thank you so much.

1:45:38.833,1:45:41.500
Thanks for the opportunity. Thanks, Dayna.

1:45:41.500,1:45:45.458
Thanks, Lorraine. So

1:45:47.333,1:45:50.291
the University of Alberta
doing some really incredible things.

1:45:50.291,1:45:53.166
I love it.

1:45:53.166,1:45:56.000
Now, if you can believe it, we have come

1:45:56.458,1:45:59.416
to the end of symposium today.

1:45:59.708,1:46:01.000
I want to

1:46:02.500,1:46:05.250
invite again actually, I want to

1:46:06.541,1:46:10.791
thank everyone
who has been a part of this today

1:46:10.791,1:46:13.708
for taking the time and being so generous

1:46:14.708,1:46:17.625
and and open.

1:46:17.625,1:46:20.333
Those health care professionals
and the audience

1:46:20.625,1:46:24.291
who took the time to take part
and be in the symposium.

1:46:24.583,1:46:27.833
I know those that were that were speaking.

1:46:27.833,1:46:31.750
It takes a great deal of courage
to share your experience.

1:46:31.750,1:46:36.916
And then those in the research fields
that marry all that experience

1:46:36.916,1:46:40.833
with the depth and breadth of research
and offer up tools like.

1:46:40.833,1:46:42.166
The Matrix

1:46:43.166,1:46:45.541
I know that the work that you’re doing is

1:46:45.541,1:46:49.750
is just so difficult,
but so important, though.

1:46:49.750,1:46:50.875
Thank you.

1:46:50.875,1:46:53.250
I now I’d like to welcome back Dr.

1:46:53.250,1:46:56.833
Margaret MacKinnon for a short debrief on

1:46:57.708,1:47:00.791
on everything that we’ve heard today.

1:47:00.791,1:47:03.583
We’re just pouring in with
thanks for all of the

1:47:04.083,1:47:07.583
all of the
the panelists and for the symposium.

1:47:08.708,1:47:09.833
Dr. MacKinnon.

1:47:09.833,1:47:11.166
Margaret,

1:47:12.000,1:47:13.583
this has just been great.

1:47:13.583,1:47:18.458
I mean, can you I know that you’re
intimately familiar with the research

1:47:18.458,1:47:23.125
and the tools that were presented today,
and you’ve heard so many stories.

1:47:23.458,1:47:26.500
What has today’s symposium taught you

1:47:26.708,1:47:29.375
about risk and resilience

1:47:30.708,1:47:31.541
So much?

1:47:31.541,1:47:36.125
And I just want to echo your words and
thanking everyone who contributed today.

1:47:36.500,1:47:39.375
It is not easy to tell these stories.

1:47:39.375,1:47:41.541
It’s hard to listen to them.

1:47:41.541,1:47:44.041
But I think what I learned
and was reminded of again today is

1:47:44.041,1:47:46.208
that we’re not alone in this.

1:47:47.125,1:47:50.166
You know, in speaking to health
care workers often hear people say it’s

1:47:50.416,1:47:52.000
I feel so alone.

1:47:52.000,1:47:53.583
I don’t think other people necessarily

1:47:53.583,1:47:57.750
are having the same experiences
because we are having the same reactions.

1:47:57.750,1:48:01.666
And I think what reminded here
today, it’s a community that we share

1:48:02.000,1:48:06.583
and the work that we have to do together,
and that includes organizations,

1:48:06.875,1:48:10.875
individuals, members of government,
policymakers.

1:48:11.250,1:48:13.958
We’re in this together
to support one another.

1:48:14.291,1:48:17.375
And just being reminded
and knowing of these stories,

1:48:17.708,1:48:22.416
knowing the tools that can help us
and working together towards a common

1:48:22.416,1:48:25.416
purpose of supporting and strengthening

1:48:25.791,1:48:28.833
our health care worker community.

1:48:28.833,1:48:29.750
Absolutely.

1:48:31.291,1:48:34.666
If you want, wanted to have

1:48:35.791,1:48:38.250
folks in the audience walk away with.

1:48:38.250,1:48:41.541
You know, just one thing today.

1:48:41.875,1:48:45.458
I know there’s many that we spoke about,
and I know this is putting pressure on you

1:48:45.458,1:48:48.875
because maybe I didn’t tell you
that I was going to ask this question,

1:48:48.875,1:48:54.208
but what would that what would you want
folks to walk away from with today?

1:48:54.666,1:48:56.458
Yeah, I know.

1:48:57.000,1:48:59.166
I’ve worked
as a clinical psychologist in the past,

1:48:59.166,1:49:00.750
and I think
one of the most difficult things

1:49:00.750,1:49:04.750
when we face trauma is often
to reach out to others for support.

1:49:05.583,1:49:08.041
You know, I’ve worked with patients
where even making a phone call

1:49:08.416,1:49:11.166
is painful, it’s difficult, it’s hard.

1:49:11.500,1:49:13.375
And I think
certainly when we’re in situations

1:49:13.375,1:49:17.125
like this, we do have a tendency often
to turn inwards and.

1:49:17.125,1:49:21.000
What I want to encourage
people to do is turn to one another.

1:49:21.666,1:49:23.333
We’re here to support each other.

1:49:23.333,1:49:28.541
We have each other’s backs, are part of
a community that’s of service who serve.

1:49:28.875,1:49:32.208
And we want to thank you again,
all of you, for your service.

1:49:33.291,1:49:35.333
Thank you so much.

1:49:35.333,1:49:37.708
Now you’re going to see up on the screen

1:49:37.708,1:49:39.750
to follow us here.

1:49:40.958,1:49:43.708
Then, if you’d like to take a look
at the research,

1:49:43.708,1:49:45.875
there’s the website, social media.

1:49:46.208,1:49:47.416
It’s all up.

1:49:47.416,1:49:50.708
It’ll come up on the screen
and you can follow along

1:49:51.750,1:49:56.333
with the resources bbc.co.uk and to a FAQ

1:49:56.625,1:49:59.708
and all of the partners and sponsors.

1:49:59.708,1:50:03.750
Thank you to everyone
who has taken the time to be here today.

1:50:03.750,1:50:08.250
We hope that you are leaving here
with helpful takeaways.

1:50:09.541,1:50:13.000
If you want to leave
just one word in the chat

1:50:13.000,1:50:17.166
about how you are feeling about this
session, please do.

1:50:18.166,1:50:23.041
It’s always nice to see
how folks are feeling, but as I said,

1:50:23.375,1:50:27.666
please take a look at the resources
that here and you can go back

1:50:28.625,1:50:30.833
to this video at a later date.

1:50:31.291,1:50:33.125
Thank you again for joining.

1:50:33.125,1:50:36.208
Have a wonderful day and

1:50:37.208,1:50:51.833
thank you.

0:00:07.540,0:00:12.130
Hello everyone. Hi there. Thanks for making
it into this room. I know we had a little

0:00:12.130,0:00:17.150
bit of technical difficulties, but everyone
who made it, I’m so glad you’re here. My name

0:00:17.150,0:00:20.880
is Amy Van Es and I’ll be your host and moderator
for this session.

0:00:20.880,0:00:24.990
I’d like to begin by acknowledging the land
on which McMaster University is located, which

0:00:24.990,0:00:29.840
is the traditional territory of the Haudenosaunee
and Anishinaabe Nations, and within the lands

0:00:29.840,0:00:34.590
protected by the “Dish with One Spoon”
wampum belt. That wampum uses the symbolism

0:00:34.590,0:00:39.600
of a dish to represent the territory and one
spoon to represent that the people are to

0:00:39.600,0:00:43.559
share the resources of the land and only take
what they need.

0:00:43.559,0:00:47.700
We seek a new relationship with the original
peoples of this land, one based in honour

0:00:47.700,0:00:52.610
and deep respect. May we be guided by love
and right action as we transform our personal

0:00:52.610,0:00:57.360
and institutional relationships with our Indigenous
friends and neighbours.

0:00:57.360,0:01:01.899
It is in the same spirit that I welcome all
of you to our third of three town halls. Today’s

0:01:01.899,0:01:05.909
event is focused on self-care and self-compassion
for healthcare providers to cope with the

0:01:05.909,0:01:08.060
occupational stress during the pandemic.

0:01:08.060,0:01:12.369
This event is supported by the Public Health
Agency of Canada as part of their work to

0:01:12.369,0:01:17.130
address P T S D and trauma in those most affected
by COVID-19.

0:01:17.130,0:01:20.920
In this town hall, we may discuss healthcare
providers who have experienced challenges

0:01:20.920,0:01:25.200
in their work and home life during the pandemic.
There could be moments that are disturbing

0:01:25.200,0:01:29.460
to you, and it’s totally fine if you wish
to excuse yourself from this event at any

0:01:29.460,0:01:30.460
point.

0:01:30.460,0:01:34.130
Additionally, if you require wellness support,
there are a number of wonderful organizations

0:01:34.130,0:01:38.110
ready to help. You can learn more about each
from the links in the chat.

0:01:38.110,0:01:42.790
Over the past two and a half years, we’ve
heard so much about the strain on the healthcare

0:01:42.790,0:01:47.020
system and on healthcare providers due to
the pandemic, and we owe a debt of gratitude

0:01:47.020,0:01:52.540
to all the physicians, nurses, therapists,
personal support workers, and public safety

0:01:52.540,0:01:57.350
personnel who, despite facing incredible challenges
in their daily work lives, still found the

0:01:57.350,0:02:00.990
time and courage to talk to us and share their
experience.

0:02:00.990,0:02:05.049
This research project aims to shine a light
on the impact that the pandemic has had on

0:02:05.049,0:02:09.210
the mental health of all those healthcare
providers who have given so much of themselves

0:02:09.210,0:02:13.990
to the service of others and continue to do
so. The evidence-based resources and tools

0:02:13.990,0:02:19.140
we’re offering to help build mental health
literacy, support and resiliency are our health,

0:02:19.140,0:02:25.200
healthcare salute: our way of saying thank
you so much for your service.

0:02:25.200,0:02:28.590
One more thing. Before we get into the meat
and potatoes of today’s topic, I wanted to

0:02:28.590,0:02:31.950
let you know that there will be time for our
experts to answer your questions towards the

0:02:31.950,0:02:36.180
end of the hour. So to submit questions you
can use the q and a function that’s at the

0:02:36.180,0:02:39.670
bottom of your screen, and they’ll show up
on my end of things when it comes time for

0:02:39.670,0:02:41.170
the panel discussion.

0:02:41.170,0:02:45.459
We’ve also just posted a code of conduct in
the chat, so please, let’s all work together

0:02:45.459,0:02:49.450
to ensure this remains a safe space for sharing
and learning for everyone.

0:02:49.450,0:02:54.599
So to begin our program today, we’re going
to watch a pre-recorded presentation by Mauda

0:02:54.599,0:02:58.800
Karram, who will join us live today as well.
In the talk, she’ll be diving into some findings

0:02:58.800,0:03:03.080
from her recent research about self-care and
self-compassion for healthcare providers during

0:03:03.080,0:03:04.080
the pandemic.

0:03:04.080,0:03:08.950
Mauda is a clinical research assistant in
the Trauma and Recovery Research Unit at McMaster

0:03:08.950,0:03:14.409
University. She completed her undergraduate
degree at McMaster in the psychology, neuroscience

0:03:14.409,0:03:18.520
and behavior program with a mental health
specialization and a minor in theatre and

0:03:18.520,0:03:23.549
film studies. Currently, she’s the project
coordinator of this ongoing Canada-wide project

0:03:23.549,0:03:25.040
on moral injury.

0:03:25.040,0:03:29.050
Thank you so much Mauda, for sharing — or
for contributing to the conversation today.

0:03:29.050,0:03:33.370
And let’s take a peek at the recording.

0:03:33.370,0:03:34.370
​

0:03:34.370,0:03:37.670
Hello everyone. We’d like to thank you all
for being here today. My name is Mauda Karram,

0:03:37.670,0:03:43.500
and on behalf of the Trauma and Recovery Research
Unit at McMaster University, I’d like to share

0:03:43.500,0:03:48.200
some of our research findings with you on
healthcare providers, self-care and self-compassion

0:03:48.200,0:03:51.300
during the COVID-19 pandemic.

0:03:51.300,0:03:56.409
During the COVID-19 pandemic healthcare providers
have endured prolonged periods of heightened

0:03:56.409,0:04:02.629
stress as well as exposure to potentially
traumatic events. In times of distress, uncertainty,

0:04:02.629,0:04:08.450
[and] increased workloads, we want to know
how healthcare providers have cared for themselves

0:04:08.450,0:04:12.050
and their mental health during the COVID-19
pandemic.

0:04:12.050,0:04:17.660
We conducted a research study out of the Trauma
and Recovery Research Unit at McMaster University,

0:04:17.660,0:04:21.400
where we invited healthcare providers from
across Canada to share with us their experiences

0:04:21.400,0:04:27.919
during the COVID-19 pandemic. This study had
both an interview portion and a survey portion

0:04:27.919,0:04:32.200
where we collected myriad data, some of which
we’d like to share with you today.

0:04:32.200,0:04:37.720
Today we’re going to take a deeper look into
how healthcare providers have coped with stress

0:04:37.720,0:04:43.080
during the pandemic, and whether healthcare
providers have demonstrated self-compassion

0:04:43.080,0:04:46.639
towards themselves.

0:04:46.639,0:04:50.810
With the interview portion of our study, we
were able to hear firsthand the experiences

0:04:50.810,0:04:56.160
of healthcare providers during the COVID-19
pandemic. Healthcare providers were asked

0:04:56.160,0:05:01.210
a series of questions related to various mental
health challenges and impacts they’ve encountered.

0:05:01.210,0:05:06.730
Today, we hope to magnify the perspectives
of healthcare providers when asked the following

0:05:06.730,0:05:11.930
question: “Some people use various types
of coping strategies when they’re experiencing

0:05:11.930,0:05:17.830
stressful situations. Have you used any particular
strategies to help you cope?”

0:05:17.830,0:05:22.930
Here we have the data from 48 out of the 51
participants who provided demographic information.

0:05:22.930,0:05:28.560
As illustrated by the data here, participants
were mainly female respiratory therapists

0:05:28.560,0:05:35.139
residing in Ontario. Results from our study
revealed two overarching themes each with

0:05:35.139,0:05:36.490
two subthemes.

0:05:36.490,0:05:40.840
I’ll begin with our first theme here, shifting
approaches to coping.

0:05:40.840,0:05:48.600
So overall, from what we’ve heard from healthcare
providers, there seems to have been a constant

0:05:48.600,0:05:54.020
shift in how healthcare providers approach
their choices of coping strategies. As we

0:05:54.020,0:05:58.270
will talk about in the second theme, these
approaches were often influenced by changing

0:05:58.270,0:06:01.440
barriers and differing waves of the pandemic.

0:06:01.440,0:06:05.530
Ultimately, healthcare providers navigated
their way through coping with the challenges

0:06:05.530,0:06:10.590
they faced on a day-to-day basis, in an attempt
to find out what works best for them and their

0:06:10.590,0:06:11.690
own mental health.

0:06:11.690,0:06:16.580
in this quote, this healthcare provider had
initially turned to the use of alcohol as

0:06:16.580,0:06:22.810
a coping strategy, but decided to seek professional
advice and ultimately turn to meditation and

0:06:22.810,0:06:25.960
a useful sleep routine.

0:06:25.960,0:06:30.740
On the one hand, healthcare providers describe
this feeling of being able to make an intentional

0:06:30.740,0:06:35.889
effort to cope and improve their mental health
in a way that they perceive to be healthy,

0:06:35.889,0:06:41.130
positive, and effective in reducing stress,
both short term and long term.

0:06:41.130,0:06:47.180
This healthcare provider spoke about strategies
such as yoga, therapy and meditation, where

0:06:47.180,0:06:52.090
they describe them as methods for self care,
ultimately creating a positive impact on the

0:06:52.090,0:06:58.060
individual’s life where they describe these
behaviours they will carry on past the pandemic.

0:06:58.060,0:07:03.039
Towards the other side of these approaches
to decision making, some healthcare providers

0:07:03.039,0:07:08.229
sought out coping strategies that were lower
effort and easily accessible, often due to

0:07:08.229,0:07:13.400
the lack of bandwidth or capacity to make
an intentional effort. Importantly, healthcare

0:07:13.400,0:07:20.270
providers describe these strategies as negative
or unhealthy, yet continued to use them as

0:07:20.270,0:07:26.910
they still provided that desired result of
distraction, relaxation, numbing out physical

0:07:26.910,0:07:31.490
and emotional stress, and avoiding having
to process their emotions.

0:07:31.490,0:07:36.599
Examples from this quote here included alcohol
use and binge eating viewed as a temporary

0:07:36.599,0:07:41.300
solution, ultimately creating these feelings
of guilt.

0:07:41.300,0:07:47.220
Onto the second overarching theme from the
experiences shared by healthcare providers,

0:07:47.220,0:07:52.090
many described a range of barriers that impeded
upon their usual ways of coping to manage

0:07:52.090,0:07:54.050
work-related stress.

0:07:54.050,0:08:00.319
First, we have pandemic-related restrictions
where healthcare providers reported an inability

0:08:00.319,0:08:05.380
to access their usual or desired coping strategies
due to government-level policies that were

0:08:05.380,0:08:10.389
put in place that apply to everybody. This
included various closures and limits on social

0:08:10.389,0:08:13.500
gatherings, as illustrated by these quotes.

0:08:13.500,0:08:19.860
Healthcare providers would describe these
strategies as being not allowed or that they

0:08:19.860,0:08:21.949
can’t do what they normally would do to support
their mental health.

0:08:21.949,0:08:28.979
And then we have these circumstantial barriers
where various circumstances of the individual

0:08:28.979,0:08:33.830
influence their ability to engage coping strategies
to reduce stress. These circumstances were

0:08:33.830,0:08:40.550
specific to the healthcare provider and their
own individual experiences, and included various

0:08:40.550,0:08:47.649
barriers such as seasonal changes, exhaustion,
lack of motivation, and a key aspect of perceived

0:08:47.649,0:08:49.459
impacts on family and friend relationships.

0:08:49.459,0:08:54.640
Here, there were a few factors at play where
healthcare providers described that they would

0:08:54.640,0:08:59.460
refrain from seeking social support from family
and friends as they were fearful of traumatizing

0:08:59.460,0:09:05.480
them with their experiences, feeling like
a burden to their loved ones, that their loved

0:09:05.480,0:09:10.380
ones wouldn’t truly understand, and that oftentimes
they wouldn’t want to engage in conversations

0:09:10.380,0:09:13.870
about political views on vaccines and masks.

0:09:13.870,0:09:21.000
So now we’d like to turn our attention to
the topic of self-compassion, what it means

0:09:21.000,0:09:26.300
to be self-compassionate, and how we can measure
self-compassion in individuals.

0:09:26.300,0:09:32.579
Self-compassion is demonstrated through behaviours
and thoughts one has towards themselves.

0:09:32.579,0:09:38.690
It is when one is open and moved by their
own suffering, caring, kind, understanding,

0:09:38.690,0:09:44.170
and non-judgemental to themselves and their
inadequacies, and recognize their own experiences

0:09:44.170,0:09:46.980
as part of the common human experience.

0:09:46.980,0:09:52.209
So by looking at self-compassionate behaviors,
we can understand one’s responses to pain

0:09:52.209,0:10:00.320
and failure, one’s predicament, and how one
pays attention to their own suffering.

0:10:00.320,0:10:04.680
Here we have some quotes from healthcare providers
in our study where they’ve touched on various

0:10:04.680,0:10:10.310
aspects of self-compassion in ways in which
we will discuss shortly. As highlighted In

0:10:10.310,0:10:15.339
blue, we see phrases such as “We’re all
going through the same thing”; “It’s

0:10:15.339,0:10:19.890
hard to ask for help when you feel that maybe
someone else or there are other people that

0:10:19.890,0:10:24.920
are more deserving of the help”; “I
try to have compassion about the situation”;

0:10:24.920,0:10:28.930
and words such as “permission” and
“guilt.”

0:10:28.930,0:10:35.490
There are essentially two ends to each measure
of self-compassion, according to Kristin Neff,

0:10:35.490,0:10:40.180
whom is an expert in the field of compassion
and self-compassion.

0:10:40.180,0:10:44.920
Here we have a positive poll where behaviors
are compassionate and a negative poll where

0:10:44.920,0:10:46.230
behaviors are unpassionate.

0:10:46.230,0:10:53.010
In this first column, we have self-kindness
and self-judgment. Self kindness refers to

0:10:53.010,0:10:58.960
the gentle and understanding attitude towards
oneself and expressing unconditional acceptance

0:10:58.960,0:11:04.840
towards oneself. Self-judgment on the other
hand, refers to the harsh judgment of oneself

0:11:04.840,0:11:11.550
for shortcomings. In the second column, common
humanity speaks to the notion that all humans

0:11:11.550,0:11:16.569
fail or make mistakes, and no one person can
lead a perfect life.

0:11:16.569,0:11:21.180
On the other hand, isolation is when one feels
isolated by their imperfections, as if they

0:11:21.180,0:11:24.649
are the only one who failed or is suffering.

0:11:24.649,0:11:30.070
In the final column, mindfulness is being
aware of one’s suffering experience in the

0:11:30.070,0:11:36.620
moment and seeing it with clarity, on the
other hand, over-identified as having an exaggerated

0:11:36.620,0:11:40.529
storyline of the negative aspects of self.

0:11:40.529,0:11:45.240
Today we’d like to share the results from
this self-compassion questionnaire from healthcare

0:11:45.240,0:11:49.300
providers across Canada who participated in
the survey.

0:11:49.300,0:11:56.460
So 426 participants completed the self-compassion
scale In the survey portion of our study.

0:11:56.460,0:12:01.510
Of note, participants were mainly female nurses
residing in Ontario.

0:12:01.510,0:12:07.320
So healthcare providers scored similarly on
scales aimed to measure self-compassion as

0:12:07.320,0:12:13.480
scales aimed to measure negative self-compassion,
and this was similar across all professions.

0:12:13.480,0:12:19.149
The overall results indicate moderate levels
of self-compassion.

0:12:19.149,0:12:26.130
Further, looking at how self-compassion scores
compared with other measures in our study,

0:12:26.130,0:12:31.860
preliminary findings reveal a potential relationship
between self-compassion and resiliency and

0:12:31.860,0:12:38.810
self-compassion and emotion regulation. Specifically,
data show a significant positive correlation

0:12:38.810,0:12:44.209
between self-compassion and resiliency. So
here where participants scored higher on self-compassion,

0:12:44.209,0:12:46.570
they also scored higher on resiliency.

0:12:46.570,0:12:53.329
Also, data showed a significant negative correlation
between self-compassion and difficulties in

0:12:53.329,0:12:59.110
emotion regulation, where participants who
scored higher on self-compassion scale also

0:12:59.110,0:13:03.930
scored lower on the difficulties in emotion
regulation scale.

0:13:03.930,0:13:11.270
So overall and in summary today, healthcare
providers have struggled to engage in usual

0:13:11.270,0:13:17.120
coping strategies due to various COVID-19–related
barriers, and we saw here that healthcare

0:13:17.120,0:13:21.730
providers fluctuated between an intentional
effort and a quick-fix decision influenced

0:13:21.730,0:13:28.010
by various factors including closures, circumstantial
barriers, and differing weights of the pandemic.

0:13:28.010,0:13:33.490
So we see here that there is an urgent need
to develop supports and resources for healthcare

0:13:33.490,0:13:38.709
providers to cope with occupational stress
and the unique psychological burden of the

0:13:38.709,0:13:44.650
COVID-19 pandemic to improve mental health
outcomes. And we also saw what these moderate

0:13:44.650,0:13:48.790
self-compassion scores, that they point to
the necessity to understand how we can support

0:13:48.790,0:13:53.649
healthcare providers by not only providing
coping tools, but addressing various factors

0:13:53.649,0:13:57.930
impacting mental health and the ability to
seek coping strategies.

0:13:57.930,0:14:02.120
Thank you all so much for being here today
and allowing me to share with you some of

0:14:02.120,0:14:09.130
our important findings from our research.
These were our references for today,

0:14:09.130,0:14:16.370
and we’d like to also thank our collaborators
and supporters.

0:14:16.370,0:14:17.370
​

0:14:17.370,0:14:20.240
Thank you so much for sharing your research.
Mauda. You know, it’s clear that there’s a

0:14:20.240,0:14:24.930
real need for resources to be developed to
help health healthcare providers who have

0:14:24.930,0:14:30.490
just like given, given, and given once more
to cope with their work during the pandemic.

0:14:30.490,0:14:37.190
So let’s develop some ideas right here. I’d
like to invite a few more people to the table

0:14:37.190,0:14:42.079
to continue this discussion and get into the
nitty gritty of how to integrate self-compassion

0:14:42.079,0:14:43.350
into our lives.

0:14:43.350,0:14:49.970
So welcome to this digital room, Kim Ritchie,
Hugo Schielke, Margaret McKinnon, and Mauda

0:14:49.970,0:14:54.880
Karram. I see you all coming in.

0:14:54.880,0:15:01.149
Ah, hello. Hi folks. Okay, so we’ve already
met Mauda, but for the rest of you, I was

0:15:01.149,0:15:04.589
hoping you could each take a moment to introduce
yourselves and tell us a bit about your role

0:15:04.589,0:15:08.500
as it relates to our topic today. Margaret,
do you mind if we start with you?

0:15:08.500,0:15:11.510
Thank you so much Amy. So my name is Margaret
McKinnon.

0:15:11.510,0:15:14.620
I’m the Homewood chair in mental health and
trauma, and I’m also a professor in the Department

0:15:14.620,0:15:21.649
of Psychiatry and Behavioural Neurosciences
at McMaster. My trade, as we say in the military

0:15:21.649,0:15:25.520
work we do, is I’m a clinical psychologist
and clinical neuropsychologist. And I have

0:15:25.520,0:15:29.570
had the privilege of serving on the front
lines of the pandemic, so spending times,

0:15:29.570,0:15:36.990
time rather, in the hospitals providing supports
to staff on COVID units and ICU units.

0:15:36.990,0:15:39.459
Thank you, Margaret. And what about you, Hugo?

0:15:39.459,0:15:43.430
Hello everyone. My name is Hugo Schielke.
I’m the trauma services development lead for

0:15:43.430,0:15:47.899
Homewood Health. Also a clinical psychologist
specialized in helping people with trauma

0:15:47.899,0:15:55.610
dissociative disorders. And I guess my relationship
to this topic is that without self-compassion,

0:15:55.610,0:15:58.790
you really aren’t able to allow yourself to
give yourself the care you need.

0:15:58.790,0:16:02.449
And so that, that’s what we’ll be talking
about today.

0:16:02.449,0:16:04.779
Thank you, Hugo. And Kim, would you like to
introduce yourself?

0:16:04.779,0:16:10.790
Hi everyone. My name’s Kim Ritchie and I’m
an assistant professor at Trent University,

0:16:10.790,0:16:15.959
and I also hold an adjunct position in at
McMaster University in the Department of Psychiatry

0:16:15.959,0:16:17.170
and Behavioural Neurosciences.

0:16:17.170,0:16:24.399
With this lab, I’m also — my background
is I’m a registered nurse, and primarily in

0:16:24.399,0:16:26.040
mental health.

0:16:26.040,0:16:32.630
Thank you Kim, and welcome everyone again.
Do Hugo, I’d love to start with you, and I’d

0:16:32.630,0:16:38.050
really love to start by grounding us, all
in this room, in a shared understanding of

0:16:38.050,0:16:39.769
the topic we’re going to talk about today.

0:16:39.769,0:16:45.300
So my big question, and I think probably a
question for the audience is, is there a difference

0:16:45.300,0:16:47.790
between self-compassion and self-care?

0:16:47.790,0:16:56.250
That is such a good question. And the short
answer is yes. The longer answer is that,

0:16:56.250,0:17:03.040
again, I guess in some ways I already spoke
to this, that it is very, very, very difficult

0:17:03.040,0:17:10.799
to give yourself the care you need if you
aren’t being fair and gentle and kind and

0:17:10.799,0:17:11.799
compassionate with yourself.

0:17:11.799,0:17:15.669
And so each of those words is different ways
of saying compassionate, right? So being fair

0:17:15.669,0:17:19.900
is another way of being compassionate, right?
So making sure you’re not judging yourself

0:17:19.900,0:17:24.650
overly harshly, which is what we tend to do
in this culture and these cultures. We’ve

0:17:24.650,0:17:28.319
learned that to make changes, we need to judge
ourselves harshly when in fact the opposite

0:17:28.319,0:17:31.130
is true when you look at the research.

0:17:31.130,0:17:35.350
And so lots more I can say about this, but
the short answer to your question is, yes,

0:17:35.350,0:17:42.120
so self-care is giving yourself the care you
need, and what allows us to do that is to

0:17:42.120,0:17:46.010
relate to ourselves in a compassionate way,
right? To be gentle with ourselves, to be

0:17:46.010,0:17:49.140
interested in what’s going on, to validate
what’s valid, and have an easy manner with

0:17:49.140,0:17:52.830
ourselves and encouraging ourselves to give
ourselves that care when we need it.

0:17:52.830,0:17:59.080
Okay. Wonderful. So self-compassion, the compassion
is like the feeling and the desire to treat

0:17:59.080,0:18:02.049
yourself, and the self-care are the actions
that you take. Would that be right?

0:18:02.049,0:18:03.049
Yeah.

0:18:03.049,0:18:04.049
Okay, great, thank you.

0:18:04.049,0:18:07.270
We think of it as like the how and the what,
right? So self-compassion is how you relate

0:18:07.270,0:18:10.770
yourself, and then self-care is what you do
to take care of yourself.

0:18:10.770,0:18:13.659
Excellent, excellent. Okay. Thank you.

0:18:13.659,0:18:17.620
Mauda, I’d love to know — thank you so much
again for sharing your research — I’d love

0:18:17.620,0:18:22.100
to know what the most sort of surprising or
insightful outcome of that research was for

0:18:22.100,0:18:23.100
you.

0:18:23.100,0:18:28.860
Yeah. Thank you, Amy. I think, you know, ultimately
having the privilege of listening to healthcare

0:18:28.860,0:18:32.970
providers experiences and being that point
of contact between what’s happening on the

0:18:32.970,0:18:37.450
front lines and how we can play a role in
helping, I think that’s all kind of been truly

0:18:37.450,0:18:38.450
insightful.

0:18:38.450,0:18:43.539
Most specifically, I guess what resonated
with me was that for healthcare providers

0:18:43.539,0:18:47.990
who turned to those quick fix strategies that
I talked about in the presentation that were

0:18:47.990,0:18:53.450
perceived to be unhealthy or that those who
struggled to cope to reduce their stress,

0:18:53.450,0:18:58.020
it wasn’t necessarily that perhaps healthcare
providers didn’t want to cope or didn’t want

0:18:58.020,0:19:01.429
to put in that additional effort to support
their mental health.

0:19:01.429,0:19:05.690
Because many healthcare providers expressed
the desire to cope and even mentioned that

0:19:05.690,0:19:10.770
if they had perhaps had more benefits or more
bandwidth, that some desired strategies would’ve

0:19:10.770,0:19:15.480
been more accessible. And although it may
not seem like this at first glance, speaking

0:19:15.480,0:19:20.470
on behalf of the research point of view, it
allows us to see and hear from healthcare

0:19:20.470,0:19:24.990
providers what they need to cope, so that
we can find ways to help reduce that burden

0:19:24.990,0:19:31.900
of having to use rest time and extra energy
to scramble seeking what’s available. And

0:19:31.900,0:19:37.179
you know, you’ll hear some of these strategies
today from us, to combat these barriers and

0:19:37.179,0:19:41.720
ease the process of self-care and coping so
that it isn’t this unachievable for healthcare

0:19:41.720,0:19:45.100
providers to be able to care for themselves
and their mental health.

0:19:45.100,0:19:50.110
Yeah, wonderful. Thank you, thank you for
saying that. That kind of segues perfectly

0:19:50.110,0:19:56.470
into my next question, which is, in that presentation
we learned about these quick fixes, right?

0:19:56.470,0:20:00.290
The examples that were shared were alcohol,
binge eating — because they provide that

0:20:00.290,0:20:05.110
desired stress relief in the small amount
of time that we know healthcare providers

0:20:05.110,0:20:07.549
have to focus on themselves.

0:20:07.549,0:20:16.740
So Hugo, I’m wondering, these quick fixes
strategies also mentioned sort of end up in

0:20:16.740,0:20:21.680
a residual feeling of guilt. So my question
is, how can healthcare providers begin to

0:20:21.680,0:20:24.700
work past that guilt?

0:20:24.700,0:20:29.150
Such a good and really important question,
right? So if we look at, maybe part of it

0:20:29.150,0:20:35.270
is, the way I think about this is that self-understanding
enables self-compassion, which then enables

0:20:35.270,0:20:36.270
compassionate action, right?

0:20:36.270,0:20:40.640
So it’s actually three steps. Sometimes people
think, I just need to do this thing. But to

0:20:40.640,0:20:47.100
get there is actually lots of steps and easiest
broken down into three. And so how do they

0:20:47.100,0:20:51.679
get past that guilt, towards that compassion
action? So the first part is a fair self-understanding.

0:20:51.679,0:20:55.490
That it makes so much sense that when you’re
overwhelmed, you reach to the things that

0:20:55.490,0:20:59.039
you know of helped even a little bit, even
just for a short period of time, because at

0:20:59.039,0:21:00.400
least it’s some form of relief.

0:21:00.400,0:21:05.400
So it’s about having, again, a fair relationship
with yourself, not shaming yourself for doing

0:21:05.400,0:21:12.940
the best you know how so far, right? And then
the next piece is knowing that it is also

0:21:12.940,0:21:17.450
really hard to change how you give yourself
the care you need and from a quick fix to

0:21:17.450,0:21:23.570
something that is something that helps for
a longer period of time, but might take longer

0:21:23.570,0:21:26.179
to help you to get into that routine of doing
that.

0:21:26.179,0:21:31.840
And also for, to feel those effects, right?
So it’s knowing that you have to give up something

0:21:31.840,0:21:38.420
to work towards something. And that also means
number one, knowing what those other things

0:21:38.420,0:21:43.660
are. Two, trusting that they’ll work enough
to want to practice them. Then three, practicing

0:21:43.660,0:21:47.320
them, usually when you don’t need them, so
that you’re more able to do it when you really

0:21:47.320,0:21:49.750
need to rely on that skill.

0:21:49.750,0:21:55.730
And then it’s really during those times when
you’re really struggling, again, being gentle

0:21:55.730,0:21:59.210
with yourself. It’s sometimes I think about
this as like giving yourself the care you

0:21:59.210,0:22:04.220
need, and there’s an acronym. One part I borrow
from D.B.T., one part developed to help trauma

0:22:04.220,0:22:09.290
patients. So the first letter is “G”:
so to give yourself the care you need. So

0:22:09.290,0:22:13.010
“G,” being gentle with yourself,
is all the how. Gentle with yourself.

0:22:13.010,0:22:19.500
“I” is interested in why you might
be feeling this way and what you might be

0:22:19.500,0:22:23.970
missing, right? Or what might change how you
feel if you noticed it. Right?

0:22:23.970,0:22:28.309
“V” is validating what’s valid.
So being fair with yourself, but not what’s

0:22:28.309,0:22:31.650
not — so you don’t tell yourself I’m a horrible
human being for suffering this way. I’m just

0:22:31.650,0:22:34.100
human for suffering like this, right?

0:22:34.100,0:22:38.850
“E” stands for easy manner. So being
kind and gentle and fair with yourself, even

0:22:38.850,0:22:40.770
if you’re not able to do things the way you
wish to yet.

0:22:40.770,0:22:44.720
And then the care. So for giving yourself
the care you need. The “C” stands

0:22:44.720,0:22:48.970
for being curious about what could really
help in the situation, all the different things

0:22:48.970,0:22:53.110
I know I’m learning, I’ve been working towards,
what could really help in this moment?

0:22:53.110,0:22:57.650
“A” stands for, the “A”
of care, stands for acknowledging that change

0:22:57.650,0:23:00.100
is hard. Doing things differently is difficult.

0:23:00.100,0:23:04.830
“R” stands for reflecting on, of
the different options, which one is most likely

0:23:04.830,0:23:07.760
to help me get to where I want to be?

0:23:07.760,0:23:11.990
And “E” stands for encouraging yourself
to do that thing that you’ve decided is probably

0:23:11.990,0:23:15.740
the best thing, even and especially — so
it’s a triple E— so encouraging yourself

0:23:15.740,0:23:20.340
even, especially when it’s hard, because the
reality is we all know that changing habits

0:23:20.340,0:23:22.029
are hard.

0:23:22.029,0:23:23.029
Yeah.

0:23:23.029,0:23:27.920
And the last bit I’ll say here to make sure
people are fair with themselves is that again,

0:23:27.920,0:23:28.920
it’s steps.

0:23:28.920,0:23:32.340
So it’s learning what you can do ahead of
time. Understanding that what you’re doing,

0:23:32.340,0:23:35.020
you don’t want to anymore. Getting to a place
where you’re going to learn something new,

0:23:35.020,0:23:40.140
practicing it. And then what tends to happen
is you notice first after you could have,

0:23:40.140,0:23:45.460
and here’s where people may shame themselves
for, I knew better then I did it, right? But

0:23:45.460,0:23:50.900
actually this is an occasion to give yourself
credit because, oh wait, I now know that I

0:23:50.900,0:23:54.190
can do something different. That’s actually
an accomplishment, not a reason for shame.

0:23:54.190,0:23:55.190
Does that makes sense?

0:23:55.190,0:23:56.190
Yeah.

0:23:56.190,0:23:58.380
And the same thing is true. So it’s first
after that you notice, then it’s during, but

0:23:58.380,0:24:01.830
you can’t do the new thing yet, then it’s
before, but you can’t do the new thing yet

0:24:01.830,0:24:04.410
and then it’s before you’re like, oh my God,
I think this time I would actually be able

0:24:04.410,0:24:08.570
to do it, right? And so it’s again, being
really fair with yourself. So how do you get

0:24:08.570,0:24:14.450
out of the guilt? It starts by having a fair
understanding of yourself, and a relationship

0:24:14.450,0:24:20.110
with yourself that is gentle, interested,
validating, easy mannered, curious, acknowledging,

0:24:20.110,0:24:25.210
reflecting, and really encouraging yourself
to even when it’s hard to not give up and

0:24:25.210,0:24:26.809
to take that step.

0:24:26.809,0:24:35.350
Beautiful. Thank you. You know Margaret, Hugo
mentioned, you know that, I guess what I’ll

0:24:35.350,0:24:40.809
say is that it makes sense to me that one
way to adjust this behaviour, like the the

0:24:40.809,0:24:45.120
quick fixes that we started this discussion
with about is to make self-compassion more

0:24:45.120,0:24:46.120
accessible.

0:24:46.120,0:24:49.020
And I think that’s kind of Hugo, what you
were saying, right? We need to be fair with

0:24:49.020,0:24:54.000
ourselves and we need to just like take the
little steps of practice when we’re not in

0:24:54.000,0:24:56.919
this moment of crisis of really, really truly
needing it.

0:24:56.919,0:25:02.669
So I’m wondering, Margaret, what are some
equally low-effort strategies that healthcare

0:25:02.669,0:25:05.130
providers could integrate into their day,
to practice?

0:25:05.130,0:25:13.020
Thanks, Amy. And I want to start, having been
on the COVID and ICU units and medical floors

0:25:13.020,0:25:18.440
and other places in the hospitals during the
pandemic, and what we often heard from people

0:25:18.440,0:25:25.730
was, “I can’t take a break. I don’t want
to let my team down. If I take a break then

0:25:25.730,0:25:28.490
others have to fill in for me.”

0:25:28.490,0:25:34.770
And that’s a really hard place to be in when
we feel that if we take that time and have

0:25:34.770,0:25:40.320
that self-compassion for ourselves, that we’re
letting others down. And I think one really

0:25:40.320,0:25:45.340
simple thing that we can say to ourselves
is that if we don’t put the oxygen masks on

0:25:45.340,0:25:48.929
ourselves, we won’t be able to help others.

0:25:48.929,0:25:53.059
And it often sounds like something that we’ve
been told for years and years and years, but

0:25:53.059,0:25:59.080
it’s really true. It’s hard to accept sometimes,
but it’s true. And I think part of this is

0:25:59.080,0:26:03.890
giving ourselves the permission to be able
to take, to use these strategies.

0:26:03.890,0:26:10.410
I’m going to say also that often healthcare
workers have a sense of duty. And duty I think

0:26:10.410,0:26:14.580
is something I know myself I struggle with,
that I have such a sense of duty that I’ll

0:26:14.580,0:26:20.059
work to the point of exhaustion. Or stay somewhere.
I stayed in — I was at a hospital once for

0:26:20.059,0:26:24.890
36 hours and I was in the storage closet most
of that time, right? Not sleeping because

0:26:24.890,0:26:29.450
I just felt so strongly that I had a duty
to support others.

0:26:29.450,0:26:34.340
And I think that’s often where we find ourselves
in as healthcare workers, is our sense of

0:26:34.340,0:26:40.340
duty and our obligation, which is so important
and such a valuable part of our identity,

0:26:40.340,0:26:44.510
but also something that I think until we can
put that oxygen mask on ourselves is very

0:26:44.510,0:26:46.950
difficult. And so —

0:26:46.950,0:26:51.880
Sorry Margaret, I didn’t mean to cut you off.
I was just wondering actually if you could

0:26:51.880,0:26:56.380
share more about that experience because I
think that that experience in the closet at

0:26:56.380,0:27:03.210
the hospital is really pertinent to this conversation,
right? Like what you were doing was providing

0:27:03.210,0:27:07.730
a moment of respite for the healthcare providers.
So I’m wondering if you could explain more

0:27:07.730,0:27:12.140
about what that was and how you feel that
affected the healthcare providers.

0:27:12.140,0:27:18.321
Yeah, absolutely. And so I was in the storage
closet on an ICU unit and healthcare workers

0:27:18.321,0:27:23.090
don’t have a lot of time, right? That’s the
other part of this is, Hugo and Mauda were

0:27:23.090,0:27:25.700
talking about, there’s not a lot of time,
and so how do we help people to take that

0:27:25.700,0:27:31.350
pause for a moment and just either talk to
someone about the experiences that they’re

0:27:31.350,0:27:37.210
having or do something that help can help
to get them in the moment and present.

0:27:37.210,0:27:41.130
And so we can think about very simple things.
For example, using our senses, so our sense

0:27:41.130,0:27:49.720
of touch or sight or sound or smell. So one
very simple thing that, that I do is I have

0:27:49.720,0:27:54.000
worry stones. So these are worry stones. They’re
just simple stones that you could hold in

0:27:54.000,0:27:56.230
your hand and rub your fingers on.

0:27:56.230,0:28:00.809
And what that you’re doing there is that you’re
paying attention to the sensation of the stones

0:28:00.809,0:28:05.299
in your hands, you’re rubbing your fingers
on them, and it’s just a way of simply grounding

0:28:05.299,0:28:12.490
yourself in the moment. That’s one very low,
I would say low effort, yet high reward strategy

0:28:12.490,0:28:14.390
that healthcare workers might be able to use.

0:28:14.390,0:28:19.370
We call this grounding. So that notion of
using your senses to help keep you in the

0:28:19.370,0:28:25.390
moment. It’s also that permission when you
come home to say to your family, for example,

0:28:25.390,0:28:30.250
“I’ve had a really difficult day, I really
need a break.” Because often we come

0:28:30.250,0:28:34.990
in and say, “I want to make sure so-and-so
is okay. I want to call so-and-so. I want

0:28:34.990,0:28:39.600
to make sure everything is right for everyone
else.” And that’s especially hard when

0:28:39.600,0:28:42.940
you’re a parent, right? When you come home
and everybody comes to the door and they’re

0:28:42.940,0:28:48.409
waiting for you. But can we give ourselves
permission again to take that time? Just to

0:28:48.409,0:28:55.029
say no distractions, no conversation, I need
this moment for myself.

0:28:55.029,0:28:58.120
It’s also really important to think about
the things that have helped us in the past.

0:28:58.120,0:29:03.549
I often say mental health is not rocket science.
It’s actually think in the past about what’s

0:29:03.549,0:29:07.659
helped you. So for example, I know for me,
I know when I’m overwhelmed, when I get irritable,

0:29:07.659,0:29:12.880
that’s a very bad sign for me if I’m irritable.
Cause I’m not generally an irritable person.

0:29:12.880,0:29:16.840
And so when that happens, I want to think
about what’s helped in the past. Generally

0:29:16.840,0:29:23.450
that’s doing something social, having a bath,
sitting down with my dog and petting her,

0:29:23.450,0:29:30.390
whatever that may be. These low effort strategies—
low efforts are often hard, because while

0:29:30.390,0:29:36.520
they sound low effort, it’s taking that time
to give yourself permission to take that break.

0:29:36.520,0:29:40.737
It’s also allowing yourself to say, I’m not
going to take an extra shift. I am going to

0:29:40.737,0:29:41.980
take a day off.

0:29:41.980,0:29:42.980
Mm-hmm.

0:29:42.980,0:29:48.570
And again, when we have that sense of duty
and obligation, which we all, I think, come

0:29:48.570,0:29:53.370
to these helping professions with, but be
that public safety personnel like paramedics

0:29:53.370,0:29:58.270
or firefighters, and we come with that sense
of duty. Where come because we want to help

0:29:58.270,0:30:04.780
others. But again, we can’t help others unless
we’re able to help ourselves and put that

0:30:04.780,0:30:06.420
oxygen mask on ourselves.

0:30:06.420,0:30:13.890
Yeah, absolutely. And one of the things that
was mentioned in the talk was, so many people

0:30:13.890,0:30:19.000
have a hard time talking to loved ones about
this experience — and actually when I first

0:30:19.000,0:30:25.120
came into this topic and I was doing research
on for this very talk, I thought, oh, well

0:30:25.120,0:30:28.380
that’s a really good, that’s a really good
support, is talking to your loved ones.

0:30:28.380,0:30:35.820
Like, how can you like engage them without
burdening them? But I actually think maybe,

0:30:35.820,0:30:42.770
because that’s so complicated from both sides
of the coin, right? So my question for you

0:30:42.770,0:30:47.370
Kim, is given that so many people have a hard
time talking to their loved ones about these

0:30:47.370,0:30:53.090
experiences that they’ve been through, what
else could you recommend for person-to-person

0:30:53.090,0:30:54.090
support?

0:30:54.090,0:31:00.620
Yeah. Thanks so much, Amy. That’s a great
question. And I think one of the things we’ve

0:31:00.620,0:31:05.970
really learned from the research and we talk
a lot about in the interviews actually, is

0:31:05.970,0:31:11.500
that healthcare providers are really, really
good at taking care of others. And as we said

0:31:11.500,0:31:17.580
here too, and really delivering that patient-centered
care, but really struggle with turning that

0:31:17.580,0:31:20.639
to themselves and taking care of themselves.

0:31:20.639,0:31:26.420
And, you know, Margaret also mentioned about
identity, and I think healthcare providers

0:31:26.420,0:31:32.560
see themselves as — they’re the ones who
take care of others, and that’s part of the

0:31:32.560,0:31:39.220
culture. And it kind of goes against the culture
to turn that inwards and to start looking

0:31:39.220,0:31:40.230
at themselves.

0:31:40.230,0:31:50.029
So I think at work, taking care of each other
is important too, and supporting each other.

0:31:50.029,0:31:58.840
And I think teams already do that. But it
might just be recognizing your colleagues,

0:31:58.840,0:32:05.390
and giving them permission to take time for
themselves, in addition to giving yourself

0:32:05.390,0:32:07.110
permission.

0:32:07.110,0:32:16.120
And I think at home, as Margaret said, I think
being aware of your need to take time for

0:32:16.120,0:32:22.820
yourself, I think that’s the first step. But
then actually being able to find a way to

0:32:22.820,0:32:30.790
take that few minutes that you might need
just to care for yourself is also a strategy

0:32:30.790,0:32:32.320
that you could use at home.

0:32:32.320,0:32:37.580
I almost wonder, Hugo as well. I mean, you’re
very expert in this, and I wonder if you’d

0:32:37.580,0:32:41.000
like to talk a little bit more about grounding
and some of the ways that people can use sites

0:32:41.000,0:32:45.600
or their — use their senses to assess with
some of this as well.

0:32:45.600,0:32:52.620
Sure, happy to. So first of all, I’d say you
did a lovely job of describing, like finding

0:32:52.620,0:32:55.470
those things that speak to you and connecting
with them, right?

0:32:55.470,0:33:00.019
Because that’s really at the heart of grounding
. Well, there’s kind of two components really,

0:33:00.019,0:33:04.200
I guess. The one we’re talking about there
is really anchoring to the present, really

0:33:04.200,0:33:08.310
helping yourself — you can think of like
a ship, right? We feed an anchor into the

0:33:08.310,0:33:14.860
present. But it also is a pulling yourself
into, like, if you think about grounding as

0:33:14.860,0:33:18.059
like an image, you can be too far away from
the ground, like overwhelmed.

0:33:18.059,0:33:22.080
Where you can be so overwhelmed, you kind
of collapse and feel like you’re underground,

0:33:22.080,0:33:26.830
right? And so grounding is a set of skills
that helps you get to level ground, if that

0:33:26.830,0:33:31.381
makes sense. And so sometimes that’s when
something reminds us of the past and we start

0:33:31.381,0:33:35.980
to feel like this is like, or just like the
past, or because the present is so currently

0:33:35.980,0:33:40.250
overwhelming that we’re feeling overwhelmed
or just so overwhelmed and flooded that we

0:33:40.250,0:33:46.859
shut down and collapse. And grounding is great
for any and all of those things. And yeah,

0:33:46.859,0:33:51.880
lots of different ways to do it. At the heart
of it is really, helping yourself focus your

0:33:51.880,0:33:58.760
attention on the here and now. And there’s,
and I would say that different strategies,

0:33:58.760,0:34:02.490
different grinding strategies work differently
well for different people.

0:34:02.490,0:34:07.720
So to not give up if one doesn’t resonate
with you right away, but to know there’s lots

0:34:07.720,0:34:12.639
of them. And so here’s just a couple, right,
a couple ideas. The first is, Margaret as

0:34:12.639,0:34:20.960
you pointed out so beautifully, like if there’s
an object in particular that you find you

0:34:20.960,0:34:23.960
enjoy, the sight, the touch, the feel of,
right?

0:34:23.960,0:34:29.179
Grounding is most effective when we’re working
with what I call like grounding helpers that

0:34:29.179,0:34:33.230
we find we connect with and help us: just
by spending time with it, we feel better.

0:34:33.230,0:34:37.480
Right? So like, for example, you happen to
be wearing a beautiful shawl today, right?

0:34:37.480,0:34:39.810
So, and I imagine, it’s probably soft.

0:34:39.810,0:34:40.810
Yes.

0:34:40.810,0:34:44.910
And so you can use that as a grounding help,
just to kind of notice and describe to yourself

0:34:44.910,0:34:50.540
what does this feel like? Because touch is
often the fastest thing to help us with grounding.

0:34:50.540,0:34:55.329
So worry stones, different textures, different
temperatures, taking a sip of water, right,

0:34:55.329,0:35:01.040
or a warm beverage. Something with the smell
so you can get as many of your sentences as

0:35:01.040,0:35:07.860
possible involved. Making sure your breathing
is a huge part of this. And so for many people,

0:35:07.860,0:35:12.920
part of their grounding helper kit, if they
can think about that way, is sense that they

0:35:12.920,0:35:16.609
enjoy — or like tea, because that way they
can have the smell as they’re having a nice

0:35:16.609,0:35:19.160
warm beverage that’s also soothing.

0:35:19.160,0:35:26.950
It can be having objects that have particular
personal resonance for you or connecting with

0:35:26.950,0:35:32.040
people, and especially pets. Pets can be incredibly
grounding, right? And just as Margaret, you

0:35:32.040,0:35:36.420
were talking about your dog, I couldn’t help
but smile. And that’s the kind of grounding

0:35:36.420,0:35:43.830
that’s especially powerful, is the ones that
help you feel like, oh, yeah, right. Like

0:35:43.830,0:35:47.280
that. What going to, that’s going to be for,
each person’s going to be a little different,

0:35:47.280,0:35:50.800
but those are the ways to reach towards, is
those kinds of pieces.

0:35:50.800,0:35:56.882
Yeah. I find it really insightful the way
that you all are talking. I’ve thought a lot

0:35:56.882,0:36:01.950
about grounding myself, because everyone experiences
some degree of anxiety. So for example, when

0:36:01.950,0:36:05.660
I’m coming to a talk like this, I really like
to engage in grounding practices before I

0:36:05.660,0:36:11.630
enter the room, and then I’m fully present.
But one thing I’ve never heard before is that

0:36:11.630,0:36:15.300
it’s really helpful in grounding to engage
the senses. Like I really think that’s a really

0:36:15.300,0:36:19.290
important kernel of insight for those, because
I think that could —

0:36:19.290,0:36:20.579
All five if you can.

0:36:20.579,0:36:21.579
Yeah, go ahead.

0:36:21.579,0:36:26.950
All five if you can. So the more that you
can be involving and the more you’re connecting

0:36:26.950,0:36:31.220
and — one way to connect with it is to describe
it to yourself as if you were writing. As

0:36:31.220,0:36:35.640
if like someone else, if they were reading
it. Remember those long-form novels, where

0:36:35.640,0:36:39.260
they used to describe way too much detail,
just don’t do that anymore, right? But if

0:36:39.260,0:36:42.630
you were writing that so they could imagine
what you’re going through. Cause that’s how

0:36:42.630,0:36:46.560
you really anchor in, right, is by the dense
description, if that makes sense.

0:36:46.560,0:36:51.340
Right, right. Yeah, I just think that’s so
interesting. Because when I think of the techniques

0:36:51.340,0:36:56.410
that I used to ground myself, they’re all,
most of them are touch, right? Like standing

0:36:56.410,0:36:58.109
barefoot in the grass.

0:36:58.109,0:36:59.109
Mm-hmm.

0:36:59.109,0:37:03.380
Or I have a little — similar to Margaret,
I have a little toy here that I play with

0:37:03.380,0:37:08.690
to keep my hands busy. So I just find that
the senses insight is so interesting.

0:37:08.690,0:37:14.220
Mauda, I’m wondering, what sort of techniques
do you recommend for people, for healthcare

0:37:14.220,0:37:18.780
providers to start, begin to begin engaging
in self-compassion?

0:37:18.780,0:37:24.859
Yeah. Well, I can kind of speak a little bit
to what we’ve heard from healthcare providers

0:37:24.859,0:37:34.120
to daily things that help them cope and reduce
the stress from work. So for example, establishing

0:37:34.120,0:37:40.329
daily routines was a big one, where there’s
adequate time for nutrition, well-balanced

0:37:40.329,0:37:45.560
meals, sleep, exercise, social connections.
And these can be just small little daily things.

0:37:45.560,0:37:50.420
Meal prepping, for example. So that you don’t
have to worry about going home and cooking

0:37:50.420,0:37:55.680
and having that additional stress for the
day. You know, pets: taking the dog on a long

0:37:55.680,0:38:05.400
walk in nature. Practicing breathing. Fresh
air, sunlight, being outdoors. Even some healthcare

0:38:05.400,0:38:11.510
providers describe leaving specific days set
aside for leisure. Things that are enjoyable

0:38:11.510,0:38:16.319
to them, activities that they would have preplanned
so they know that this day’s coming up, there’s

0:38:16.319,0:38:21.430
something to look forward to that I’m going
to enjoy on that day and make me feel good

0:38:21.430,0:38:23.380
about myself.

0:38:23.380,0:38:29.060
And even integrating those daily strategies
such as mindfulness or gratitude practices:

0:38:29.060,0:38:33.650
Wake up first thing in the morning, have these
little practices that you know, Hugo and Margaret

0:38:33.650,0:38:37.640
were talking about, that you can carry that
self-compassion with you on throughout the

0:38:37.640,0:38:41.910
day. Yeah, those are just a few things that
we’ve heard that really work.

0:38:41.910,0:38:45.760
Wonderful. Thank you, Mauda. I’m actually
wondering, I’m going a little off script here,

0:38:45.760,0:38:51.470
but I’ve got a question that I think actually
might be helpful. And I’m wondering if one

0:38:51.470,0:39:00.270
of you could maybe explain what you mean by
practice breathing, and really practically

0:39:00.270,0:39:07.180
explain how someone might engage in that.

0:39:07.180,0:39:09.470
I think Hugo probably be best suited to —

0:39:09.470,0:39:10.470
Okay.

0:39:10.470,0:39:11.470
Sure. Hugo.

0:39:11.470,0:39:15.630
I’ll just do a quick nod to Kara in the chat,
noting shaking as a grounding practice, right?

0:39:15.630,0:39:20.369
Like shaking off, shaking out the stuff. That’s
actually a really great way to, cause movement

0:39:20.369,0:39:25.890
is also a way of like — that in a way, it’s
touch, in terms of like, it’s appropriate

0:39:25.890,0:39:26.940
deception, right?

0:39:26.940,0:39:31.640
That’s a kind of beautiful way to ground and
let it all go. Thank you for sharing that,

0:39:31.640,0:39:37.130
Kara, that’s a beautiful suggestion. Especially
if you’re starting to feel shut down, right?

0:39:37.130,0:39:41.770
Like starting with small movement and working
to bigger movements can be really helpful.

0:39:41.770,0:39:46.980
So yeah, breathing. I mean, I think [there
are] a couple things. One, cause again, that

0:39:46.980,0:39:52.490
self understanding leads to self-compassion
to compassionate action. When we aren’t breathing,

0:39:52.490,0:39:58.430
and I can do this — you can hear me do this
— as I get talking, I get excited and so

0:39:58.430,0:40:01.900
I am really focused on talking and not breathing.

0:40:01.900,0:40:12.660
When we aren’t breathing, a couple things
happen. One, having air helps us feel safe.

0:40:12.660,0:40:18.141
So when we don’t have air, our body actually
has a real reason to not feel safe. And we

0:40:18.141,0:40:22.750
often, when we’re stressed, we kind of hold
our breath waiting for the moment to pass

0:40:22.750,0:40:28.160
or we hyperventilate, right? Like, but neither
one is actually getting our bodies the air

0:40:28.160,0:40:30.000
it needs, right?

0:40:30.000,0:40:34.040
And so our body then is like, oh, you are
worried about this, but now I’m super worried

0:40:34.040,0:40:37.240
about this. And then the mind gets even more
worried, right?

0:40:37.240,0:40:38.400
Right. Like danger.

0:40:38.400,0:40:42.010
Exactly. Cause it’s real danger. If you’re
not getting the air, that is actual danger.

0:40:42.010,0:40:47.470
Right? That’s clear and present danger at
that point. And so having an intentional breathing

0:40:47.470,0:40:52.020
practice, and there’s so many different ways
of doing this, so I would really encourage

0:40:52.020,0:40:56.420
people to just find what resonates for them.
There’s so many different things to try out.

0:40:56.420,0:41:05.170
Most important is to be getting good deep
breaths. Like breathing out longer than in

0:41:05.170,0:41:10.640
helps you relax. Breathing in longer than
out gives you energy. So if you’re feeling

0:41:10.640,0:41:14.920
overwhelmed and anxious, you would be breathing
out longer. If you’re feeling like I need

0:41:14.920,0:41:20.599
to up-regulate myself cause I’m kind of shut
down, you want to breathe in longer.

0:41:20.599,0:41:24.310
But there’s lots. You can do boxed breathing,
you can do all kinds of different counting

0:41:24.310,0:41:30.490
options. The most important thing is just
to make sure you are breathing, and finding

0:41:30.490,0:41:32.050
something that works well for you.

0:41:32.050,0:41:37.190
And of course we always have our breath with
us, right? And that’s the other thing I’d

0:41:37.190,0:41:40.400
say about breathing, and with grounding too,
you always have the ability to shake things

0:41:40.400,0:41:45.840
off or to notice the textures and temperatures
around you, right? Or to notice what the different

0:41:45.840,0:41:49.770
sensations are, even on things that you wear
or carry with you on a regular basis.

0:41:49.770,0:41:53.680
So these are, what’s wonderful about these
two sets of skills is they’re always available,

0:41:53.680,0:41:54.680
right?

0:41:54.680,0:41:55.770
Yeah, absolutely.

0:41:55.770,0:41:59.069
And just to even know that you’re doing them,
which is also a really important thing if

0:41:59.069,0:42:05.339
you’re a healthcare provider or a human being,
who has a hard time giving yourself permission

0:42:05.339,0:42:09.670
to do things in a way that others might see
it, right? You can do grounding and breathing

0:42:09.670,0:42:11.450
and no one can know that you’re doing those
things.

0:42:11.450,0:42:15.880
Yeah, totally. It can be just this, like even
if you’re on a shift, it can be this sort

0:42:15.880,0:42:22.430
of private thing that you just are standing
at the monitor for a moment and taking a second

0:42:22.430,0:42:29.380
for yourself. Yeah, wonderful. Hugo, I’m wondering,
I know you work with folks who deal with occupational

0:42:29.380,0:42:34.861
stress in your work as a clinical psychologist
at the trauma unit at Homewood, so could you

0:42:34.861,0:42:40.250
share a bit about what you’ve observed about
your patients over the course of the pandemic?

0:42:40.250,0:42:47.260
So this is a really good question and also
one that makes me sad at two different levels.

0:42:47.260,0:42:57.930
So the first one is that I think, as a number
of us have talked about, because of the ways

0:42:57.930,0:43:01.630
that people tend to relate to themselves when
they’re drawn to the helping professions,

0:43:01.630,0:43:06.710
which is that they’re very focused on giving
and caring for others rather themselves. So

0:43:06.710,0:43:09.940
the first observation is that a lot of the
people that we would expect to see coming

0:43:09.940,0:43:15.589
in to get help aren’t. And it makes so much
sense, right?

0:43:15.589,0:43:20.940
Because people feel that I need to, this is
what I need to be doing, this work — there’s

0:43:20.940,0:43:27.140
no time to take care of myself. And so to
the first point there, it makes a lot of sense

0:43:27.140,0:43:30.619
to me that people aren’t, who might really
benefit, aren’t able to allow themselves to

0:43:30.619,0:43:35.400
give themselves permission to give themselves
the care they need, right? And so my hope

0:43:35.400,0:43:39.690
is that they do find a way to give themselves
that permission when they really need it in

0:43:39.690,0:43:44.119
terms of reaching out for local support, reaching
out for outpatient support, if that’s available

0:43:44.119,0:43:51.349
to you. I know a lot of people have work-related
support available, and if not, to really encourage

0:43:51.349,0:43:54.359
your system to support that.

0:43:54.359,0:43:59.700
And, or to come in once you feel like you
can do that, right? All of those things. If

0:43:59.700,0:44:04.410
coming inpatient is helpful. If not, outpatient.
All those pieces, right? And also meditation,

0:44:04.410,0:44:07.770
yoga, whatever speaks to you. But making sure
you’re giving yourself the care that you need

0:44:07.770,0:44:09.390
and not ignoring your needs.

0:44:09.390,0:44:14.960
In terms of the people that have come in during
the pandemic, especially healthcare workers,

0:44:14.960,0:44:20.010
all the themes we’ve just talked about just
resonates so deeply. And what I would say

0:44:20.010,0:44:28.109
with great gratitude to everyone on this call,
is for all the work they have done and then

0:44:28.109,0:44:32.369
for the reachers, researchers on this call
for the beautiful work they’ve done in helping

0:44:32.369,0:44:37.520
understand healthcare workers’ experiences,
because that’s helped us as providers be of

0:44:37.520,0:44:42.180
better support, so that we know what people
are going throughout the healthcare pandemic

0:44:42.180,0:44:48.040
, and the healthcare challenges for healthcare
workers, so that we can respond in a way that

0:44:48.040,0:44:52.150
is, again, more understanding, so therefore
more compassionate, which can hopefully facilitate

0:44:52.150,0:44:53.150
more compassionate action.

0:44:53.150,0:44:59.400
But yeah, it has been heartbreaking because
this has been so hard for so many people who

0:44:59.400,0:45:05.059
just often feel no one does understand, because
mostly they can’t, cause they aren’t there,

0:45:05.059,0:45:10.660
right? And one other thing to be aware of
is that, trauma and dissociation are tightly

0:45:10.660,0:45:15.859
linked. So if it’s too much to think about,
we don’t. We disconnect from it. We disassociate

0:45:15.859,0:45:16.859
from it.

0:45:16.859,0:45:22.980
And so people who aren’t exposed to this level
of distress, it’s hard for them to think about

0:45:22.980,0:45:27.980
it, because our brains don’t want to be connected
to distress, right? It’s because it’s overwhelming.

0:45:27.980,0:45:33.470
So our brains start to shut down and that
then makes it harder for people to then speak

0:45:33.470,0:45:36.770
to people. Cause they can tell that others
either don’t understand it or aren’t able

0:45:36.770,0:45:38.771
to stay engaged when they talk about it.

0:45:38.771,0:45:39.771
Right? Yeah.

0:45:39.771,0:45:40.771
And so the more —

0:45:40.771,0:45:41.771
Yeah. Go ahead.

0:45:41.771,0:45:46.680
The more they can allow themselves to get
help from people who are trained to be able

0:45:46.680,0:45:52.330
to remain present during those kinds of pieces,
I think the more helpful that can be.

0:45:52.330,0:45:55.819
Yeah. And that speaks, that’s really pertinent
to the part where I was mentioning about the

0:45:55.819,0:45:58.589
talking to the loved ones, right? Is that
like, it’s not necessarily —

0:45:58.589,0:46:02.520
It’s not that they don’t care. They just can’t
do it.

0:46:02.520,0:46:03.520
Right!

0:46:03.520,0:46:04.520
Yeah.

0:46:04.520,0:46:09.210
They can’t process it. They can’t really understand
it because they haven’t been, like you said,

0:46:09.210,0:46:12.950
exposed to that level of stress.

0:46:12.950,0:46:17.819
And I just wanted to — Margaret, I wanted
to pass to you, because you had mentioned

0:46:17.819,0:46:22.750
earlier a bit about, and I think this relates
to what Hugo was just saying, is that you

0:46:22.750,0:46:29.510
mentioned a bit about the relationship between
sense of duty and self-compassion, and I’m

0:46:29.510,0:46:31.140
wondering if you could just dig into that.

0:46:31.140,0:46:35.960
I don’t have a specific question, but I feel
it’s important because sense of duty I’m sure,

0:46:35.960,0:46:39.850
resonates with many in the audience. So I’m
just wondering if you can speak more about,

0:46:39.850,0:46:44.590
even when you were on the front lines there
how that relationship is and what we can do

0:46:44.590,0:46:47.280
to turn towards self-compassion in that manner.

0:46:47.280,0:46:54.010
Thanks, Amy. And as you say, it’s a difficult
one to pull apart, right? So I think, again,

0:46:54.010,0:46:58.980
we come into these helping professions because
we want to help. And our identity, as Kim

0:46:58.980,0:47:03.859
was saying, really becomes, we’re a helper,
right? That we are here and we’re making these

0:47:03.859,0:47:08.940
sacrifices. And I think many of us believe
in service: that we’re here to serve, and

0:47:08.940,0:47:12.950
therefore that service is the work that we’re
doing.

0:47:12.950,0:47:16.950
And in order to serve, we also have to be
healthy ourselves, right? Or as healthy as

0:47:16.950,0:47:22.290
we can be. Not, and many of us will — I
mean, I’ve struggled with depression and P.T.S.D.

0:47:22.290,0:47:26.730
and I’ve talked very openly about that. I
think it’s really important. But I have to

0:47:26.730,0:47:31.980
see that to help others, I also need to have
self-compassion towards myself, and give myself

0:47:31.980,0:47:37.610
the space and the time to do things that will
help me to be healthy. I will be really upfront

0:47:37.610,0:47:40.680
and say that’s, I find that very difficult.
I will be very upfront with that as a — in

0:47:40.680,0:47:48.059
the many roles that I have, it’s hard, right?
But I think part of it is that we also have

0:47:48.059,0:47:49.940
a duty to ourselves, right?

0:47:49.940,0:47:59.599
So we are the vessels of our own identity,
and we have to care for ourselves too, to

0:47:59.599,0:48:04.685
be able to perform our duty. But also we have
a duty of care to ourselves, we owe it to

0:48:04.685,0:48:07.430
ourselves to take care of us.

0:48:07.430,0:48:12.640
Absolutely. Thank you. Thank you. Margaret,
I just have one, one final question. It is

0:48:12.640,0:48:18.470
also for you. And that is that I can’t help
feel like — we’re talking about self-care

0:48:18.470,0:48:24.369
and that’s so valuable — but I can’t help
but feel like some of the circumstances that

0:48:24.369,0:48:30.630
have led to this very webinar are systemic.
It feels like it needs to be about culture

0:48:30.630,0:48:33.579
change within the healthcare industry as well.

0:48:33.579,0:48:38.350
So Margaret, I’m curious how organizations,
even though they’re also, everyone is stretched

0:48:38.350,0:48:42.470
the limits, including the organizations, but
how can they help healthcare providers right

0:48:42.470,0:48:43.470
now?

0:48:43.470,0:48:49.140
Great question. Thank you, Amy. And I think
part of it is seeing our common humanity.

0:48:49.140,0:48:53.380
So I think healthcare organizations are often
very hierarchically structured.

0:48:53.380,0:48:58.240
So there’s the view that we have, those at
the top and those on the front lines, and

0:48:58.240,0:49:02.560
there’s a lot of hierarchy in that. And I
think part of what we need to do is be able

0:49:02.560,0:49:08.000
to see each other as equals, that we care
for one another, that our first duty is one

0:49:08.000,0:49:12.049
of care and not of “this must be done
this way.”

0:49:12.049,0:49:18.770
We’re in a very unique circumstance right
now and I think we need to acknowledge that

0:49:18.770,0:49:23.630
and again, see everyone’s humanity. I think
we need to check in with people and see how

0:49:23.630,0:49:30.060
they’re doing. So it’s really helpful. When
I was out on the front lines, a lot of managers

0:49:30.060,0:49:34.490
would talk about, “I have people come
into my office and I talk to them about how

0:49:34.490,0:49:40.210
they’re doing. I get to know them personally.
I speak to them about, what do you need in

0:49:40.210,0:49:42.090
order to be able to do your job?”

0:49:42.090,0:49:48.589
We need to ask our teams that same question,
so what is it that you need? We can’t respond

0:49:48.589,0:49:53.030
to every need, but we can at least hear about
what are some of the needs that you have.

0:49:53.030,0:49:57.040
And managers and directors and leaders also
struggle, and we need to provide support and

0:49:57.040,0:49:58.910
compassion for them as well.

0:49:58.910,0:50:04.670
But I think part of this is a bit of leveling
the playing field and allowing us to see each

0:50:04.670,0:50:11.599
other as humans who all have needs and identity.
And how do we support one another in this

0:50:11.599,0:50:13.590
because we’re all in this together.

0:50:13.590,0:50:17.920
Absolutely. Thank you. And I think that’s
a beautiful note to to end our discussion

0:50:17.920,0:50:18.920
today on.

0:50:18.920,0:50:23.240
So thank you so much to all of the panelists
for participating today.

0:50:23.240,0:50:29.170
I just want to say that over the weekend I
had to take a trip to the ER with my youngest

0:50:29.170,0:50:33.940
daughter, who’s four. Everything’s fine, don’t
worry. But it was the first time that I’ve

0:50:33.940,0:50:38.750
set foot in a hospital since the pandemic,
which I consider myself very fortunate for

0:50:38.750,0:50:41.210
that to have been my case.

0:50:41.210,0:50:46.950
But when I walked in, everything looked different.
There were dividers in between the waiting

0:50:46.950,0:50:52.160
room chairs, and there were nurses in the
full P.P.E. And for me, knowing that this

0:50:52.160,0:50:55.700
webinar was coming up, it was really like
stepping into this world that you’ve all been

0:50:55.700,0:51:02.630
living in for two-plus years. And I have to
say like everyone, every single nurse, doctor,

0:51:02.630,0:51:06.890
healthcare provider that we spoke to, was
so kind to my daughter who was very scared.

0:51:06.890,0:51:13.200
And so I just wanted to say, I see you all
in the audience and thank you so much for

0:51:13.200,0:51:16.299
showing up every day and doing what you do.

0:51:16.299,0:51:20.950
It’s so important. It’s so, so important.
And if there’s one thing that you deserve,

0:51:20.950,0:51:25.500
it’s compassion from the public, but also
from yourselves.

0:51:25.500,0:51:31.270
So that’s it for me today, but before I pass
it over to Margaret to close out, I’d just

0:51:31.270,0:51:35.020
like to also thank our sponsor once more.
So thank you to the Public Health Agency of

0:51:35.020,0:51:40.360
Canada for supporting this important work.
We appreciate you. And Margaret, I’d love

0:51:40.360,0:51:43.200
to pass it to you for some final words.

0:51:43.200,0:51:44.200
Thanks,

0:51:44.200,0:51:49.280
Amy. And thank you for sharing that experience.
And I think what we have seen over the course

0:51:49.280,0:51:54.520
of the pandemic is unfortunately there has
been a real rise in incivility and violence

0:51:54.520,0:51:58.420
towards healthcare workers. I think it’s really
important that we acknowledge that and we

0:51:58.420,0:52:01.990
know that healthcare workers are facing that.

0:52:01.990,0:52:05.380
And I think what you’ve done right now is
exactly what people need to hear. That we

0:52:05.380,0:52:12.420
see you. We appreciate you. We know your service
and your sacrifices and we know your stories.

0:52:12.420,0:52:17.270
And so I think that’s how I think we’d all
like to end this symposium, is to say thank

0:52:17.270,0:52:23.750
you to the healthcare workers and public safety
personnel and other people at the front lines

0:52:23.750,0:52:29.020
of this pandemic. Thank you for your service.
Thank you for your sacrifice and let’s all

0:52:29.020,0:52:35.630
give ourselves a bit of air to allow ourselves
just to, to breathe and be present, and to

0:52:35.630,0:52:42.680
give ourselves that self-compassion that everyone
here needs. So thank you very much.

0:52:42.680,0:52:46.319
Thank you all and thank you all for joining
us today and I hope you have a wonderful rest

0:52:46.319,0:52:47.840
of your day. Take care.

• COVID-19 and moral injury in Canadian healthcare providers
• Predict, prevent and manage moral injuries in frontline healthcare workers and leaders facing the COVID-19 pandemic
• Associations between psychosocial stressors at work and moral injury in frontline healthcare workers and leaders facing the COVID-19 pandemic in Quebec, Canada: A cross-sectional study

0:00:13.889,0:00:15.150
Hello and welcome.

0:00:15.150,0:00:18.740
My name is Hannah Sung and I am moderating
the symposium today.

0:00:18.740,0:00:24.210
The topic is COVID’s hidden crisis, moral
injury in healthcare providers.

0:00:24.210,0:00:27.660
This event is two hours long with a short
break in the middle.

0:00:27.660,0:00:32.230
I would like to begin by acknowledging the
land on which McMaster University is located,

0:00:32.230,0:00:36.700
which is the traditional territory of the
Haudenosaunee and Anishinaabe nations, and

0:00:36.700,0:00:40.699
within the lands protected by the Dish With
One Spoon Wampum belt.

0:00:40.699,0:00:45.500
That wampum uses the symbolism of a dish to
represent the territory and a spoon to represent

0:00:45.500,0:00:48.910
that people should share resources and only
take what they need.

0:00:48.910,0:00:54.269
Toronto, which is where I am located today,
is home to many diverse First Nations, Inuit,

0:00:54.269,0:00:58.230
and Métis people, and is covered by the Treaty
13 and the Williams Treaties.

0:00:58.230,0:01:03.019
I hope you can take a moment to consider the
treaty territory you are on and what Land

0:01:03.019,0:01:07.040
Back and stewardship of the land mean to you
and your community.

0:01:07.040,0:01:10.280
And in fact, I’d love to hear where you are
this morning.

0:01:10.280,0:01:14.660
Chat your location if you like, just drop
the name of your city or town.

0:01:14.660,0:01:17.010
It’s nice to warm up the chat that way.

0:01:17.010,0:01:23.820
The chat is a space for you today, so please
keep it respectful and on topic.

0:01:23.820,0:01:28.190
This symposium is part of a larger project
called Healthcare Salute: Thank You for Your

0:01:28.190,0:01:33.799
Service, which is funded through PHAC, the
Public Health Agency of Canada.

0:01:33.799,0:01:37.860
And Dr. Margaret McKinnon, who you’ll be meeting
in just a moment, has been working with her

0:01:37.860,0:01:42.759
team to gather evidence on the mental health
impacts of working as healthcare providers

0:01:42.759,0:01:45.329
during the pandemic.

0:01:45.329,0:01:49.360
Data has been gathered using interviews and
surveys with healthcare providers around the

0:01:49.360,0:01:53.969
country, and the researchers will be sharing
their findings today.

0:01:53.969,0:01:58.229
Several Canadian researchers are joining to
provide insight into risk and mitigating factors

0:01:58.229,0:01:59.469
on moral injury.

0:01:59.469,0:02:05.219
And you’ll also hear from healthcare providers
who describe what they’ve experienced at work.

0:02:05.219,0:02:09.860
And it goes without saying before we begin
that we are very grateful to healthcare providers

0:02:09.860,0:02:14.110
for the work they do today and every day.

0:02:14.110,0:02:18.010
So some of what you hear today may bring up
some emotions.

0:02:18.010,0:02:20.170
That’s okay.

0:02:20.170,0:02:22.380
If you need to take a break, please do.

0:02:22.380,0:02:27.660
Maybe step away from the computer, come back,
get a glass of water, take a deep breath.

0:02:27.660,0:02:33.420
There are resources that have been compiled
and that are in the chat for you.

0:02:33.420,0:02:39.220
Please take a moment to copy and paste them
into a new browser or just take a screen cap

0:02:39.220,0:02:45.510
so that you have these numbers and websites
for your use.

0:02:45.510,0:02:51.250
And with that, I would like to introduce Dr.
Margaret McKinnon to the stage.

0:02:51.250,0:02:55.080
Hello Margaret, how are you this morning?

0:02:55.080,0:02:56.080
Good, how are you?

0:02:56.080,0:02:57.080
It’s nice to see you.

0:02:57.080,0:02:58.080
Same here.

0:02:58.080,0:03:02.739
And so today the topic is moral injury and
moral distress and why it is so important

0:03:02.739,0:03:04.760
right now to understand these things.

0:03:04.760,0:03:07.200
Can we start with some definitions?

0:03:07.200,0:03:08.860
What is moral injury?

0:03:08.860,0:03:10.250
What is moral distress?

0:03:10.250,0:03:11.810
Thank you so much, Hannah.

0:03:11.810,0:03:17.030
And before we get started, like you, I’d just
like to take a moment to acknowledge the healthcare

0:03:17.030,0:03:22.620
workers across Canada and public safety personnel
who have sacrificed so much throughout their

0:03:22.620,0:03:23.620
service.

0:03:23.620,0:03:30.360
This has been a sacrifice by healthcare workers,
but also by their families who have also been

0:03:30.360,0:03:31.360
impacted.

0:03:31.360,0:03:35.670
And we very deliberately chose the term Healthcare
Salute: Thank You for Your Service for this

0:03:35.670,0:03:36.670
project.

0:03:36.670,0:03:40.820
And also we have the honour of working very
closely with the Canadian military, and we

0:03:40.820,0:03:45.849
often use the term thank you for your service
and salute: we salute your service.

0:03:45.849,0:03:50.950
And we want to salute that same service of
healthcare workers and public safety personnel

0:03:50.950,0:03:57.190
today and thank them and their families for
their service and their sacrifice.

0:03:57.190,0:04:00.840
In talking about the research today as well,
I also want to acknowledge the people who,

0:04:00.840,0:04:03.390
and the organizations, who generously funded
this research.

0:04:03.390,0:04:07.000
And so the research that we’re presenting
today is from the Trauma and Recovery Research

0:04:07.000,0:04:12.000
Unit at McMaster University, St. Joseph’s
Healthcare, Hamilton, and Homewood Research

0:04:12.000,0:04:13.000
Institute.

0:04:13.000,0:04:18.139
It was funded by, initially by a grant from
— or rather a contract from — the Centre

0:04:18.139,0:04:23.410
of Excellence on PTSD in Ottawa, which is
now the Atlas Institute, by a very generous

0:04:23.410,0:04:27.810
donation from Homewood Health to Homewood
Research Institute, by the Public Health Agency

0:04:27.810,0:04:29.580
of Canada, and by the Canadian Institutes
of Health Research.

0:04:29.580,0:04:34.610
So we just want to take a moment as well to
thank the funders who allowed us to do this

0:04:34.610,0:04:40.000
work very early on and gather the knowledge
and information necessary for the work that

0:04:40.000,0:04:41.639
we’re talking about today.

0:04:41.639,0:04:47.660
So when we think about moral injury and moral
distress, we can think back to the words of

0:04:47.660,0:04:53.720
General Roméo Dallaire when he returned home
from Rwanda and he talked about the moral

0:04:53.720,0:04:58.190
injury and moral distress that he and the
men and women who he served with experienced

0:04:58.190,0:04:59.970
in Rwanda.

0:04:59.970,0:05:04.190
And so there, there — moral injury takes
many forms, but one is the sense that one

0:05:04.190,0:05:11.199
has either engaged in or witnessed events
that violate one’s moral and ethical values.

0:05:11.199,0:05:17.750
So for General Dallaire, he talked about being
in Rwanda and being ordered to stand down

0:05:17.750,0:05:23.770
by the United Nations and not intervene during
the genocide and the slaughter that was occurring.

0:05:23.770,0:05:28.190
And that was for him and for the men and women
with whom he served, a fundamental violation

0:05:28.190,0:05:31.940
of their ethical and moral values.

0:05:31.940,0:05:35.180
In the pandemic, and the interviews that we’ve
been doing — and others across the country

0:05:35.180,0:05:38.930
have also been doing from, other research
groups that will also be here today —we’ve

0:05:38.930,0:05:45.710
heard about, for example, when healthcare
workers have had to deny parents access to

0:05:45.710,0:05:48.660
see a critically ill child because of no-visitor
policies.

0:05:48.660,0:05:54.180
We’ve heard about the proning of older adults
and turning over an older adult who really

0:05:54.180,0:05:59.740
doesn’t want care, but their substitute decision
maker has insisted upon it, and how painful

0:05:59.740,0:06:01.150
and difficult that can be.

0:06:01.150,0:06:05.900
That proning, which takes seven people—
people talk about these things that, that

0:06:05.900,0:06:10.740
had to be done in many instances during the
pandemic, but for people it was really difficult

0:06:10.740,0:06:16.240
because it touched upon or had a sense of
betrayal of their moral or their ethical values.

0:06:16.240,0:06:21.970
Or they witnessed situations that they felt
were violation of their moral or ethical values

0:06:21.970,0:06:24.250
and were powerless to intervene.

0:06:24.250,0:06:30.940
We also heard from General Dallaire when he
returned home about the betrayal that he and

0:06:30.940,0:06:35.490
the men and women he served with felt that
they had experienced, and they talked about

0:06:35.490,0:06:41.750
being ordered to stand down, and the impact
that that had on those who they were there

0:06:41.750,0:06:42.750
to protect.

0:06:42.750,0:06:47.470
So the citizens of Rwanda, and also on the
Canadian Armed Forces, where he said this

0:06:47.470,0:06:54.590
was a betrayal by an organization that had
a duty of care to people, the people of Rwanda,

0:06:54.590,0:06:57.780
and also to those who were serving within
Rwanda.

0:06:57.780,0:07:01.919
And here we’ve heard healthcare workers talk
about in this context, about for example,

0:07:01.919,0:07:06.590
being provided with very light masks at the
beginning of the pandemic.

0:07:06.590,0:07:11.840
I even saw a video where I saw nurses being
instructed to wear Kleenexes, while they transported

0:07:11.840,0:07:14.139
bodies, over their faces.

0:07:14.139,0:07:15.139
Yes.

0:07:15.139,0:07:20.840
And so, many people serving in healthcare
at the time and continuing on, have felt that

0:07:20.840,0:07:27.650
perhaps there was not enough preparedness
for a pandemic in some situations.

0:07:27.650,0:07:31.340
Also that they felt that the organizations
or individuals who they were serving with

0:07:31.340,0:07:35.949
had a duty of care to them, and they felt
that that duty of care was not met — or

0:07:35.949,0:07:39.229
to patients as well, and families throughout
the country.

0:07:39.229,0:07:42.280
And so this really is the concept of moral
injury.

0:07:42.280,0:07:49.610
So the notion that one has engaged in or witnessed
or been powerless to prevent events or incidents

0:07:49.610,0:07:55.360
that violate one’s moral and ethical values,
or that they have felt a betrayal by an individual

0:07:55.360,0:08:03.280
and organization who they feel has a duty
of care to them during the pandemic.

0:08:03.280,0:08:09.900
There’s a lot of complex context there in
terms of understanding moral injury and moral

0:08:09.900,0:08:11.720
distress.

0:08:11.720,0:08:18.430
I hear that on an individual level it’s about
a violation of your own moral code and the

0:08:18.430,0:08:20.800
stress that that entails.

0:08:20.800,0:08:27.120
And I wonder when you use the term moral injury,
can you describe how it is an injury?

0:08:27.120,0:08:29.330
Can you tell us more about that?

0:08:29.330,0:08:35.490
So, moral injury, I would say is something
that exists in itself.

0:08:35.490,0:08:40.580
It is associated with post-traumatic stress
injuries, with depression, and with anxiety.

0:08:40.580,0:08:41.849
But it’s separate.

0:08:41.849,0:08:45.160
It has a different presentation.

0:08:45.160,0:08:51.640
And when a moral injury occurs, what we often
see is an increase in — we can see increases

0:08:51.640,0:08:58.360
for example in suicidality; difficulty functioning
at home, at work, at school; we might see

0:08:58.360,0:09:03.649
an increase in symptoms of depression, anxiety,
post-traumatic stress disorder, difficulty

0:09:03.649,0:09:06.470
sleeping and insomnia, increased substance
use and abuse.

0:09:06.470,0:09:09.990
And so really this is a form of injury.

0:09:09.990,0:09:15.520
We always talk about physical injuries, but
we don’t talk as much about psychological

0:09:15.520,0:09:16.520
injuries.

0:09:16.520,0:09:20.360
And this is a psychological injury that has
occurred to an individual.

0:09:20.360,0:09:26.610
It’s resolved again of their service and their
sacrifice.

0:09:26.610,0:09:27.810
Thank you so much for that.

0:09:27.810,0:09:28.810
Margaret.

0:09:28.810,0:09:33.450
I know that we’re going to be hearing from
you again later on this morning.

0:09:33.450,0:09:38.030
First we are going to hear some findings from
your research team.

0:09:38.030,0:09:42.760
Did you have anything you wanted to add just
before we move on?

0:09:42.760,0:09:49.149
I would just again like to thank the individuals
and organizations who sponsored this research.

0:09:49.149,0:09:53.990
So again, the Public Health Agency of Canada,
the Homewood — Homewood Health Incorporated

0:09:53.990,0:09:57.810
through the generous donation to Homewood
Research Institute — Centre of Excellence

0:09:57.810,0:10:00.970
on PTSD, and of course the Canadian Institutes
of Health Research.

0:10:00.970,0:10:06.100
This work would not be possible without them,
and I think it’s work that really we need

0:10:06.100,0:10:11.500
to do in order to best support healthcare
workers, public safety personnel, and their

0:10:11.500,0:10:12.770
families over this time.

0:10:12.770,0:10:14.890
So thank you Hannah, very much.

0:10:14.890,0:10:17.140
And thank you so much for moderating this
session.

0:10:17.140,0:10:19.029
We’re really grateful.

0:10:19.029,0:10:22.740
I’m just so happy to be here and to be learning
for sure.

0:10:22.740,0:10:28.040
And so speaking of learning, we are going
to go now to a short presentation from a member

0:10:28.040,0:10:31.190
of Margaret’s research team Yuanxin Xue.

0:10:31.190,0:10:34.000
Hi everyone, thanks for having me here today.

0:10:34.000,0:10:39.720
My name is Yuanxin Xue, and I had the pleasure
to work with the Trauma and Recovery lab led

0:10:39.720,0:10:42.810
by Dr. Margaret McKinnon over the past year
and a half.

0:10:42.810,0:10:47.320
I’m really excited to be here to share some
of the results we found in a scoping review.

0:10:47.320,0:10:51.450
We started the summer of 2021 and that we
completed earlier this year.

0:10:51.450,0:10:57.000
So it’s on the potential circumstances associated
with the moral injury and moral distress in

0:10:57.000,0:10:59.880
a healthcare workers and public safety personnel.

0:10:59.880,0:11:03.410
And this is specifically during the pandemic.

0:11:03.410,0:11:07.779
So I just want to warn you, this is a fairly
short presentation, so there may be some details

0:11:07.779,0:11:14.000
on the slides that I won’t be directly speaking
to, but they’ll still be there for your reference.

0:11:14.000,0:11:19.870
So, we knew that healthcare workers and public
safety personnel were encountering many morally

0:11:19.870,0:11:23.200
and ethically challenging situations during
the pandemic.

0:11:23.200,0:11:27.360
And we really wanted to see what was out there
in the literature in terms of the circumstances

0:11:27.360,0:11:32.339
that may cause or may potentially lead to
moral injury and moral distress.

0:11:32.339,0:11:37.279
So this is the research question we used to
guide our review: What are the shared and

0:11:37.279,0:11:42.750
unique circumstances of healthcare workers
and public safety personnel during COVID globally

0:11:42.750,0:11:46.720
that are potentially associated with moral
distress and moral injury?

0:11:46.720,0:11:52.470
So here are some of the abbreviations I’ll
be using throughout the slides, and I just

0:11:52.470,0:11:56.370
want to direct your attention to the last
one there, P.M.I.D.E.

0:11:56.370,0:12:01.380
But this one stands for potentially morally
injurious or distressful event.

0:12:01.380,0:12:06.279
And we used this term to look at moral injury
and moral distress as a collective.

0:12:06.279,0:12:09.980
Our goal wasn’t really to try to delineate
between these two terms, so we thought it

0:12:09.980,0:12:18.639
would be a better idea to look at them together
and to see moral stressors more holistically.

0:12:18.639,0:12:20.540
So here’s a brief overview of our methods.

0:12:20.540,0:12:26.421
We started our search in, or the search of
our articles, in the beginning of 2020 and

0:12:26.421,0:12:27.579
we went until May 2021.

0:12:27.579,0:12:33.699
And we included any article that talked about
healthcare workers or select public safety

0:12:33.699,0:12:39.170
personnel populations in the COVID-19 context,
and they also focused on circumstances that

0:12:39.170,0:12:41.960
might lead to moral injury or moral distress.

0:12:41.960,0:12:47.150
So that’s definitely a bit of a oversimplification,
but you can find the more detailed methods

0:12:47.150,0:12:48.150
online.

0:12:48.150,0:12:53.530
And from that search, we identified approximately
1400 articles and in the very end included

0:12:53.530,0:12:54.530
57.

0:12:54.530,0:12:58.230
So before I get onto this map here, I just
wanted to say that out of the 57 articles,

0:12:58.230,0:13:01.560
all of them were primarily focused on healthcare
workers.

0:13:01.560,0:13:06.579
There was only a very small subsample of public
safety personnel in six of those articles,

0:13:06.579,0:13:09.830
but they were also aggregated with the healthcare
workers as well.

0:13:09.830,0:13:12.260
So it’s really hard to differentiate those
results.

0:13:12.260,0:13:16.170
So for the most part, the results I’ll be
talking about today, they’re primarily relevant

0:13:16.170,0:13:20.410
to healthcare workers, but that’s not to say
that they’re not relevant to public safety

0:13:20.410,0:13:23.310
personnel as well, we just need to do a bit
more research.

0:13:23.310,0:13:28.820
So this here is the world map and we have
different parts shaded in just based on the

0:13:28.820,0:13:31.959
included studies and the populations they
studied.

0:13:31.959,0:13:37.360
So you can see that the majority of articles
are focused on North America and there was

0:13:37.360,0:13:43.279
some in East Asia and South Asia, some in
Europe, and a few others across the globe

0:13:43.279,0:13:45.850
as well.

0:13:45.850,0:13:51.149
And in terms of the results we found, so after
collecting all the relevant data and coding

0:13:51.149,0:13:57.269
them, we’re able to come up with the six overarching
themes that describe the types of circumstances

0:13:57.269,0:14:01.259
associated with potentially morally injuries
or distressful events.

0:14:01.259,0:14:05.370
So the first one here, it had to do with the
risk of contracting or transmitting COVID-19.

0:14:05.370,0:14:08.290
There were 34 articles included.

0:14:08.290,0:14:13.540
And we saw that some articles spoke about
how this is particularly relevant for healthcare

0:14:13.540,0:14:17.940
workers who were more vulnerable to having
severe infection, or those that were living

0:14:17.940,0:14:19.050
with vulnerable populations.

0:14:19.050,0:14:22.699
Now, the second one here, the inability to
work on the frontlines.

0:14:22.699,0:14:27.620
This one really speaks to some of that guilt
that healthcare workers have faced when they

0:14:27.620,0:14:31.153
didn’t have the same level of risk or exposure
compared to some of their colleagues who were

0:14:31.153,0:14:32.850
on the frontlines.

0:14:32.850,0:14:37.300
And this also included people who needed to
quarantine, and then there was that additional

0:14:37.300,0:14:38.860
workload that was placed on their other colleagues.

0:14:38.860,0:14:44.529
The third one here is the provision of suboptimal
care.

0:14:44.529,0:14:48.450
And this one really just refers to healthcare
workers not being able to provide that same

0:14:48.450,0:14:51.009
level of care as they would’ve liked to.

0:14:51.009,0:14:56.360
And this was partially exacerbated by all
of the uncertainty during the pandemic, but

0:14:56.360,0:15:00.470
also by the infection control measures that
created distance between the providers and

0:15:00.470,0:15:04.870
patients, as well as the visitation policies
that made it difficult for family gatherings.

0:15:04.870,0:15:10.730
The fourth thing here, it refers to care prioritization
and resource allocation.

0:15:10.730,0:15:14.600
So this really refers to all those tough decisions
healthcare workers had to make when resources

0:15:14.600,0:15:19.089
were scarce and there was only a limited capacity
to do what they could.

0:15:19.089,0:15:21.790
This was especially tough when it came to
critical care resources.

0:15:21.790,0:15:27.529
The fifth theme here, it refers to healthcare
workers perception of that lack of support

0:15:27.529,0:15:29.310
and unfair treatment by their organization.

0:15:29.310,0:15:35.250
And so some of the ideas that I were in this
category included not having adequate benefits

0:15:35.250,0:15:39.860
or protection for the workers, as well as
the lack of communication and transparency

0:15:39.860,0:15:43.120
about the whole situation.

0:15:43.120,0:15:49.430
And the last one here, it’s the stigma, discrimination,
and abuse the healthcare workers faced.

0:15:49.430,0:15:54.180
Some of the articles included in the section
spoke to how healthcare workers, they were

0:15:54.180,0:15:58.070
viewed as virus carriers by their friends,
colleagues, and even their family.

0:15:58.070,0:16:03.060
Some experienced discrimination by their community
and others also reported acts of violence

0:16:03.060,0:16:06.800
by patients and other families.

0:16:06.800,0:16:12.149
So when we look at all these themes and the
articles that were included in each in terms

0:16:12.149,0:16:17.089
of where they’re geographically located, for
the most part, all of these themes, apart

0:16:17.089,0:16:19.959
from one, they are fairly globally spread.

0:16:19.959,0:16:25.220
And this is especially true for the risk of
contracting or transmitting COVID-19, as well

0:16:25.220,0:16:29.350
as the perceived lack of support and unfair
treatment by their organization.

0:16:29.350,0:16:34.529
So the only exception was the category of
stigma, discrimination, and abuse, where there

0:16:34.529,0:16:36.519
was a lack of articles from North America.

0:16:36.519,0:16:42.540
But this is not mean to say that this doesn’t
happen in North America, but it’s more likely

0:16:42.540,0:16:47.690
due to potential underreporting of some of
these issues in the context of moral injury

0:16:47.690,0:16:49.290
and moral distress.

0:16:49.290,0:16:52.860
And we definitely need to do more research
to get a better understanding of the severity

0:16:52.860,0:16:55.470
of those experiences and the.

0:16:55.470,0:17:00.100
So with that, that concludes the presentation
and I just want to say thank you to Dr. Margaret

0:17:00.100,0:17:04.189
McKinnon, as well as everyone who contributed
and really made this review possible.

0:17:04.189,0:17:07.090
And thank you guys so much for listening today.

0:17:07.090,0:17:11.871
It was a pleasure to speak with you all.

0:17:11.871,0:17:17.740
Thank you so much to Yuanxin who will be hearing
from in one moment.

0:17:17.740,0:17:23.300
First we’re going to hear from another presentation
from another member of this research team.

0:17:23.300,0:17:24.740
It’s from Andrea Brown.

0:17:24.740,0:17:26.520
So let’s watch.

0:17:26.520,0:17:28.250
Thank you for inviting me to speak today.

0:17:28.250,0:17:32.230
My name is Andrea Brown and I’m a research
associate in the Trauma and Recovery Research

0:17:32.230,0:17:33.880
Unit at McMaster University.

0:17:33.880,0:17:40.450
Since September of 2020, we have been collecting
information about moral injury and healthcare

0:17:40.450,0:17:41.540
providers across Canada.

0:17:41.540,0:17:46.169
And what we’re finding is that healthcare
providers are in fact experiencing moral injury

0:17:46.169,0:17:49.610
during the pandemic.

0:17:49.610,0:17:54.580
Moral injury has been called the signature
wound of service, although this was originally

0:17:54.580,0:17:59.169
brought forward for military members, we also
believe that it applies to our healthcare

0:17:59.169,0:18:00.980
providers.

0:18:00.980,0:18:07.400
In our very first webinar in the Healthcare
Salute series, Kim Ritchie and Andrea D’Alessandro-Lowe

0:18:07.400,0:18:13.140
gave some information about the types of events
that healthcare providers have identified

0:18:13.140,0:18:17.030
as morally injurious or morally distressing.

0:18:17.030,0:18:19.740
These include witnessing patients dying alone.

0:18:19.740,0:18:25.039
At one point, during the pandemic, family
members weren’t allowed to go and and have

0:18:25.039,0:18:27.570
end of lifetime with their loved ones.

0:18:27.570,0:18:31.600
And during this time, healthcare providers
had to watch their patients dying alone.

0:18:31.600,0:18:35.900
And this spanned the age ranges of very old
to very young.

0:18:35.900,0:18:41.940
Also providing invasive care, which is perceived
as futile and prolongs the suffering of their

0:18:41.940,0:18:42.940
patients.

0:18:42.940,0:18:47.770
Increasing workload and decreasing staff,
which is an something that’s impacting our

0:18:47.770,0:18:50.330
healthcare providers even today.

0:18:50.330,0:18:57.360
Bullying, violence and divided opinions as
well as the disconnect between frontline staff

0:18:57.360,0:19:00.640
and their organization.

0:19:00.640,0:19:05.549
So we know the types of events that are being
identified as morally injurious or morally

0:19:05.549,0:19:10.930
distressing by healthcare providers, but we’re
also wondering what are the impacts.

0:19:10.930,0:19:18.549
In particular, we’re wondering about post-traumatic
stress, depression, anxiety, stress, dissociation,

0:19:18.549,0:19:19.640
substance use, and resilience.

0:19:19.640,0:19:23.620
Are these things that are also impacting our
healthcare providers?

0:19:23.620,0:19:31.659
So in order to understand this better, we
have had a survey, or we had a survey that

0:19:31.659,0:19:37.539
was open from September of 2020 until September
of 2022, and it was open to healthcare providers

0:19:37.539,0:19:39.560
across Canada to complete.

0:19:39.560,0:19:43.710
The bulk of our participants were nurses and
respiratory therapists, but we also had many

0:19:43.710,0:19:50.160
other healthcare providers complete, including
occupational therapists, physicians, those

0:19:50.160,0:19:52.940
in dentistry, long-term care and mental health.

0:19:52.940,0:20:00.560
And in total, we had nearly 700 people complete
the survey or partially complete the survey.

0:20:00.560,0:20:03.890
Near 80% of our participants identified as
being female.

0:20:03.890,0:20:07.580
The bulk were from Ontario living and practicing.

0:20:07.580,0:20:12.049
We also had nearly 10% from Alberta and British
Columbia.

0:20:12.049,0:20:16.970
We did have representation from across the
provinces, although we didn’t have representation

0:20:16.970,0:20:23.110
from the territories, and nearly 70% of our
participants identified as having European

0:20:23.110,0:20:26.390
ancestry.

0:20:26.390,0:20:30.010
The first question we really wanted to know
is how many of our participants said that

0:20:30.010,0:20:34.659
they were experiencing these events or these
situations that they would define as morally

0:20:34.659,0:20:35.659
injurious.

0:20:35.659,0:20:41.730
So we asked them a question asking if they
had been exposed to three types of events

0:20:41.730,0:20:45.010
that goes against their core, their moral
codes or values.

0:20:45.010,0:20:50.409
So these are events in which they did something
or didn’t do something that went against their

0:20:50.409,0:20:56.049
moral code, they witnessed somebody else doing
something or not doing something that went

0:20:56.049,0:21:01.500
against their moral code and then being directly
impacted by something that somebody else did

0:21:01.500,0:21:04.990
or didn’t do that went against the moral code
or their values.

0:21:04.990,0:21:11.039
So what we found is that 70% of our participants
were exposed to these types of events that

0:21:11.039,0:21:17.690
went against their moral code or their values,
and 67% of our participants said that they

0:21:17.690,0:21:19.620
experienced these events in 2021.

0:21:19.620,0:21:28.179
And 72% of our participants in 2022 said that
they had experienced these events this year,

0:21:28.179,0:21:31.600
and that was between January and September.

0:21:31.600,0:21:36.770
So we know the types of events that are being
defined as morally injurious, and we know

0:21:36.770,0:21:41.890
that two-thirds of our healthcare population
are experiencing these types of events.

0:21:41.890,0:21:46.440
So then we wanted to know how is it impacting
them?

0:21:46.440,0:21:52.960
So we asked questions in our survey, and what
we found was that those who perceived a greater

0:21:52.960,0:22:03.789
moral injury also experienced greater rates
of depression, anxiety, stress, post-traumatic

0:22:03.789,0:22:06.679
stress, and dissociation.

0:22:06.679,0:22:12.620
These are at a statistically significant level,
but we also found that those who had greater

0:22:12.620,0:22:18.080
perceived moral injuries also used more substances
in order to try and cope.

0:22:18.080,0:22:24.080
So this includes increasing alcohol use, cannabis
use, and other recreational drugs.

0:22:24.080,0:22:29.720
Although this wasn’t statistically significant,
there was a positive correlation between the

0:22:29.720,0:22:30.720
two.

0:22:30.720,0:22:36.490
And what we also found is that those who had
perceived greater moral injury also had decreased

0:22:36.490,0:22:37.490
resilience.

0:22:37.490,0:22:43.640
So this is the feelings that they could cope
with the stresses and that they could bounce

0:22:43.640,0:22:45.059
back with the stresses.

0:22:45.059,0:22:51.110
So we know that what the morally injurious
events are, we know that two-thirds at least

0:22:51.110,0:22:54.890
of our healthcare population are experiencing
these events, and we know that it’s impacting

0:22:54.890,0:23:01.550
their mental health, their coping ability,
and their ability to bounce back.

0:23:01.550,0:23:06.309
So together with our collaborators, we have
created some recommendations for healthcare

0:23:06.309,0:23:11.679
organizations and leaders, and it begins with
listening and understanding healthcare providers’

0:23:11.679,0:23:16.990
experiences and the impact these experiences
have had on healthcare providers and their

0:23:16.990,0:23:21.870
family, because the impacts go home with them.

0:23:21.870,0:23:26.910
Asking healthcare providers questions about
what they need to perform their roles and

0:23:26.910,0:23:33.190
improve their mental health, because healthcare
providers know what they need more than anybody.

0:23:33.190,0:23:38.289
And then providing access to appropriate supports
for healthcare providers.

0:23:38.289,0:23:44.610
So taking what you’ve learned when you’re
listening to their experiences and understanding

0:23:44.610,0:23:48.450
what it is that they need, and then providing
them with those supports.

0:23:48.450,0:23:55.150
The supervisors and the management in these
organizations are also under a lot of stress.

0:23:55.150,0:24:00.190
They have to balance the needs of the healthcare
providers and the organizations to make sure

0:24:00.190,0:24:04.160
that the services are being provided for our
population.

0:24:04.160,0:24:09.049
So another recommendation we made is to provide
supervisors and management with resources

0:24:09.049,0:24:13.330
and training to support healthcare providers’
mental health.

0:24:13.330,0:24:20.110
And finally, we recommend to establish evidence-based
policies to guide ethically difficult decisions.

0:24:20.110,0:24:25.159
While on the job, healthcare providers have
to make life-and-death decisions.

0:24:25.159,0:24:30.860
And they said it would be helpful if they
had policies to help guide these decisions

0:24:30.860,0:24:35.520
and that these policies were based in evidence.

0:24:35.520,0:24:41.020
So to summarize my very short presentation
today, we know that healthcare providers are

0:24:41.020,0:24:46.140
experiencing moral injury, and we also know
the types of events that they are saying are

0:24:46.140,0:24:47.860
morally injurious.

0:24:47.860,0:24:52.770
We also know that these moral injuries are
impacting their mental health, their ability

0:24:52.770,0:24:55.640
to bounce back, and substance use.

0:24:55.640,0:25:02.480
So what we are going to do is to continue
to conduct research to identify interventions

0:25:02.480,0:25:09.070
and to identify the long-term impacts of these
moral injuries.

0:25:09.070,0:25:11.320
Thank you very much.

0:25:11.320,0:25:12.390
Thank you so much, Andrea.

0:25:12.390,0:25:17.390
And I have a feeling that there were probably
many people in this webinar who are nodding

0:25:17.390,0:25:23.169
along to the observations and the details
and the recommendations that you just shared

0:25:23.169,0:25:24.279
with us.

0:25:24.279,0:25:34.210
So I would like to invite Yuanxin and Andrea
to join me for a quick debrief of your presentations.

0:25:34.210,0:25:39.210
Your presentations were filled with detail,
and I would like to just go very big picture

0:25:39.210,0:25:40.780
if I may.

0:25:40.780,0:25:47.330
And first I’ll ask you, Yuanxin: you showed
us the map of all the various places from

0:25:47.330,0:25:48.870
which you drew your research.

0:25:48.870,0:25:54.830
Did you find important similarities between
your findings globally and the data in Canada?

0:25:54.830,0:25:55.830
Yeah.

0:25:55.830,0:25:57.410
No, no, for sure.

0:25:57.410,0:25:58.410
And thank you for that question.

0:25:58.410,0:26:01.080
I think that was actually a big part of why
we started the review.

0:26:01.080,0:26:06.870
We wanted to see if what we’re seeing in Canada
was really happening across the globe as well.

0:26:06.870,0:26:10.580
And although most of the articles were more
the based in North America, I think we did

0:26:10.580,0:26:14.030
get a glimpse of what it does look like globally.

0:26:14.030,0:26:19.279
And I think like when you look at the themes
we found and the other information that we

0:26:19.279,0:26:23.750
gathered on Canadian healthcare workers through
the interviews and the surveys they’re basically

0:26:23.750,0:26:28.060
saying the same thing, but just they’re just
organized a little bit differently.

0:26:28.060,0:26:33.190
And I think two of the really big similarities,
there’s probably anything that’s related to

0:26:33.190,0:26:38.330
patients and not being able to provide the
optimal care that they used to be — whether

0:26:38.330,0:26:45.049
it be not having, having patients that had
to die alone because of visitor policies or

0:26:45.049,0:26:51.169
other limitations to work because of increased
workloads or changing protocols, or simply

0:26:51.169,0:26:57.100
just witnessing like patients who were receiving
care that healthcare workers may have felt

0:26:57.100,0:26:58.480
was futile.

0:26:58.480,0:27:02.380
I think that was definitely a big similarity
between what we see here, as well as in the

0:27:02.380,0:27:03.380
review.

0:27:03.380,0:27:10.440
And I would say another big area was had to
do with the organizations, and that just perceived

0:27:10.440,0:27:14.010
a lack of support or sometimes even betrayal.

0:27:14.010,0:27:20.850
The healthcare workers felt when there was
inadequate PPE, inadequate staffing, and just

0:27:20.850,0:27:27.880
that disconnect that sometimes there was between
the frontline workers and their organization.

0:27:27.880,0:27:36.519
Well, I find that so interesting that you
found those key similarities because, as someone

0:27:36.519,0:27:40.720
who doesn’t work in healthcare, I would think
that depending on your region, depending on

0:27:40.720,0:27:46.149
the type of healthcare system, that there
would be some real specificity about the work

0:27:46.149,0:27:47.149
that happens.

0:27:47.149,0:27:53.309
But in fact, there were certain experiences
that healthcare workers had just across the

0:27:53.309,0:27:54.620
board during the pandemic.

0:27:54.620,0:27:56.520
Mm-hmm, for sure.

0:27:56.520,0:28:00.070
I think like when you look at big picture,
I think it’s pretty much, you’re looking at

0:28:00.070,0:28:01.070
the same things.

0:28:01.070,0:28:05.880
But maybe if you like zoom into Canada or
different parts of the world, the severity

0:28:05.880,0:28:09.171
or extent to certain experiences, that that
might differ.

0:28:09.171,0:28:14.090
But I think for the most part we’re seeing
that healthcare workers, they were experiencing

0:28:14.090,0:28:18.120
moral injury, they were experiencing moral
distress and there’s definitely a lot that

0:28:18.120,0:28:19.630
can be done there.

0:28:19.630,0:28:20.780
Mm-hmm.

0:28:20.780,0:28:22.440
Thank you Yuanxin.

0:28:22.440,0:28:23.760
I would like to move over to —

0:28:23.760,0:28:25.159
Can I just add on to that?

0:28:25.159,0:28:26.159
Andrea, please do.

0:28:26.159,0:28:27.159
Yeah.

0:28:27.159,0:28:28.159
Okay.

0:28:28.159,0:28:31.880
So during Yuanxin’s presentation, he said
that the one area that wasn’t as supported

0:28:31.880,0:28:38.080
in North America was the stigma, discrimination,
and abuse, but I think that might be because

0:28:38.080,0:28:40.260
of when those publications took place.

0:28:40.260,0:28:44.620
Cause our research is actually finding that
in the last year, that is a moral injury that

0:28:44.620,0:28:48.240
has come up more and more in our conversations
with healthcare providers.

0:28:48.240,0:28:53.650
So it could just be that the research ended
and was published towards the end of 2021.

0:28:53.650,0:28:56.730
So that means it was submitted before that.

0:28:56.730,0:29:00.200
So in the last year it actually has risen.

0:29:00.200,0:29:01.200
Yes.

0:29:01.200,0:29:05.269
It’s interesting because in your presentation
you said, Andrea, that you were looking at

0:29:05.269,0:29:12.059
research or you, you, your team was conducting
surveys that go all the way up to just a couple

0:29:12.059,0:29:14.940
of months ago, until September 2022?

0:29:14.940,0:29:17.390
The end of September, right.

0:29:17.390,0:29:18.390
Yeah.

0:29:18.390,0:29:23.330
So I would love to ask you, Andrea, again,
very big picture, why do you think it’s important

0:29:23.330,0:29:28.230
to understand how moral injury specifically
is related to mental health when it comes

0:29:28.230,0:29:29.710
to healthcare providers?

0:29:29.710,0:29:37.340
I think the big thing, Hannah, is that understanding
the impact of moral injury on healthcare providers

0:29:37.340,0:29:41.860
will help us to provide them with the supports
that they need and what types of supports

0:29:41.860,0:29:43.549
that they need to have.

0:29:43.549,0:29:46.230
Healthcare providers play a vital role in
our society.

0:29:46.230,0:29:50.179
And it’s one of the things that Canadians
are always so proud of, is our healthcare

0:29:50.179,0:29:51.340
system.

0:29:51.340,0:29:55.529
Our healthcare providers, who have always
made life-and-death types of decisions, and

0:29:55.529,0:30:01.080
have always been in these types of situations,
something about COVID-19 is different, and

0:30:01.080,0:30:02.970
it’s intensified everything.

0:30:02.970,0:30:10.120
And so we now know that they’re facing moral
injuries, and we know how it’s impacting them.

0:30:10.120,0:30:17.289
So we as society, at the government level
and at the organizational, understanding this

0:30:17.289,0:30:23.050
can start to implement the behaviours and
the skills and support for our healthcare

0:30:23.050,0:30:27.700
providers to help them while they’re helping
us.

0:30:27.700,0:30:29.590
Mm-hmm.

0:30:29.590,0:30:36.200
And I’m glad to see that there are some questions
that are coming through the chat.

0:30:36.200,0:30:43.649
So I will say that there are probably too
many to get to them all, but please keep them

0:30:43.649,0:30:45.960
coming and I will get to as many as I can.

0:30:45.960,0:30:49.440
So I’m just going to choose one here for you
both, Yuanxin and Andrea.

0:30:49.440,0:30:55.450
Karen is asking, when gender-based analysis
was applied to your research, were there any

0:30:55.450,0:31:03.809
important variations and findings based on
specific occupation and/or sex and gender

0:31:03.809,0:31:05.929
of the healthcare provider?

0:31:05.929,0:31:09.080
Would either of you like to speak to that?

0:31:09.080,0:31:16.360
At this time, I have not run the analyses
on the gender based analysis.

0:31:16.360,0:31:21.309
But I would reiterate that 80% of our population
identified as being female.

0:31:21.309,0:31:25.669
So it’ll be a small percentage that identify
as male or non-binary.

0:31:25.669,0:31:31.109
Thank you.

0:31:31.109,0:31:35.090
And I will ask one more question.

0:31:35.090,0:31:40.970
What are the next steps in terms of interventions,
any suggestions and or recommendations?

0:31:40.970,0:31:45.149
I know, Andrea, that there were several in
your presentation.

0:31:45.149,0:31:48.510
Maybe you can go into some of them in detail.

0:31:48.510,0:31:49.510
Sure.

0:31:49.510,0:31:55.139
So, one of the things that’s come out of our
research is that we’ve made some recommendation,

0:31:55.139,0:32:02.150
and I know that Sangita has put a link to
these recommendations within the, in the chat.

0:32:02.150,0:32:06.460
In addition, with the funding that we’re receiving
from the Public Health Agency of Canada, we

0:32:06.460,0:32:11.070
are creating some psychoeducational programs
that will be available online.

0:32:11.070,0:32:18.179
It includes some training for trauma-informed
care for, for not — it can be used by healthcare

0:32:18.179,0:32:23.779
providers in their work, but it can also be
for people who are supporting healthcare providers

0:32:23.779,0:32:29.580
and understanding that everybody has traumas
and when we’re working together, these traumas

0:32:29.580,0:32:31.020
are impacting people regardless.

0:32:31.020,0:32:37.269
So when you’re dealing with somebody, realize
that they’re, they might not always be in

0:32:37.269,0:32:40.860
the same situation that you are because of
what’s happened in the past or what’s ongoing

0:32:40.860,0:32:48.269
at work, or also creating with the University
of Alberta some psychoed programs, online

0:32:48.269,0:32:50.330
programs on what is moral injury.

0:32:50.330,0:32:56.019
And then we’ve also created one on PTSD stress.

0:32:56.019,0:32:59.899
And that will help people to understand, let’s
say that you’re a healthcare provider and

0:32:59.899,0:33:03.090
you really don’t understand why you’re not
sleeping well.

0:33:03.090,0:33:07.760
And I’m sure that healthcare providers do
understand this, but it’ll help to go in and

0:33:07.760,0:33:12.490
say, PTSD and stress and moral injury, this
is how it affects your body and this is why

0:33:12.490,0:33:13.970
you’re feeling this way.

0:33:13.970,0:33:18.330
And we will also connect you with some some
other information that you have.

0:33:18.330,0:33:26.429
And there are also supports available online
that we will connect you with.

0:33:26.429,0:33:34.289
So it sounds like the experiences that healthcare
providers may be having, it’s good to have

0:33:34.289,0:33:42.890
the language and the backup and the evidence
to show that healthcare providers need help,

0:33:42.890,0:33:46.679
and that these injuries affect the ability
to do the job?

0:33:46.679,0:33:47.679
Right.

0:33:47.679,0:33:50.760
And remembering that healthcare providers
are helpers.

0:33:50.760,0:33:56.809
They’re always helpers, and they often put
themselves lowest on their list of who to

0:33:56.809,0:33:58.590
take care of themselves.

0:33:58.590,0:34:03.700
But it shouldn’t just be on healthcare providers
to take care of themselves.

0:34:03.700,0:34:07.260
We as a society need to do what we can to
support our healthcare providers.

0:34:07.260,0:34:13.550
The government needs to put in the laws and
the regulations to support our healthcare

0:34:13.550,0:34:15.580
providers, and the organizations need to do
that too.

0:34:15.580,0:34:20.220
So let’s take the focus off the healthcare
providers taking care of their mental health,

0:34:20.220,0:34:23.290
and let’s put it on everybody to support our
healthcare providers.

0:34:23.290,0:34:24.290
Absolutely.

0:34:24.290,0:34:30.500
Well, Andrea and Yuanxin, thank you so much
for your research and your presentations.

0:34:30.500,0:34:32.000
I really appreciate it.

0:34:32.000,0:34:33.940
Thank you, Hannah.

0:34:33.940,0:34:35.240
Thank you.

0:34:35.240,0:34:36.540
Thank you.

0:34:36.540,0:34:43.859
And while we are speaking about healthcare
providers, why don’t we speak to healthcare

0:34:43.859,0:34:44.859
providers?

0:34:44.859,0:34:49.599
We have a panel of three people who have very
generously given their time and are about

0:34:49.599,0:34:51.919
to share their experiences with us.

0:34:51.919,0:34:54.820
I’d like to quickly introduce you to them.

0:34:54.820,0:34:58.960
Michele Johnson, if you could join, Krissha
Fortuna.

0:34:58.960,0:35:00.790
Jennifer Kwan.

0:35:00.790,0:35:02.339
Michele and Krissha are nurses.

0:35:02.339,0:35:04.160
Jennifer is a family doctor.

0:35:04.160,0:35:09.349
And if you’re on Twitter, if you were on Twitter
during the pandemic, you know Jennifer has

0:35:09.349,0:35:16.140
provided a lot of information there for laypeople
such as myself to understand COVID data.

0:35:16.140,0:35:23.329
So I want to ask all three of you about what
you’re hearing today about moral injury and

0:35:23.329,0:35:29.260
moral distress and whether these definitions
in these observations speak to you when you

0:35:29.260,0:35:31.030
think about your day-to-day work.

0:35:31.030,0:35:38.020
But first, can I ask you just very quickly
in 10 seconds to tell us what is your job

0:35:38.020,0:35:41.050
and what is your favourite thing about your
work.

0:35:41.050,0:35:43.880
Maybe Michelle, I’ll start with you.

0:35:43.880,0:35:45.760
Okay.

0:35:45.760,0:35:50.260
So I’m a nurse of 32 years in a hospital in
downtown Toronto.

0:35:50.260,0:35:53.360
And there’s three things I really love about
my job.

0:35:53.360,0:36:02.190
It’s this kind of collection of this science,
hands-on critical thinking and this empathetic

0:36:02.190,0:36:08.500
opportunity to meet with a stranger, a stranger
in distress, who I can reach out with my heart

0:36:08.500,0:36:12.460
and reach theirs and have a moment that’s
like — it’s an incredible privilege to be

0:36:12.460,0:36:13.530
able to do that.

0:36:13.530,0:36:20.569
And the other thing is this kind of incredible
support I get in my whole life, all aspects

0:36:20.569,0:36:22.599
of my life, that I get from my colleagues.

0:36:22.599,0:36:29.260
Like, working with people who are caregivers
is an incredible privilege, because we care

0:36:29.260,0:36:35.470
for each other in the same way we care for
the public and people we’ve never met, we

0:36:35.470,0:36:39.829
care deeply for each other — and that’s
a pretty wonderful job.

0:36:39.829,0:36:42.800
I love that description.

0:36:42.800,0:36:43.870
Thank you so much.

0:36:43.870,0:36:48.359
And I’ll also just mention, Michele, that
I think your microphone is rubbing on a little

0:36:48.359,0:36:49.359
something.

0:36:49.359,0:36:51.490
I don’t know if you want to just — yeah,
check that out.

0:36:51.490,0:36:55.819
But you sound great and maybe I’ll go to Krissha
now.

0:36:55.819,0:37:07.430
Can you tell us about your job and what you
love about it?

0:37:07.430,0:37:10.290
Krissha is not here at the moment.

0:37:10.290,0:37:16.890
I’m sorry, I introduced Krissha, but my view
of the Zoom is very complicated, so I could

0:37:16.890,0:37:20.210
not see that she’s actually not here at the
moment.

0:37:20.210,0:37:21.410
She is here!

0:37:21.410,0:37:28.160
As you can see from the chat, you have to
have a moment like this in a Zoom.

0:37:28.160,0:37:38.000
I’m not sure if we can get Mike to help out
with bringing Krissha into the panel so that

0:37:38.000,0:37:40.830
Krissha can speak with us.

0:37:40.830,0:37:43.960
But maybe for now, I’ll just go to Jennifer.

0:37:43.960,0:37:48.359
Can you tell us a little bit about your job
and your favourite thing about it?

0:37:48.359,0:37:52.570
Thanks Hannah, and thanks everyone for joining
us today.

0:37:52.570,0:37:55.560
I’m a family doctor in Burlington.

0:37:55.560,0:37:56.580
I do love my job.

0:37:56.580,0:37:58.020
I love my patients.

0:37:58.020,0:38:04.050
It is such a privilege to care for people
and their families and develop these long-term

0:38:04.050,0:38:07.490
relationships and get to know them over time.

0:38:07.490,0:38:11.500
It’s both rewarding and heartbreaking cause
sometimes we do see things happen to people,

0:38:11.500,0:38:18.570
but it’s such a privilege to be there to help
fix things that we can fix and to hold people’s

0:38:18.570,0:38:23.859
hands like figuratively when they are going
through illnesses and help people with their

0:38:23.859,0:38:24.859
health over time.

0:38:24.859,0:38:31.830
So I really do love my job and despite some
of the moral distress that we experience,

0:38:31.830,0:38:36.500
it is still a very — a great honour to be
a family doctor.

0:38:36.500,0:38:39.010
Thank you, Jennifer.

0:38:39.010,0:38:41.829
And Krissha is joining us now.

0:38:41.829,0:38:47.290
I would love for you to tell us in 10 seconds
about your job and what you love about it.

0:38:47.290,0:38:49.270
Hi, everybody.

0:38:49.270,0:38:52.230
Sorry about that.

0:38:52.230,0:38:57.810
What I love about my job is getting up to
see patients every day, helping those who

0:38:57.810,0:39:02.040
need help, who brighten.

0:39:02.040,0:39:07.670
They might need something like a flu shot
and then it will change their day.

0:39:07.670,0:39:14.950
It’s about touching, it’s about speaking in
to your patients and really connecting with

0:39:14.950,0:39:18.560
them in some ways you can to just help.

0:39:18.560,0:39:24.740
I don’t know, it’s just always an innate feeling
towards — in my line of work, it’s just,

0:39:24.740,0:39:30.619
I’ve always loved helping and I felt like
I was born, I was put in this world for the

0:39:30.619,0:39:34.470
purpose of helping somebody.

0:39:34.470,0:39:40.089
And it’s just interacting with people every
day and making a difference.

0:39:40.089,0:39:47.329
That’s how I believe how I was put in this
world, is to help people day in and day out,

0:39:47.329,0:39:48.810
no matter what.

0:39:48.810,0:39:50.690
Thank you.

0:39:50.690,0:39:51.690
Krissha.

0:39:51.690,0:39:56.829
And I know that you are a nurse and that you
work with people who are, I believe newcomers

0:39:56.829,0:39:58.670
to Canada, at the moment.

0:39:58.670,0:39:59.670
Yes.

0:39:59.670,0:40:00.670
That’s your work, correct?

0:40:00.670,0:40:01.670
Yeah.

0:40:01.670,0:40:05.210
I currently work with newcomers and refugees
coming into Canada.

0:40:05.210,0:40:16.339
I provide mostly primary care, help them go
over, like helping them with resources and

0:40:16.339,0:40:22.680
working through a lot of barriers and really
advocating for patients because how come this

0:40:22.680,0:40:28.530
patient can’t get their, what they need in
order for them to be healthy, however these

0:40:28.530,0:40:36.350
people can, and what I’ve noticed is there’s
a lot of racism involved, and there’s just

0:40:36.350,0:40:40.280
a lot of barriers for patients, especially
coming into Canada.

0:40:40.280,0:40:48.960
And myself as an immigrant, I know exactly
how I transitioned over here and how challenging

0:40:48.960,0:40:50.030
it was.

0:40:50.030,0:40:57.020
And oftentimes that’s how I’ve been connecting
and able to empathize with patients like that,

0:40:57.020,0:40:59.410
because they’re also struggling.

0:40:59.410,0:41:06.100
And then I think that’s why I have chosen
this field, is because in some ways I’m doing

0:41:06.100,0:41:09.810
more than just cleaning up a wound or whatnot.

0:41:09.810,0:41:15.599
I’m actually doing something for them for
their future.

0:41:15.599,0:41:24.609
And it, it strikes me as you’re speaking that
you work with people who are in a vulnerable

0:41:24.609,0:41:28.109
situation because they’re new to the country
and they face many barriers.

0:41:28.109,0:41:33.060
But I guess all healthcare workers come in
contact with people who are in a vulnerable

0:41:33.060,0:41:36.530
moment because they need your help.

0:41:36.530,0:41:41.770
And Krissha, if I may start with you, in terms
of experiences throughout the pandemic and

0:41:41.770,0:41:48.160
doing your work, earlier in the pandemic,
you were working in long-term care, and I

0:41:48.160,0:41:54.109
would like to know what did it feel like at
first to be managing your nursing staff, especially

0:41:54.109,0:42:00.500
when it came to outbreaks of COVID in the
facility?

0:42:00.500,0:42:08.760
So while I was working in long-term care,
I think that all of us we were all quite scared.

0:42:08.760,0:42:18.800
For us, it was kind of an invisible dooming
cloud coming in and you know, and soon as

0:42:18.800,0:42:22.470
you know it, you just get it and then it spreads
like wildfire.

0:42:22.470,0:42:31.500
So for us, it was really important for me
to ensure that staff are well protected and

0:42:31.500,0:42:38.430
they always, because you have to think about
it, they have people to come home to.

0:42:38.430,0:42:45.619
They have family, loved ones, children, grandparents,
and these are the people who rely on them.

0:42:45.619,0:42:49.400
There’s a reason why they come out and do
this job every day.

0:42:49.400,0:42:59.200
So for me, I’ve had one experience where I
had to practically raise my voice at the staff

0:42:59.200,0:43:00.349
because we were in an outbreak.

0:43:00.349,0:43:06.079
And in an outbreak situation, you really need
to be considerate and you need to be very

0:43:06.079,0:43:13.160
cautious and you need to be on your high alert
because at that time, we didn’t know what

0:43:13.160,0:43:14.160
COVID was.

0:43:14.160,0:43:19.900
We didn’t have all these informations and
how widespread it could be and how it travels

0:43:19.900,0:43:25.190
through airborne and what kind of protections
do we need.

0:43:25.190,0:43:29.650
So for me, I had to stand up for them, because
I had to tell them, “Listen, you know

0:43:29.650,0:43:30.839
what?

0:43:30.839,0:43:34.099
I need you guys to protect each other.

0:43:34.099,0:43:38.030
This is the only way we really can come out
of this.

0:43:38.030,0:43:39.310
You look out for me.

0:43:39.310,0:43:44.599
You look out for her, and you look out for
him, or you look out for your next teammate.

0:43:44.599,0:43:48.359
That is what it is all about.”

0:43:48.359,0:43:52.600
And I think I was reprimanded for the fact
that I shouldn’t be yelling, I shouldn’t be

0:43:52.600,0:44:00.510
raising my voice at staff, but I thought at
that time I was being honest and I really

0:44:00.510,0:44:07.950
laid out the reality that it could be any
of us who will get sick, and then God forbid

0:44:07.950,0:44:09.510
it spreads to other family members.

0:44:09.510,0:44:15.000
Like my dad was a diabetic — or is a diabetic.

0:44:15.000,0:44:16.800
I was very scared.

0:44:16.800,0:44:17.800
Yeah.

0:44:17.800,0:44:24.270
So that’s how some people might not like my
approach, but I felt that I had to make that

0:44:24.270,0:44:29.400
very clear, that safety was very important.

0:44:29.400,0:44:34.020
I can definitely hear that emotions were running
high because when you say you raised your

0:44:34.020,0:44:38.270
voice, you were stretched to that point where
you needed to do that.

0:44:38.270,0:44:42.920
Michele, I would like to turn to you for a
moment because you were also a nurse.

0:44:42.920,0:44:47.240
And you mentioned that you have been in nursing
for 32 years.

0:44:47.240,0:44:52.590
I feel like if you’ve been doing anything
for 32 years, you’ve probably seen it all.

0:44:52.590,0:44:55.880
But COVID was unprecedented, as we know.

0:44:55.880,0:45:00.740
Were there any firsts that you witnessed at
work during the pandemic?

0:45:00.740,0:45:01.740
Yeah.

0:45:01.740,0:45:03.220
Thanks Hannah.

0:45:03.220,0:45:05.790
There certainly were.

0:45:05.790,0:45:11.010
And just to start out with, I want to just
say thank you so much to the researchers who’ve

0:45:11.010,0:45:15.190
done this work, it’s actually touched my heart
so, so deeply.

0:45:15.190,0:45:24.250
I feel a little, it’s, it’s — I’m really
touched to, to have what I’ve experienced

0:45:24.250,0:45:31.930
and the emotions that we as nurses carry,
to have it received so wholesomely by the

0:45:31.930,0:45:35.210
researchers and reflected back, has actually
really touched my heart.

0:45:35.210,0:45:37.319
And I’m a little bit like, Whew!

0:45:37.319,0:45:48.520
This is kind of exciting to realize that all
that we have done is being so validated, and

0:45:48.520,0:45:49.520
that’s really wonderful.

0:45:49.520,0:45:50.599
So thank you for that.

0:45:50.599,0:45:57.800
And what I would like to say is what I saw
for the first time was sort of the impact

0:45:57.800,0:46:04.660
of this moral injury and moral distress and
the sort of way that COVID tipped things.

0:46:04.660,0:46:12.740
When when COVID arrived, we didn’t realize
how deeply us nurses depend on each other.

0:46:12.740,0:46:15.410
We are a resilient collective.

0:46:15.410,0:46:21.930
We are, we are a network of caregivers who
care for each other and care for our patients.

0:46:21.930,0:46:26.530
And it’s a real — I’m doing this with my
hands cause it’s a way to articulate how we

0:46:26.530,0:46:30.849
are — we’re greater than the sum of our
parts when we are together.

0:46:30.849,0:46:37.079
And when COVID came, they gave us these flimsy
little blue surgical masks and the only work

0:46:37.079,0:46:40.470
if we all wear them and we stay six feet apart.

0:46:40.470,0:46:49.490
And that imperative to isolate left us alone
and our distresses became individualized.

0:46:49.490,0:46:52.830
Prior to this, we had always come together.

0:46:52.830,0:46:58.460
I could find a colleague and say, “Hey,”
and suddenly we were individualized.

0:46:58.460,0:47:00.770
We weren’t a collective, we weren’t together.

0:47:00.770,0:47:05.780
When I experienced what any of us experienced,
the fear, the anxiety, the sorrows, when we

0:47:05.780,0:47:12.550
were in a situation of overwhelm, we were
alone with that feeling.

0:47:12.550,0:47:17.540
And I had never before seen nurses breaking
down, isolated.

0:47:17.540,0:47:19.650
We’ve all cried in our shifts.

0:47:19.650,0:47:28.810
That’s — but to have to find nurses sobbing
in utility rooms and in quiet corners, it

0:47:28.810,0:47:34.730
stood in a stark contrast to SARS, which came
20 years ago.

0:47:34.730,0:47:38.550
When it came, we were all rapidly given N95
masks in the hospital.

0:47:38.550,0:47:42.841
And the whole city was scared of us, but we
knew we were safe cause we had our N95 masks

0:47:42.841,0:47:47.810
and we knew they would keep us safe and we
were able to gather and we were able to support

0:47:47.810,0:47:48.810
each other.

0:47:48.810,0:47:54.580
And the sense of betrayal that I feel because
we’ve been denied proper PPE — because it

0:47:54.580,0:48:01.609
was, here’s your blue mask, stay apart — it
has fractured this incredible network that

0:48:01.609,0:48:05.470
nurses depend on professionally and personally.

0:48:05.470,0:48:11.640
We come to work for 12 hours and we support
each other so that we can also go home and

0:48:11.640,0:48:15.690
still be as good of people as we can be.

0:48:15.690,0:48:21.330
And I personally feel, I’m quoting Margaret,
I wrote some of her words down, like a guilt

0:48:21.330,0:48:26.680
and shame in the difficulties of, and the
moral distress of our failure to our collective

0:48:26.680,0:48:33.330
selves as nurses and allied health professionals,
including doctors, in our stuff, and there’s

0:48:33.330,0:48:36.810
been no time, energy, or focus for us to come
back and support each other.

0:48:36.810,0:48:44.200
And this, this is a big — what’s the word?

0:48:44.200,0:48:53.650
Like, this fracture is really detrimental
to novice nurses, to newcomers to the profession.

0:48:53.650,0:48:55.990
It’s a really vulnerable time.

0:48:55.990,0:49:02.849
And if they don’t have this, I don’t know
how they’ll stay.

0:49:02.849,0:49:05.150
And the healthcare system depends on them.

0:49:05.150,0:49:09.630
So I really appreciate the urgency that you
researchers are putting into looking at this.

0:49:09.630,0:49:11.780
It’s really, really, really wonderful.

0:49:11.780,0:49:16.290
Thank you.

0:49:16.290,0:49:17.690
Thank you, Michele.

0:49:17.690,0:49:22.849
I want to say that I can feel the emotion
and I was doing a lot of deep breathing as

0:49:22.849,0:49:28.840
you were speaking, and I invite everyone listening
who’s experiencing your story right now to

0:49:28.840,0:49:34.580
take a deep breath — or many, if you need
— and Michele, what I hear from what you’re

0:49:34.580,0:49:39.720
saying is echoes of the fear that Krissha
was talking about, the fear in the workplace,

0:49:39.720,0:49:46.190
and then on top of that, the isolation, which
is so debilitating for people who work as

0:49:46.190,0:49:50.650
a team, and who need to work as a team.

0:49:50.650,0:49:53.560
I would like to turn to Jennifer now.

0:49:53.560,0:50:00.500
You work as a family doctor, and I mentioned
off the top that you also provided COVID charts

0:50:00.500,0:50:04.900
every day on Twitter, which was very useful
for people who were fearful and who wanted

0:50:04.900,0:50:08.690
more information or to know how to understand
the information.

0:50:08.690,0:50:15.250
I know you did that Twitter work above and
beyond your regular job and healthcare professionals

0:50:15.250,0:50:22.089
have been going above and beyond on an individual
level, well, since before the pandemic, but

0:50:22.089,0:50:25.750
also have been asked to do that during this
time.

0:50:25.750,0:50:31.500
What has that been like in your experience
— that constant kind of above and beyond

0:50:31.500,0:50:32.570
feeling?

0:50:32.570,0:50:41.609
Well, thanks to Michele and Krissha for articulating
it so well, that feeling, especially early

0:50:41.609,0:50:45.190
in the pandemic, when there was no vaccines,
right?

0:50:45.190,0:50:48.530
We didn’t even have masks at times.

0:50:48.530,0:50:51.980
I remember even in my clinic, we were like
trying to order more masks.

0:50:51.980,0:50:56.090
We were running low, like how can we protect
our staff and continue to see patients, but

0:50:56.090,0:51:03.240
our supplier — our expect-delivery day,
it kept going back by months.

0:51:03.240,0:51:08.839
So it was that kind of fear that we all felt
initially and I think everyone tried to pitch

0:51:08.839,0:51:13.900
in in whatever way we can, like going beyond
what our regular clinical duties were.

0:51:13.900,0:51:16.900
For myself, I thought, oh, like I can share
information.

0:51:16.900,0:51:20.760
Yeah, it’s not part of my job, but I felt
like that was another way we can all work

0:51:20.760,0:51:21.760
together.

0:51:21.760,0:51:23.839
And I think early pandemic, we all did that.

0:51:23.839,0:51:30.230
Like we all thought about what we can contribute
and have a collective effort to protect our

0:51:30.230,0:51:32.650
patients, protect our families.

0:51:32.650,0:51:37.890
So I think that feeling we all definitely
shared.

0:51:37.890,0:51:43.809
And even now I think the struggle is that
we’re still constantly adapting to the changing

0:51:43.809,0:51:45.000
environment now.

0:51:45.000,0:51:49.210
Like COVID is increasing again, now we have
other respiratory viruses like RSV.

0:51:49.210,0:51:51.320
There’s just so much going on.

0:51:51.320,0:51:53.460
The children’s hospitals are struggling.

0:51:53.460,0:51:59.770
We’re still trying to keep PPE supplies up
and trying to protect our patients.

0:51:59.770,0:52:06.319
For example, we’re still doing outdoor visits
in the parking lot for people who have respiratory

0:52:06.319,0:52:10.240
symptoms, but the weather’s changing, so we
have to adapt to that.

0:52:10.240,0:52:16.030
And it can be difficult because when patients
are sick and struggling, sometimes they’re

0:52:16.030,0:52:23.200
also very upset, and that can affect us and
the staff if people are upset at us.

0:52:23.200,0:52:26.510
But really we shouldn’t be upset at one another.

0:52:26.510,0:52:32.359
We should still continue to try and have that
kind of collective sense of tackling the pandemic

0:52:32.359,0:52:34.109
together.

0:52:34.109,0:52:38.670
Because really I think that’s what everyone’s
grieving, we’re missing our pre-COVID times

0:52:38.670,0:52:44.480
where we didn’t have to have this looming
cloud, like Krissha said, over our heads,

0:52:44.480,0:52:46.920
and just live our lives and be normal.

0:52:46.920,0:52:52.980
But now that we know, it’s been so long, we
just never know when or if that will happen.

0:52:52.980,0:52:59.200
We have to continue to work together and adapt
and support one another through this.

0:52:59.200,0:53:03.920
Thank you, Jennifer.

0:53:03.920,0:53:10.420
You mentioned many things, but one of the
things you mentioned is that people are upset.

0:53:10.420,0:53:15.300
And I saw some data the other day, I don’t
know how they’re measuring it, but there’s

0:53:15.300,0:53:24.030
more rudeness — and I think that probably,
especially as people who deal with the public,

0:53:24.030,0:53:28.000
you probably don’t need a study or research
to show you that.

0:53:28.000,0:53:33.260
I’m just wondering if any one of you would
like to, to tell us about what it’s like to

0:53:33.260,0:53:40.410
be the helper, as we’ve talked about, and
all your energy goes into helping on the job

0:53:40.410,0:53:48.490
— and yet it is such an exhausting job for
all the reasons that you have outlined, needing

0:53:48.490,0:53:57.089
to go above and beyond, needing to really
have part of your mind go to PPE and thinking

0:53:57.089,0:54:07.510
about that, or the lack thereof, thinking
about handling patients who are upset.

0:54:07.510,0:54:09.930
And there are different types of exhaustion
too.

0:54:09.930,0:54:13.470
There’s physical exhaustion, but then there’s
mental exhaustion.

0:54:13.470,0:54:19.330
And I’m wondering if anybody would like to
jump in and just talk about how they handle

0:54:19.330,0:54:25.210
that.

0:54:25.210,0:54:30.000
I can probably provide an example.

0:54:30.000,0:54:42.819
I — there’s not really a way to handle this
huge stressor, I think.

0:54:42.819,0:54:49.589
How I managed to work through it and because
— like when I was in an outbreak situation,

0:54:49.589,0:54:50.920
I was pretty isolated.

0:54:50.920,0:54:53.040
I was away from my family members.

0:54:53.040,0:54:55.359
I had to live in the hotel.

0:54:55.359,0:54:57.980
There was — you’re by yourself.

0:54:57.980,0:55:01.520
You essentially get up to go to work.

0:55:01.520,0:55:06.510
You prepare yourself and you’re — I think
somebody wrote in the comments that they used

0:55:06.510,0:55:10.059
to cry in the car going in.

0:55:10.059,0:55:11.819
That used to be me.

0:55:11.819,0:55:14.910
That used to be how I managed to deal with
it.

0:55:14.910,0:55:21.630
And then, you’re worried about your other
colleagues who were also sick.

0:55:21.630,0:55:29.620
But the only thing you have to do is , you
have to get stuff done.

0:55:29.620,0:55:33.610
Someone has to take care of these people,
because who else is going to take care of

0:55:33.610,0:55:35.830
them, you know?

0:55:35.830,0:55:39.580
We have this like moral thing where we don’t
leave anyone behind.

0:55:39.580,0:55:46.260
We are in this position of power and these
people are so helpless and you treat them

0:55:46.260,0:55:50.420
like family, they’re part of your family.

0:55:50.420,0:55:54.090
You don’t leave anybody behind, so what do
you have to do?

0:55:54.090,0:55:58.289
You have to get up and then you have to do
it.

0:55:58.289,0:56:05.400
You have to put yourself in bootstraps, and
then you have to make a strong face for everyone

0:56:05.400,0:56:11.559
else because the next person you’re looking
at, who you might — they’re also just feeling

0:56:11.559,0:56:13.010
the same way as you are.

0:56:13.010,0:56:18.160
They’re also just breaking down inside, but
they don’t want to show it because they’re

0:56:18.160,0:56:24.180
scared that they’re going to be either stigmatized
or be labeled or whatnot.

0:56:24.180,0:56:28.170
But they’re also kind of like, I don’t want
to break down at work, I’m not that type of

0:56:28.170,0:56:29.170
person.

0:56:29.170,0:56:32.490
They have a lot of pride in their jobs and
they’re really dedicated.

0:56:32.490,0:56:42.160
So yeah, I remember crying because I couldn’t
care for somebody because I had spent so much

0:56:42.160,0:56:43.780
time on another patient.

0:56:43.780,0:56:54.349
And it’s true what they have, the research
shows, it’s, you’re never supposed to be in

0:56:54.349,0:56:59.349
a position where you have to be God.

0:56:59.349,0:57:00.660
You shouldn’t be.

0:57:00.660,0:57:04.859
You shouldn’t have to choose this person lives
and this person dies because you’re only one

0:57:04.859,0:57:10.242
nurse for 32 patients and everyone’s COVID
positive, and you only have a handful of staff,

0:57:10.242,0:57:14.280
and most of the staff are scared for their
own loved ones.

0:57:14.280,0:57:21.990
So I remember me and just the other, the PSW
who showed up for her patients, who’ve known

0:57:21.990,0:57:24.190
them for years and years and years.

0:57:24.190,0:57:28.430
And then we cry in the back and we say, you
know what?

0:57:28.430,0:57:32.160
We have to do, like, we have to take care
of these people.

0:57:32.160,0:57:33.640
Let’s get stuff done.

0:57:33.640,0:57:39.480
Let’s get, if we have to, if we miss some
stuff, what can we do?

0:57:39.480,0:57:40.480
Right?

0:57:40.480,0:57:46.319
Let’s just like, let’s just try our best,
because we are the only one who can help them.

0:57:46.319,0:57:49.299
And then there’s — they can’t even help
themselves.

0:57:49.299,0:57:55.220
And you have family members calling phones
and whatnot and you can’t even use the phone

0:57:55.220,0:57:56.940
because they’re all full of messages.

0:57:56.940,0:58:01.819
And as soon as the one phone rings, it’s like,
“Hi, did you hear about my family member?

0:58:01.819,0:58:02.819
Did you hear?

0:58:02.819,0:58:06.740
I’ve been calling everywhere” and I’m
like, “I’m so sorry.” This is a,

0:58:06.740,0:58:08.450
you can’t provide updates.

0:58:08.450,0:58:09.589
Yeah.

0:58:09.589,0:58:14.720
It’s … what you have to do.

0:58:14.720,0:58:16.480
Every day is like a war.

0:58:16.480,0:58:20.069
You have to put on your — you have to put
on your gear, you have to put on your mask,

0:58:20.069,0:58:21.820
you have to put on your face shield.

0:58:21.820,0:58:27.210
You have to be prepared, like wearing PPE
all the time.

0:58:27.210,0:58:33.340
You’re going to have your … nose marks,
and then you’re going to get severe headache

0:58:33.340,0:58:39.660
because of all the, Hasbro has provided you
with rubber band and a plastic shield and

0:58:39.660,0:58:46.590
stuff, and you’re like, am I — is this COVID,
is this just a headache, or is this just the

0:58:46.590,0:58:47.590
face shield?

0:58:47.590,0:58:49.280
You know?

0:58:49.280,0:58:57.710
And yeah, you have to … sometimes what made
me feel better, was that looking back at patients

0:58:57.710,0:59:01.810
when they were like, at their best, when they
were like laughing, they were just joking

0:59:01.810,0:59:07.810
around or they did some silly thing, or their
family members came and visited and how they

0:59:07.810,0:59:09.380
were reacting.

0:59:09.380,0:59:11.299
Yeah, , and it’s true what Michele said.

0:59:11.299,0:59:13.289
It’s really about camaraderie, right?

0:59:13.289,0:59:23.890
And then this pandemic kind of made us feel
more isolated and really fend for our own.

0:59:23.890,0:59:25.450
And it’s true.

0:59:25.450,0:59:27.250
Like, you go in utility closets.

0:59:27.250,0:59:32.380
I went to the chapel, I cried, and then I
was praying.

0:59:32.380,0:59:34.920
I was like, I hope I don’t get it.

0:59:34.920,0:59:41.130
And I, I hope no one else, you know — sorry,
I have monopolized the time.

0:59:41.130,0:59:44.420
If anyone wants to go, go.

0:59:44.420,0:59:46.869
Never say sorry.

0:59:46.869,0:59:50.000
Your stories are so important to us.

0:59:50.000,0:59:51.770
And Michele, I saw you nodding a lot.

0:59:51.770,0:59:53.250
Is there anything you wanted to add?

0:59:53.250,0:59:55.180
Yeah, and thanks Krissha.

0:59:55.180,0:59:56.849
You’ve really, you captured it.

0:59:56.849,0:59:58.500
It’s for sure what we deal with.

0:59:58.500,1:00:04.740
It’s this, it’s this— I would like to just
put it into a bit of context, because of my

1:00:04.740,1:00:08.770
elder status in the profession.

1:00:08.770,1:00:17.319
I remember when it was a really honourable,
not frantic, human, I might even call it a

1:00:17.319,1:00:18.319
gentle profession.

1:00:18.319,1:00:24.059
You know, in 1990 when I graduated, we had
only begun the defunding.

1:00:24.059,1:00:27.410
Defunding is said to have begun somewhere
in ’85, ’87.

1:00:27.410,1:00:35.840
Our healthcare system has been defunded for
32 years that I’ve been there.

1:00:35.840,1:00:45.920
The impact of consistent, progressive defunding
has come at the expense of — and I’m a bit

1:00:45.920,1:00:52.599
biased and I’m sorry — but nurses, we are
the bulk, physical workers of our healthcare

1:00:52.599,1:00:53.599
system.

1:00:53.599,1:00:55.210
We are the backbone of every hospital.

1:00:55.210,1:00:57.960
If you need a doctor, you go to a doctor’s
office.

1:00:57.960,1:01:00.870
If you’re in a hospital, it’s because you
need a nurse.

1:01:00.870,1:01:01.870
And we have defunded.

1:01:01.870,1:01:08.640
We as a province have chosen to defund healthcare
for 32 years, and it has brought all of us

1:01:08.640,1:01:09.700
to the brink.

1:01:09.700,1:01:17.440
The system now depends on each nurse working
full out and to an exhausted state that I

1:01:17.440,1:01:22.119
have never seen before.

1:01:22.119,1:01:32.150
And it is a malignancy that I think jeopardizes
the future of our healthcare system so fundamentally,

1:01:32.150,1:01:37.650
because nurses are fleeing, because they have
reached their limits.

1:01:37.650,1:01:40.869
They are, we are, all deeply exhausted.

1:01:40.869,1:01:44.080
And what happens with deep exhaustion, is
mistakes happen.

1:01:44.080,1:01:50.360
The moral injuries that do happen in distress
because we’ve made mistakes are real.

1:01:50.360,1:01:52.720
We don’t sleep very well at night.

1:01:52.720,1:01:57.720
We arrive — when, when someone hears a nurse
works 12 hours, it’s a lie.

1:01:57.720,1:02:01.390
I’m at work for 13 hours.

1:02:01.390,1:02:05.490
Our government has betrayed us by Bill 124.

1:02:05.490,1:02:13.099
And our unions haven’t been able to mobilize
any action to be of benefit to us.

1:02:13.099,1:02:19.270
And I just feel like a real threat is looming
at how our hospitals are going to function

1:02:19.270,1:02:27.390
and our healthcare and our nursing homes when
nurses begin to fall because it’s too much.

1:02:27.390,1:02:29.640
We can’t, we’re done.

1:02:29.640,1:02:35.760
We’re, we’re, we’re, we’re, we’re, we’re,
we’re breaking, you know.

1:02:35.760,1:02:41.799
It’s just, it’s, it’s a great urgent grief
and fear of mine.

1:02:41.799,1:02:50.539
I hear so much Michele in what you’re saying
that matches with the research that we have

1:02:50.539,1:02:54.190
been hearing about.

1:02:54.190,1:02:58.960
I hear the sense of betrayal organizationally
speaking.

1:02:58.960,1:03:07.890
I’m wondering if there’s anything else that
anyone on this panel has heard about in terms

1:03:07.890,1:03:11.700
of the definitions of moral injury and moral
distress and the research findings.

1:03:11.700,1:03:18.539
Was there anything else that really struck
you as fitting with your day to day experiences

1:03:18.539,1:03:24.520
at work?

1:03:24.520,1:03:30.819
I guess, one thing I wanted to mention is,
at the end of the day with this defunding

1:03:30.819,1:03:36.619
of the healthcare system, impacting all healthcare
workers, and at the end of the day, it’s the

1:03:36.619,1:03:38.849
patients that are going to suffer, right?

1:03:38.849,1:03:44.410
And sometimes we don’t see it with, it’s not
as immediate, like when you watch someone

1:03:44.410,1:03:48.390
get COVID and get really sick which is very
devastating.

1:03:48.390,1:03:55.619
But sometimes there’s these kind of long,
slow-burning kind of fires.

1:03:55.619,1:04:01.290
So for example, I have patients that would
get like a breast lump and then they have

1:04:01.290,1:04:06.319
to wait for imaging and they have to wait
for biopsy and they have to wait for results.

1:04:06.319,1:04:10.750
And then they have to wait for the specialist
to see them to find out what are the needs,

1:04:10.750,1:04:11.750
surgery or chemo.

1:04:11.750,1:04:16.340
And it’s, it’s so traumatizing to the patient
to have all these weights because the healthcare

1:04:16.340,1:04:18.220
system is so overwhelmed.

1:04:18.220,1:04:23.040
And these are kind of stories that you may
not hear as much because it’s kind of a more

1:04:23.040,1:04:28.089
slow, chronic problem that keeps getting worse.

1:04:28.089,1:04:32.640
For example, pap smears, now it takes like
four months for a result.

1:04:32.640,1:04:35.700
And that’s, what if we’re missing something?

1:04:35.700,1:04:38.010
What if there is something abnormal that needs
to be followed up on?

1:04:38.010,1:04:41.099
And we’re just not even getting results in
time.

1:04:41.099,1:04:47.049
So it, it’s hard because these things are
not as visible, but patient care is impacted

1:04:47.049,1:04:51.170
and when things are delayed, the diagnosis
is delayed.

1:04:51.170,1:04:55.620
Treatment may be more invasive and aggressive
because the cancer is worse.

1:04:55.620,1:05:03.859
So I think that hopefully maybe, if we can
continue to advocate for our professions and

1:05:03.859,1:05:08.030
for proper funding of the healthcare system,
we can avoid a collapse.

1:05:08.030,1:05:12.670
But it’s not looking great in terms of the
trajectory right now.

1:05:12.670,1:05:18.010
And it’s just very sad to see how a lot of
the weight is placed on our shoulders when

1:05:18.010,1:05:23.369
we really need the government to step in and
make things right.

1:05:23.369,1:05:32.460
I’d like to jump in if I can now with a question
from somebody who is here listening.

1:05:32.460,1:05:36.800
Her name is Tracy and she says she manages
a 31-bed unit.

1:05:36.800,1:05:39.770
“I am at 48% staffing.

1:05:39.770,1:05:45.569
My staff are at the breaking point.”
So this is what Michele is describing, and

1:05:45.569,1:05:52.099
Tracy says, “I am seeing toxic interactions
between our core staff and new I.E.N.”

1:05:52.099,1:05:53.900
If someone wants to explain what I.E.N.

1:05:53.900,1:05:58.970
means, I’m sorry, I don’t know, but Tracy
is saying she needs help.

1:05:58.970,1:06:01.109
“I’ve been a nurse for 30 years.

1:06:01.109,1:06:03.380
Is there anything I can do to help all my
staff?”

1:06:03.380,1:06:08.840
This is a very big question, but if there’s
anyone who, Krissha or Michelle or Jennifer,

1:06:08.840,1:06:18.150
if you have a piece of advice for Tracy, she
would like some advice.

1:06:18.150,1:06:20.210
I wish I had advice.

1:06:20.210,1:06:24.180
I wish I knew the answer.

1:06:24.180,1:06:33.460
It’s that your staffing levels are not rare
to have to run with 50% of your full-time

1:06:33.460,1:06:38.609
lines vacant, and no one to work those, that’s
normative now in healthcare.

1:06:38.609,1:06:43.790
What that means, if you don’t know what that
means, it means you work short.

1:06:43.790,1:06:47.940
And if you work 10% short, arguably each nurse
does 10% more work.

1:06:47.940,1:06:51.400
If you’re 20% short, you’re doing 20% more.

1:06:51.400,1:06:52.400
30% short.

1:06:52.400,1:06:54.720
So her unit’s running at 50% short.

1:06:54.720,1:06:56.650
That’s not surprising to me.

1:06:56.650,1:06:59.819
That’s probably where most of our emerg systems
are at.

1:06:59.819,1:07:04.349
And at that rate, the nurses who are coming
on, are working 50% more — because there’s

1:07:04.349,1:07:05.510
not fewer people.

1:07:05.510,1:07:09.270
Our population has grown while our funding
has shrunk.

1:07:09.270,1:07:16.750
So I think being a manager who cares and can
hear and can do their very best to support

1:07:16.750,1:07:23.069
and can recognize how everybody who does show
up tries their best and works their hardest.

1:07:23.069,1:07:27.950
I really appreciate when my boss says to me,
Michele, thank you for coming to work.

1:07:27.950,1:07:29.150
Thank you for showing up.

1:07:29.150,1:07:31.180
Thank you so much for staying late.

1:07:31.180,1:07:34.950
Thank you for everything you do.

1:07:34.950,1:07:38.529
It is pretty, pretty important to be thanked.

1:07:38.529,1:07:43.710
So that’s like the smallest thing I can suggest.

1:07:43.710,1:07:46.650
And I think Tracy, you’re not alone.

1:07:46.650,1:07:53.109
There’s every manager, every nursing unit
manager is dealing with this identical problem,

1:07:53.109,1:08:01.270
and the ability to affect an improvement is
really, really going to be difficult …

1:08:01.270,1:08:06.309
What I see is the fracture when she speaks
of senior nurses [who are] aggressive at each

1:08:06.309,1:08:07.309
other.

1:08:07.309,1:08:08.799
There’s a real fracture of relationships.

1:08:08.799,1:08:14.089
And this kind of, what I described as this
kind of thing, we used to stick together and

1:08:14.089,1:08:16.210
now — I have done it.

1:08:16.210,1:08:20.029
I have snapped at my fellow senior nurses.

1:08:20.029,1:08:27.359
I’ve snapped, and I’ve been — we now isolate
just so that we can self-regulate.

1:08:27.359,1:08:33.120
And we used to co-regulate and now we self-regulate
and it’s — we’ve lost an ability.

1:08:33.120,1:08:39.330
We’ve lost our way to find that relationship
when that’s fundamental to how we get through

1:08:39.330,1:08:40.330
our days.

1:08:40.330,1:08:45.790
And without that, we can hire new nurses,
but they don’t stay because there’s not a

1:08:45.790,1:08:47.390
network of support for them.

1:08:47.390,1:08:50.520
They are even more isolated and more afraid.

1:08:50.520,1:08:54.080
And it’s like a problem that’s like a snowball
going down a hill.

1:08:54.080,1:08:58.660
It’s getting bigger and bigger because as
people leave, there’s more work, as there’s

1:08:58.660,1:09:04.260
more work, there’s less support, there’s less
support, there’s less processing of the injury.

1:09:04.260,1:09:05.589
That’s part of our job.

1:09:05.589,1:09:07.549
Moral distress is part of our job.

1:09:07.549,1:09:12.230
It’s part of the, it’s part of the water we
swim in.

1:09:12.230,1:09:21.710
Like, there’s just no way you can be a nurse
and not have experienced this.

1:09:21.710,1:09:29.960
It’s just COVID tipped the balance in such
a negative way, and I think the people who

1:09:29.960,1:09:35.750
are studying nursing and healthcare workers’
traumas prior to COVID, I think the numbers

1:09:35.750,1:09:39.469
are probably there saying, yeah, the traumas
have been there all along.

1:09:39.469,1:09:44.949
But COVID certainly has just tipped it all,
the balance not in our favour.

1:09:44.949,1:09:47.009
So stay strong Tracy.

1:09:47.009,1:09:51.640
And I think love in the nurses you have is
already pretty great because, well, it’s kind

1:09:51.640,1:09:52.900
of all we can do.

1:09:52.900,1:09:53.900
I’m —

1:09:53.900,1:09:56.430
That’s great advice, Michele.

1:09:56.430,1:09:57.430
Thanks.

1:09:57.430,1:09:59.949
Yes, please finish your sentence.

1:09:59.949,1:10:01.280
I didn’t mean to cut you off.

1:10:01.280,1:10:02.300
Oh, it’s okay.

1:10:02.300,1:10:05.490
Nurses, we create nursing care plans for our
patients.

1:10:05.490,1:10:08.730
It’s kind of, if you’re a nurse, you know
what I’m talking about, that it’s what we

1:10:08.730,1:10:11.470
do to sort of, we create a nursing care plan.

1:10:11.470,1:10:16.790
And I have this wish that as nurses we can
create a nursing care plan for nurses that

1:10:16.790,1:10:21.600
we can figure out, cause our job’s so unique
and it’s so misunderstood.

1:10:21.600,1:10:24.010
We’re not represented in media.

1:10:24.010,1:10:25.500
People don’t understand what nurses do.

1:10:25.500,1:10:30.230
I feel like only nurses understand just what
we do, cause we’re there.

1:10:30.230,1:10:31.590
Anybody can follow me around for 12 hours.

1:10:31.590,1:10:32.590
I welcome you.

1:10:32.590,1:10:33.590
Please come.

1:10:33.590,1:10:37.810
I’ll try to help you understand what nurses
do, but I really would love to see us be able

1:10:37.810,1:10:45.860
to find a way to care for ourselves because
our problems are pretty unique in our environment

1:10:45.860,1:10:49.760
and our, our, our challenges are unique.

1:10:49.760,1:10:52.679
So that’s it.

1:10:52.679,1:10:58.780
I really hope that some of the recommendations
that Andrea had shared earlier can be like

1:10:58.780,1:11:03.760
a nurse’s, like a plan that you’re talking
about, a care plan.

1:11:03.760,1:11:09.840
I am running just a couple of minutes late
in our agenda, but I do want to close this

1:11:09.840,1:11:15.239
panel, which honestly, I could keep listening
to you for so long, I know that you have so

1:11:15.239,1:11:19.740
many stories and experiences that are very
illuminating.

1:11:19.740,1:11:25.429
But it, it, it, I don’t want to seem trite,
but I do want to end on some sort of a positive

1:11:25.429,1:11:31.071
note in terms of, when we started our panel,
we talked about what you love about the job,

1:11:31.071,1:11:35.650
and then we talked about the immense hardships
that you face every day.

1:11:35.650,1:11:40.659
And Krissha, you mentioned, you just have
to do it.

1:11:40.659,1:11:42.389
You just have to deliver the patient care.

1:11:42.389,1:11:43.850
You just do it.

1:11:43.850,1:11:46.699
You hug your colleague and you just keep going.

1:11:46.699,1:11:52.350
So I’m wondering, briefly, if everyone can
mention what is the one thing or what is a

1:11:52.350,1:11:59.820
thing that does keep you going, that can recharge
you reliably so you can continue to work.

1:11:59.820,1:12:02.610
And it’s in the spirit of the advice for Tracy.

1:12:02.610,1:12:10.469
You know, I would love to hear from all of
you, one thing that does that for you.

1:12:10.469,1:12:19.010
I see Krissha’s thinking, so I’ll leave her
for a moment.

1:12:19.010,1:12:21.830
Yeah, I’m going to be thinking.

1:12:21.830,1:12:22.830
Yeah.

1:12:22.830,1:12:25.110
It’s like a deep, dark dive.

1:12:25.110,1:12:26.110
Sorry.

1:12:26.110,1:12:27.110
Jennifer, would you like to start?

1:12:27.110,1:12:29.930
Sure, I can start.

1:12:29.930,1:12:35.960
I think one thing that keeps me going is that
when patients are at their most vulnerable,

1:12:35.960,1:12:43.450
when they’re sick and in distress, they need
someone to be there to be that calm, reliable

1:12:43.450,1:12:44.450
person.

1:12:44.450,1:12:49.650
And even though sometimes we don’t feel that
way, we’re struggling too, and we’re working

1:12:49.650,1:12:55.790
with limited resources, but the patient still
needs someone to be there for them that can

1:12:55.790,1:12:57.370
help them navigate the system.

1:12:57.370,1:12:59.330
And at the end of the day, that’s our job.

1:12:59.330,1:13:01.080
We need to help people.

1:13:01.080,1:13:02.080
We want to help people.

1:13:02.080,1:13:06.130
That’s why we came into the profession, whether
as a doctor or nurse or any other healthcare

1:13:06.130,1:13:07.130
provider.

1:13:07.130,1:13:10.310
And that’s what we will continue to do.

1:13:10.310,1:13:15.880
And that keeps me going because no one else
can be that person for that patient in that

1:13:15.880,1:13:23.780
time, and it’s just an honour to be in that
role.

1:13:23.780,1:13:24.780
Thank you.

1:13:24.780,1:13:26.560
And Michele?

1:13:26.560,1:13:33.800
I think when I spoke of what I love about
the profession, it’s still there.

1:13:33.800,1:13:36.320
All of what I spoke of is still there.

1:13:36.320,1:13:43.469
It’s not gone.

1:13:43.469,1:13:47.760
And so I only, it’s fracturing, but it’s not
gone and it’s still there and it’s still what

1:13:47.760,1:13:56.850
brings a lot of joy to all of our hearts,
that ability to be a team that comes together

1:13:56.850,1:13:59.699
and helps someone who’s in distress.

1:13:59.699,1:14:08.469
Who brings our incredible critical thinking
skills, our incredible scientific understanding,

1:14:08.469,1:14:17.639
our hands-on technical skills, when we can
do right by our patients, it’s a very glorious

1:14:17.639,1:14:18.639
moment.

1:14:18.639,1:14:27.500
And I think those still happen for sure, and
they’re still pretty rewarding moments.

1:14:27.500,1:14:34.409
I echo the same as Michele and Jennifer.

1:14:34.409,1:14:46.660
What keeps me going is a lot of coffee and
a lot of self-talk that like, you can do this,

1:14:46.660,1:14:51.870
you were put in this earth for a purpose.

1:14:51.870,1:14:53.250
And it’s true … what Michelle said.

1:14:53.250,1:14:54.270
It is a bit fractured.

1:14:54.270,1:14:59.460
cause now I see it in a different way now.

1:14:59.460,1:15:03.050
However, the only thing I can do is do right.

1:15:03.050,1:15:09.150
Do right by your patients, make your own difference.

1:15:09.150,1:15:11.699
And that’s what keeps me going.

1:15:11.699,1:15:14.239
I’m just like, I’m here to do my job.

1:15:14.239,1:15:21.050
I’m here to take care of this person … during
this shift, and that’s my responsibility.

1:15:21.050,1:15:24.830
And I will take care of them to the best of
my ability.

1:15:24.830,1:15:31.950
And yeah, because I, there’s now for me, I
no longer have trust with the system.

1:15:31.950,1:15:39.699
I now, I’m not very, I don’t trust the system,
I don’t think it works for any of us or for

1:15:39.699,1:15:43.219
the patients and for their own health and
safety.

1:15:43.219,1:15:46.770
So I have a lot of, I’m quite cautious.

1:15:46.770,1:15:53.040
I’m always, it’s terrible now, because I’m,
I’m more like a, kind of like a cynic now

1:15:53.040,1:15:54.090
because I don’t trust it.

1:15:54.090,1:16:00.190
But it doesn’t mean that, it doesn’t always,
it’s not always negative, it’s always positive.

1:16:00.190,1:16:06.300
So what I always think about is my patients
being discharged, walking out of there and

1:16:06.300,1:16:15.830
being, like having done something to promote
their own health, and making a really — and

1:16:15.830,1:16:21.260
also I find that they’ve also spoken to us
and really understand like, you guys are really

1:16:21.260,1:16:23.330
short, you guys are super short-staffed.

1:16:23.330,1:16:28.280
And they understand and they give us, and
they’re, they empathize with us and they say,

1:16:28.280,1:16:29.280
“I’m so sorry.

1:16:29.280,1:16:34.090
I’m not going to try to call, but I just need
this one thing.” And I’m like, “It’s

1:16:34.090,1:16:35.090
okay.

1:16:35.090,1:16:36.090
It’s fine.

1:16:36.090,1:16:41.040
You know, you need something, you need something.”
But they’re really, and I, and I appreciate

1:16:41.040,1:16:42.040
that.

1:16:42.040,1:16:43.040
I really do.

1:16:43.040,1:16:50.850
And I also appreciate them not voting for
Doug Ford, but that’s usually how we do it

1:16:50.850,1:16:52.980
during campaign season.

1:16:52.980,1:16:55.909
But yeah.

1:16:55.909,1:16:58.349
And yeah, sharing a laugh with them.

1:16:58.349,1:17:02.699
I don’t know if you guys notice, I really
like to laugh and that’s one of my thing is

1:17:02.699,1:17:10.760
just making people laugh and making my patients
laugh and I, that’s what keeps me going, is

1:17:10.760,1:17:16.159
at least like during their time of need, I
can always at least try to make them laugh,

1:17:16.159,1:17:23.050
and put a positive spin on a negative situation.

1:17:23.050,1:17:24.930
Your patients are lucky to have you.

1:17:24.930,1:17:29.820
And I say that to you Krissha and to you Michelle,
and to you Jennifer.

1:17:29.820,1:17:33.420
And I want to echo the feelings that are coming
through the chat.

1:17:33.420,1:17:36.060
There are many hearts and many thank yous.

1:17:36.060,1:17:43.650
I wish I could say thank you in an even bigger
way, but just, I hope you can see in the chat

1:17:43.650,1:17:49.389
that people are so appreciative of the space,
of the stories you’ve shared, and that you

1:17:49.389,1:17:54.520
brought your whole selves to this conversation,
which I’m sure was not easy though.

1:17:54.520,1:17:57.900
So thank you very, very much for today.

1:17:57.900,1:18:00.140
Thank you.

1:18:00.140,1:18:06.280
And I would like to tell everybody who is
here, please take this opportunity to have

1:18:06.280,1:18:09.860
a very quick break.

1:18:09.860,1:18:14.150
It’s meant to be five minutes, but maybe we’ll
even shorten it to three minutes.

1:18:14.150,1:18:15.150
We’ll see.

1:18:15.150,1:18:18.550
This is your time to grab a glass of water
if you need.

1:18:18.550,1:18:24.739
Also in the chat, I encourage everyone to
drop one word to just say how you’re feeling

1:18:24.739,1:18:26.010
at the end of that panel.

1:18:26.010,1:18:30.530
It would be really nice to connect or feel
that connection with everybody else who’s

1:18:30.530,1:18:31.530
here.

1:18:31.530,1:18:32.530
How are you feeling?

1:18:32.530,1:18:34.080
How are you doing?

1:18:34.080,1:18:38.909
So we’ll be on a quick break and then we’ll
come back with another panel with healthcare

1:18:38.909,1:18:40.880
researchers on this topic.

1:18:40.880,1:18:43.440
Thank you very much.

1:18:43.440,1:18:44.440
Hello.

1:18:44.440,1:18:49.110
And we’re coming back from the break.

1:18:49.110,1:18:52.989
Thank you so much to everybody who is keeping
the chat going.

1:18:52.989,1:19:00.110
I really enjoyed reading the comments, trying
to stay on top of them, but I’m so happy to

1:19:00.110,1:19:07.520
see how people are sharing what that last
panel felt like, to be a part of that conversation,

1:19:07.520,1:19:09.239
to be hearing the conversation.

1:19:09.239,1:19:15.130
A lot of feeling connected and recognized
and inspired and empowered.

1:19:15.130,1:19:20.699
So thank you everybody who is listening and
participating.

1:19:20.699,1:19:26.590
Now we are going to go to another panel this
time with researchers.

1:19:26.590,1:19:31.659
This panel is on risk and mitigating factors
of moral injury and moral distress and Canadian

1:19:31.659,1:19:34.090
healthcare providers during the pandemic.

1:19:34.090,1:19:41.050
So I’d like to introduce Mahée Gilbert-Ouimet
in Quebec, Michelle McCarron in Saskatchewan,

1:19:41.050,1:19:44.969
and Margaret McKinnon is coming back for this
panel as well.

1:19:44.969,1:19:50.800
So you three will be bringing your research
to this conversation, and I’ll go to each

1:19:50.800,1:19:55.050
one of you one at a time to describe your
research a little, and then we can open it

1:19:55.050,1:19:57.409
up for some conversation.

1:19:57.409,1:20:03.280
But first of all, I just want to know if anybody
has a quick reaction to what you heard in

1:20:03.280,1:20:07.280
the panel before the break.

1:20:07.280,1:20:08.760
I see Margaret nodding.

1:20:08.760,1:20:11.090
Maybe you would like to start.

1:20:11.090,1:20:12.090
Thank you, Hannah.

1:20:12.090,1:20:16.610
And you know, I don’t think we can say strongly
enough to our healthcare workers who spoke

1:20:16.610,1:20:19.170
today thank you for your courage.

1:20:19.170,1:20:25.530
We see reflected in the comments just how
much people are hearing, heard, recognized,

1:20:25.530,1:20:33.520
valued, and I think giving people words to
describe experiences are very powerful.

1:20:33.520,1:20:39.020
So hearing about moral injury, often people
say it helps me to realize I’m not alone,

1:20:39.020,1:20:43.350
that others are experiencing this, and we’re
hearing that in the chat today.

1:20:43.350,1:20:51.070
It also is a reflection of the incredible
service that nurses, physicians, occupational

1:20:51.070,1:20:57.050
therapists, environmental service workers,
admin assistants, everyone in the system has

1:20:57.050,1:20:58.050
given.

1:20:58.050,1:21:02.040
I can tell you that during the pandemic when
people were talking about the utility closets,

1:21:02.040,1:21:03.420
that rang so true.

1:21:03.420,1:21:09.920
I was in a COVID unit for a day and a half,
and I actually sat in the utility closet while

1:21:09.920,1:21:15.190
people changed their masks to provide mental
healthcare because of the only time those

1:21:15.190,1:21:18.690
healthcare workers had to receive care.

1:21:18.690,1:21:25.949
So I just feel that we cannot thank you enough
to all of you in the audience and to our panelists

1:21:25.949,1:21:30.370
for sharing your stories and for your courage
and your sacrifices.

1:21:30.370,1:21:33.230
So thank you.

1:21:33.230,1:21:35.330
Absolutely.

1:21:35.330,1:21:42.260
And Mahée or Michelle, would you like to
provide any reaction to what we just heard.

1:21:42.260,1:21:43.260
Yes.

1:21:43.260,1:21:50.929
Well, like Margaret, I want to thank you for
speaking up, for being there with us today.

1:21:50.929,1:21:53.440
I am an epidemiologist.

1:21:53.440,1:22:00.320
I work on stress at work among various population,
but the project that I’m going to speak to

1:22:00.320,1:22:06.370
you about in the next minute was my first
experience with moral injury.

1:22:06.370,1:22:13.810
And what I was not planning to say was that
I cried a lot when I was reading after the

1:22:13.810,1:22:16.360
interviews that I performed.

1:22:16.360,1:22:22.890
It was really hard and it’s kind of coming
up when I hear you speak.

1:22:22.890,1:22:25.179
So it’s a very humbling experience.

1:22:25.179,1:22:29.560
I admire you and I want to thank you.

1:22:29.560,1:22:37.870
And I, I just want to really echo what Margaret
and Mahée said about thanking the panelists,

1:22:37.870,1:22:41.480
the healthcare providers, for sharing their
stories.

1:22:41.480,1:22:48.790
It’s really so powerful hearing these stories
from you in your own words and how this experience

1:22:48.790,1:22:50.470
has impacted you.

1:22:50.470,1:22:58.930
And I had the same experience when I did research
in this area, that it brought tears to my

1:22:58.930,1:22:59.930
eyes, honestly.

1:22:59.930,1:23:07.370
Doing the interviews and then reading through
transcripts after, because just the amount

1:23:07.370,1:23:16.060
that people were impacted by their experiences
providing healthcare in those very trying

1:23:16.060,1:23:23.310
times, and the sustained impact it was having
on them, the cumulative impact, was really

1:23:23.310,1:23:24.310
powerful.

1:23:24.310,1:23:29.719
Yet they kept showing up day after day and
still doing this and trying to provide the

1:23:29.719,1:23:32.489
best care possible for patients.

1:23:32.489,1:23:39.710
And I heard those same themes echoed amongst
the healthcare panelists today, that strong

1:23:39.710,1:23:43.969
commitment to caring for patients really,
really comes through.

1:23:43.969,1:23:45.980
So thank you for that.

1:23:45.980,1:23:47.460
Yeah.

1:23:47.460,1:23:54.160
And I would like to add that for the panelists,
I was saying that there’s almost no way to

1:23:54.160,1:24:00.070
verbalize how much gratitude you feel when
you hear the stories communicated.

1:24:00.070,1:24:05.780
So please know that these are the kinds of
things we think about later, as Mahée said,

1:24:05.780,1:24:09.380
part of your research, we, your stories really
stay.

1:24:09.380,1:24:15.620
And I’m sorry, I’m just going to do this now
because we’ve been talking for so long the

1:24:15.620,1:24:19.380
batteries have died, so I, as long as you
can still hear me.

1:24:19.380,1:24:20.380
Yes?

1:24:20.380,1:24:27.230
I want to get right into the research that
all three of you are bringing to the panel.

1:24:27.230,1:24:29.140
Michelle, can we start with you?

1:24:29.140,1:24:34.440
If you want to briefly tell us about your
research and what types of stressors people

1:24:34.440,1:24:37.560
were describing to you in terms of their work
in healthcare?

1:24:37.560,1:24:38.560
Absolutely.

1:24:38.560,1:24:39.560
Thank you, Hannah.

1:24:39.560,1:24:44.989
And just before I get started, I do want to
acknowledge that I’m speaking to you from

1:24:44.989,1:24:47.989
Treaty 4 territory in Regina.

1:24:47.989,1:24:55.119
So my team and I did a qualitative study,
interview study, with healthcare providers

1:24:55.119,1:24:57.950
in the summer of 2021.

1:24:57.950,1:25:04.980
Wanting to learn more about their experiences
of providing healthcare during the pandemic

1:25:04.980,1:25:11.180
and the stressors that they were experiencing,
the workplace and the moral distress and experiences

1:25:11.180,1:25:13.590
of moral injury that arose from those.

1:25:13.590,1:25:21.380
So we conducted this study with 37 frontline
healthcare workers, whom we interviewed across

1:25:21.380,1:25:22.380
Saskatchewan.

1:25:22.380,1:25:27.710
It was supported by an IDEaS grant from the
Department of National Defence, and we had

1:25:27.710,1:25:32.250
the opportunity to speak with people in a
variety of roles.

1:25:32.250,1:25:37.441
So nurses, doctors, people in various types
of therapist positions, hospital food service

1:25:37.441,1:25:44.179
workers — so really trying to get a broad
spectrum of frontline healthcare providers.

1:25:44.179,1:25:46.610
And we also spoke to people from across the
province.

1:25:46.610,1:25:53.210
So we had a really good mix of rural, northern,
and urban healthcare providers and in a variety

1:25:53.210,1:25:54.790
of healthcare settings.

1:25:54.790,1:25:59.989
So in hospital, long-term care, or public
health, for example.

1:25:59.989,1:26:05.750
So we had representation from all of these
different parts of the province and people

1:26:05.750,1:26:08.489
and working in all sorts of roles.

1:26:08.489,1:26:14.610
Yet, there were a lot of types of workplace
stressors that people were bringing up to

1:26:14.610,1:26:17.969
us consistently when they were telling their
stories.

1:26:17.969,1:26:25.250
So some of these were preexisting the pandemic
and were exacerbated by the situations in

1:26:25.250,1:26:26.250
the pandemic.

1:26:26.250,1:26:32.790
So things like increased overtime, the regular
communication barriers that can arise when

1:26:32.790,1:26:37.929
you’re working in a large healthcare organization,
and particularly when directives were changing

1:26:37.929,1:26:44.350
so rapidly, particularly in the early days
of COVID, the stressors that come with working

1:26:44.350,1:26:53.510
in a fast-paced very high-charge, high-stakes
environment, and not always agreeing with

1:26:53.510,1:26:59.130
some of the decisions being made by leadership
about the different directives that they had

1:26:59.130,1:27:00.410
to follow.

1:27:00.410,1:27:06.909
So there were workplace stressors like that,
but there were also some workplace stressors

1:27:06.909,1:27:12.969
people described that were really novel for
them arising from the pandemic.

1:27:12.969,1:27:22.199
So things like staff redeployments to ensure
that coverage was in areas of greatest need.

1:27:22.199,1:27:29.370
Things that really they felt was impacting
the quality of the patient care that they

1:27:29.370,1:27:30.460
could provide.

1:27:30.460,1:27:37.480
So reducing or temporarily shutting down entire
services, delaying surgeries.

1:27:37.480,1:27:43.110
So if they weren’t emergent, then they were
typically delayed in a lot of cases.

1:27:43.110,1:27:48.520
And people said that these might not be seen
on paper as urgent, but they still really

1:27:48.520,1:27:50.900
impact the quality of life of patients.

1:27:50.900,1:27:56.400
And having to hear how much they were suffering
because of these delays was really taking

1:27:56.400,1:27:57.560
a toll on them.

1:27:57.560,1:28:03.900
And then there were things like enforcing
visitor restrictions, and this is one that

1:28:03.900,1:28:05.631
came up over and over again.

1:28:05.631,1:28:11.300
And particularly, I was hearing lots of stories
from people who were working in long-term

1:28:11.300,1:28:18.889
care settings and they kept bringing up the
experiences of working there at Christmas

1:28:18.889,1:28:19.960
time in 2020.

1:28:19.960,1:28:23.719
So these interviews were conducted in the
summer of 2020.

1:28:23.719,1:28:31.870
And it was really heartbreaking for people
to have to keep residents from visiting with

1:28:31.870,1:28:33.830
their family members.

1:28:33.830,1:28:42.780
So they understood the logic behind the rules
that need to try to prevent the spread of

1:28:42.780,1:28:43.780
COVID.

1:28:43.780,1:28:50.800
But people kept telling me that there’s that
physically protecting residents, but then

1:28:50.800,1:28:56.030
what about the psychosocial impacts, and the
impacts to their overall quality of life and

1:28:56.030,1:28:57.429
to their families?

1:28:57.429,1:29:03.230
And sometimes people wondered if the trade
off was worth it because they saw people suffering

1:29:03.230,1:29:04.670
in other ways so much.

1:29:04.670,1:29:12.570
So sometimes people would find some creative
workarounds for the rules and try to enforce

1:29:12.570,1:29:16.389
the spirit of the law, if not the letter of
the law, per se.

1:29:16.389,1:29:22.369
So there’s a story one time of someone that
said that they, they didn’t care if they were

1:29:22.369,1:29:25.880
going to get in trouble for this, but they
weren’t going to keep this family from seeing

1:29:25.880,1:29:26.880
the patient.

1:29:26.880,1:29:31.159
So they had the family stand in the doorway
and the foyer.

1:29:31.159,1:29:33.370
So there was still the inner doors there.

1:29:33.370,1:29:39.770
They still had the resident physically distanced,
but they were at least able to speak to each

1:29:39.770,1:29:41.750
other and see each other.

1:29:41.750,1:29:46.600
If people dropped off packages at that time,
they were supposed to hold them for 24 hours

1:29:46.600,1:29:48.159
before delivering them.

1:29:48.159,1:29:55.119
Just in case — because again, not sure how
much could be transmitted from passing packages

1:29:55.119,1:29:56.170
along.

1:29:56.170,1:30:00.540
So there was one person who said that, when
families dropped off packages on Christmas

1:30:00.540,1:30:05.060
Day, they weren’t going to withhold those
from residents on Christmas.

1:30:05.060,1:30:12.909
So they took sanitary wipes, wiped the packages
down thoroughly, and delivered them.

1:30:12.909,1:30:16.580
So trying to find those compromises.

1:30:16.580,1:30:24.350
There were these stories, these examples of
people who were experiencing these moral dilemmas

1:30:24.350,1:30:31.530
about do I do what I feel is really right
for my patients and residents versus do I

1:30:31.530,1:30:34.280
follow the directives to the letter?

1:30:34.280,1:30:40.310
And people were really struggling with what
that brought up for them and wrestling with

1:30:40.310,1:30:42.420
those types of decisions.

1:30:42.420,1:30:46.730
So that, that was a really big overarching
theme there.

1:30:46.730,1:30:51.860
So maybe I’ll just stop it there for now so
I can let other people have a chance to speak,

1:30:51.860,1:30:55.949
but I’m sure we’ll come back to this at some
point.

1:30:55.949,1:30:56.949
Yes.

1:30:56.949,1:30:57.949
Thank you Michelle.

1:30:57.949,1:31:04.639
And I would like to go to Mahée because you
also did research on moral injury based on

1:31:04.639,1:31:07.739
interviews with healthcare workers in Quebec.

1:31:07.739,1:31:13.989
Were you hearing a lot of the same types of
stories, or can you tell us about the stressors

1:31:13.989,1:31:17.460
that healthcare workers were describing to
you?

1:31:17.460,1:31:18.460
Absolutely.

1:31:18.460,1:31:19.490
Thank you Hannah.

1:31:19.490,1:31:20.950
And thank you Michelle.

1:31:20.950,1:31:27.500
Yes, there are definitely overlaps between
what we shared, what we observed in our research,

1:31:27.500,1:31:34.430
so a little context for you to understand
what my team and I did.

1:31:34.430,1:31:43.450
So we led a research project among 572 frontline
healthcare workers during the third wave of

1:31:43.450,1:31:46.489
the pandemic, so also during the summer of
2021.

1:31:46.489,1:31:51.190
The project was also funded by the Ministry
of Defence of Canada.

1:31:51.190,1:31:55.230
Participants, there were two phases of the
study.

1:31:55.230,1:32:02.150
So participants first completed a quantitative
questionnaire, mainly focusing on psychosocial

1:32:02.150,1:32:10.040
stressors at work and mental health problems,
including moral injury and a subgroup of them

1:32:10.040,1:32:18.150
then were invited to be involved in qualitative
interviews to get a deeper understanding of

1:32:18.150,1:32:23.420
the events and emotions that led to moral
injuries.

1:32:23.420,1:32:31.250
So in the quantitative component of the study,
the stressor that I really want to speak about

1:32:31.250,1:32:38.650
today is the stressor that had the highest
adverse association with moral injury.

1:32:38.650,1:32:43.590
It was the lack of ethical culture in the
workplace.

1:32:43.590,1:32:51.330
It’s not surprising in our sample participants
working in a setting lacking ethical culture

1:32:51.330,1:33:00.040
had five times more risk of moral injury compared
to workers benefiting from a strong or adequate

1:33:00.040,1:33:02.300
ethical culture at work.

1:33:02.300,1:33:06.620
So you might wonder what are we calling a
lack of ethical culture?

1:33:06.620,1:33:14.130
So we asked a series of questions like, in
general, unethical situations that arise at

1:33:14.130,1:33:19.860
work or not discussed transparently with those
directly involved.

1:33:19.860,1:33:26.710
We also asked in general, analytical situation
that arise at work are not constructively

1:33:26.710,1:33:31.500
presented and openly discussed with the rest
of the workplace.

1:33:31.500,1:33:38.219
So we spoke about debriefing, the importance
of the debriefing with the team.

1:33:38.219,1:33:46.800
So in qualitative interviews, to give you
an example of a verbatim a participant reported,

1:33:46.800,1:33:53.929
“If I think about the profession that
I’m doing, a value that they told us so much

1:33:53.929,1:34:00.500
about during our university studies was that
if you are doing something, do it right, do

1:34:00.500,1:34:04.100
it neutral, but do not harm.

1:34:04.100,1:34:11.230
By obeying the directives, I consider myself
doing harm.” So it kind of resonates

1:34:11.230,1:34:15.170
with what we heard before the pause.

1:34:15.170,1:34:21.969
So this testimony was aligned with other events
that were reported by participants.

1:34:21.969,1:34:34.040
Events involved being unable to provide appropriate
care, even basic one, because of lack of resources.

1:34:34.040,1:34:40.440
We were also told about the inability to apply
security measures and directives related to

1:34:40.440,1:34:48.940
COVID-19, being unable to ensure your own
security, but also patients’ safety and not

1:34:48.940,1:34:52.070
being adequately supervised.

1:34:52.070,1:34:59.400
And this was reported a lot when speaking
about movements from units to units and having

1:34:59.400,1:35:05.670
to sometimes switch specialty and not being
adequately trained.

1:35:05.670,1:35:15.150
So these events were linked to a moral injury
through emotions like frustration, anger,

1:35:15.150,1:35:24.560
guilt, shame, helplessness, feelings of worthlessness,
isolation, or deconsolidation of the work,

1:35:24.560,1:35:33.219
collective feeling of injustice and betrayal,
like Margaret spoke about feeling of incompetence,

1:35:33.219,1:35:38.010
sadness, and also sometimes loss of meaning.

1:35:38.010,1:35:44.650
So I’m going to finish my short intervention
about the values that were reported as hurt.

1:35:44.650,1:35:55.160
They reported that professionalism was hurt,
patient and self safety, compassion, kindness,

1:35:55.160,1:35:56.630
and humanity.

1:35:56.630,1:36:06.340
So I’m finishing this little testimony by
reiterating the importance of ethical culture,

1:36:06.340,1:36:11.200
at least in our research project.

1:36:11.200,1:36:17.200
Thank you so much for that Mahée and for
describing what an ethical culture looks like,

1:36:17.200,1:36:22.840
which it, it sounds like a lot of communication
and understanding— like recognizing the

1:36:22.840,1:36:26.139
humanity of the people who do the jobs that
we need done.

1:36:26.139,1:36:30.130
Margaret, I would like to turn to you now.

1:36:30.130,1:36:35.440
Earlier when you were speaking with us, we
talked about moral injury, what it meant,

1:36:35.440,1:36:37.010
what an injury meant.

1:36:37.010,1:36:42.570
I would like to talk about the, or have you
talk about the neuroscience around trauma.

1:36:42.570,1:36:47.580
Can you describe what effect moral injury
has on our brains?

1:36:47.580,1:36:48.580
Yeah, I certainly can.

1:36:48.580,1:36:54.010
And Hannah, if you don’t mind, I’m just going
to follow up a little bit of what we said

1:36:54.010,1:36:57.210
already and then turn to that question if
that’s alright.

1:36:57.210,1:37:01.639
I think what we’ve heard from Mahée and Michelle
is very much what we also heard across the

1:37:01.639,1:37:02.639
country.

1:37:02.639,1:37:07.500
We conducted 134 qualitative interviews and
heard very similar themes, which I think speaks

1:37:07.500,1:37:12.199
to … those experiences that buying Canadian
healthcare workers together.

1:37:12.199,1:37:17.590
And we know that one of the most protective
factors against the development of post-traumatic

1:37:17.590,1:37:21.420
stress disorder in the face of situations
like this is social support.

1:37:21.420,1:37:28.619
So being able to speak to one another, to
hear one another’s stories, to provide empathy

1:37:28.619,1:37:29.990
and caring and support.

1:37:29.990,1:37:35.190
And so I think part of what our job is in
the Canadian healthcare system right now,

1:37:35.190,1:37:41.110
is to recognize the organizational and systemic
factors that are impacted upon healthcare

1:37:41.110,1:37:44.909
workers and to provide the supports to bring
the system back together again to bring the

1:37:44.909,1:37:47.130
family back together again, essentially.

1:37:47.130,1:37:51.449
We’ve done similar interviews in public safety
personnel, which we’ll be holding another

1:37:51.449,1:37:53.780
symposium on later in the year to talk about.

1:37:53.780,1:37:59.719
But I also want to say that when we looked
at what are the factors that are driving departures

1:37:59.719,1:38:04.830
from the healthcare workforce right now, and
we heard a lot about that from Michele, from

1:38:04.830,1:38:11.280
Krissha, and also from Jennifer, we found
that moral distress is what’s driving the

1:38:11.280,1:38:15.199
decision of one in two healthcare workers
who are currently considering leaving their

1:38:15.199,1:38:16.250
clinical positions in Canada.

1:38:16.250,1:38:21.340
And so when we look at the number one factor
that’s driving that, it is the moral distress

1:38:21.340,1:38:26.110
in the situations like Mahée and Michelle
described here.

1:38:26.110,1:38:30.750
And so I think when we think about the peril
that our healthcare system is currently in

1:38:30.750,1:38:37.010
due to healthcare shortages due to rapid staff
departures and so on, we really do need to

1:38:37.010,1:38:42.050
target, to know about these experiences with
the moral distress to address the organizational

1:38:42.050,1:38:47.091
and systemic factors that underlie some of
this, and to provide the individual level

1:38:47.091,1:38:50.659
supports to healthcare workers and all healthcare
workers.

1:38:50.659,1:38:55.909
Be that food services workers, occupational
therapists, nurses, physicians, everyone in

1:38:55.909,1:38:59.340
the system who’s providing this service.

1:38:59.340,1:39:04.830
And the simple value of saying thank you,
I think cannot be underestimated.

1:39:04.830,1:39:09.969
I have been in basements of hospitals saying
thank you, and to see the look on people’s

1:39:09.969,1:39:17.830
faces when they hear, thank you for your service,
because this is service and your sacrifice.

1:39:17.830,1:39:21.630
And to say thank you, those simple words are
very powerful.

1:39:21.630,1:39:24.250
And I think the more we say it, the better.

1:39:24.250,1:39:27.010
So we want to say it again publicly here today.

1:39:27.010,1:39:34.380
When we talk about the neuroscience of trauma,
we certainly know that there’s a saying in

1:39:34.380,1:39:37.610
trauma that the body keeps the score.

1:39:37.610,1:39:42.260
And so among people who have experienced trauma,
for example, we see higher rates of heart

1:39:42.260,1:39:48.380
disease, obesity, diabetes, and other forms
of cardiovascular risk factors.

1:39:48.380,1:39:53.659
We also see changes in brain functioning and
brain structure.

1:39:53.659,1:39:58.469
And so we can see pat differences in the patterns
of the way that the brain works together in

1:39:58.469,1:39:59.469
concert.

1:39:59.469,1:40:03.699
And we can also see what’s called essentially
a loss of some of the tissue in the brain

1:40:03.699,1:40:08.280
with repetitive stress or even a single trauma
in some cases.

1:40:08.280,1:40:13.570
And so what we do with all the work that we
do is focused on helping to to help with some

1:40:13.570,1:40:17.610
of the impacts of those changes in the body
and in the brain.

1:40:17.610,1:40:23.659
With moral injury, in work that we’ve done
led by Ruth Lanius at the University of Western

1:40:23.659,1:40:27.389
Ontario, and with some graduate students that
we co-supervised and postdoctoral fellows,

1:40:27.389,1:40:34.389
Chantal Lloyd and Braden Tripo, we actually
had military members and public safety personnel

1:40:34.389,1:40:40.389
who had PTSD recall events that were associated
with moral injury for them.

1:40:40.389,1:40:45.460
So that could be, for example, being in the
combat theatre and seeing a baby going down

1:40:45.460,1:40:47.449
the river and being powerless to intervene.

1:40:47.449,1:40:50.070
That’s a description, that’s an apt description.

1:40:50.070,1:40:56.860
Or being a first responder who is not able
to go into a lake to save the person because

1:40:56.860,1:40:58.429
the rules of engagements say that they can’t.

1:40:58.429,1:41:03.070
And people talk about these moral injuries
and the consequences for their lives, just

1:41:03.070,1:41:06.610
like we hear here with healthcare workers.

1:41:06.610,1:41:12.739
And what we found is that when these public
service personnel and military members recalled

1:41:12.739,1:41:19.890
these events, we saw areas of the brain involved
in disgust light up.

1:41:19.890,1:41:20.890
They were active.

1:41:20.890,1:41:25.719
So that feeling in your stomach, like you’ve
been punched in the gut, that [part of] the

1:41:25.719,1:41:30.449
brain which is called the insula, and that
region was very, very active when these memories

1:41:30.449,1:41:32.750
were recalled.

1:41:32.750,1:41:37.570
We also saw that areas of the brain, so one
is the dorsal, it’s called the dorsal anterior

1:41:37.570,1:41:42.110
cingulate, [which is] sort of the middle of
the brain, that’s associated with shame and

1:41:42.110,1:41:43.280
guilt.

1:41:43.280,1:41:46.770
And that brain region, again, was very, very
active.

1:41:46.770,1:41:50.010
And the brain was trying to compensate for
this.

1:41:50.010,1:41:55.010
So the frontal part of the brain, which really
helps to regulate our emotions, it was trying

1:41:55.010,1:42:01.989
to dampen down those feelings of disgust,
the shame and the guilt, the feeling of moral

1:42:01.989,1:42:02.989
judgment.

1:42:02.989,1:42:06.350
The brain was working overtime to try to dampen
that down in a protective way.

1:42:06.350,1:42:14.119
And so what I would say these stories tell
us is they tell us the impact of trauma and

1:42:14.119,1:42:17.239
situations like moral injury on the brain.

1:42:17.239,1:42:22.909
This is an injury like all other injuries,
and there’s so much shame and guilt that surveils

1:42:22.909,1:42:23.909
mental illness.

1:42:23.909,1:42:30.720
But here we see the changes to the brain that
occur and we can show it in a picture.

1:42:30.720,1:42:31.720
This is what’s happening.

1:42:31.720,1:42:36.489
So I think that helps to again, explain the
experience and what happens in the brain makes

1:42:36.489,1:42:40.780
complete sense in terms of people feel like
they’ve had a punch in the gut.

1:42:40.780,1:42:43.530
And this lingers after the incident itself.

1:42:43.530,1:42:48.530
These are scans that could be taken four,
five, 10, 15 years later, and we’re still

1:42:48.530,1:42:54.739
seeing that punch to the gut in the brain.

1:42:54.739,1:43:03.190
What I love about neuroscience and the work
that you do, Margaret, is that when you see

1:43:03.190,1:43:10.219
that injury and the evidence of it, I hope
that it does take the onus off of individuals

1:43:10.219,1:43:12.239
who are thinking, why can’t I cope?

1:43:12.239,1:43:13.239
Yeah.

1:43:13.239,1:43:14.690
In fact, you are wired in a way.

1:43:14.690,1:43:21.320
We are all wired in ways to react to these
situations and it’s partially why your work

1:43:21.320,1:43:24.500
is so important.

1:43:24.500,1:43:30.050
In the few minutes we have left, I would like
to ask this whole panel about what you would

1:43:30.050,1:43:36.869
like to see workplaces do in order to lessen
the impact of moral distress on healthcare

1:43:36.869,1:43:37.869
workers.

1:43:37.869,1:43:41.850
If we have heard from Michelle that moral
distress is a part of the job for nurses right

1:43:41.850,1:43:47.739
now, what can workplaces do to lessen the
impact?

1:43:47.739,1:43:53.820
And I would also like to ask about what you
are seeing in terms of hope for how workplaces

1:43:53.820,1:43:54.840
are changing.

1:43:54.840,1:43:59.570
So we’ll just start, we’re going to cram a
lot into the last five minutes, okay everyone?

1:43:59.570,1:44:03.630
So I would just like to start with what you
would like to see workplaces doing.

1:44:03.630,1:44:05.780
Maybe Michelle, would you like to begin?

1:44:05.780,1:44:06.780
Sure.

1:44:06.780,1:44:12.989
Well, I do want to say that I think it’s encouraging
that workplaces are having this discussion

1:44:12.989,1:44:14.830
more openly.

1:44:14.830,1:44:19.020
So we would see, for example, in internal
newsletters that would come out, that they

1:44:19.020,1:44:24.920
would be advertising the mental health support
line for staff telling people what sort of

1:44:24.920,1:44:25.920
E.F.A.P.

1:44:25.920,1:44:30.989
resources were available for mental health
supports and including kind of mental wellness

1:44:30.989,1:44:31.989
tips.

1:44:31.989,1:44:37.110
Now that’s where it sometimes kind of fell
flat for people that I spoke with in the interviews.

1:44:37.110,1:44:42.810
And that’s where I think we could maybe do
a better job of increasing supports for people,

1:44:42.810,1:44:48.870
is engaging the frontline healthcare workers
and determining what types of mental health

1:44:48.870,1:44:51.650
supports are going to be most meaningful for
them.

1:44:51.650,1:44:57.469
So I would have people telling me that it’s
all very well and good to provide tips on

1:44:57.469,1:45:01.929
healthy sleep hygiene, but if they’re working
so many hours and then have family to take

1:45:01.929,1:45:07.610
care of that they don’t have the number of
hours in a day to be able to sleep like that,

1:45:07.610,1:45:11.619
then they’re not able to implement those types
of suggestions.

1:45:11.619,1:45:17.600
So really engaging the frontline healthcare
workers in helping to come up with the solutions

1:45:17.600,1:45:24.599
for what is going to support them best in
the workplace.

1:45:24.599,1:45:27.590
Mahée, would you like to add to that?

1:45:27.590,1:45:28.590
Yes.

1:45:28.590,1:45:29.590
Thank you.

1:45:29.590,1:45:30.590
Thank you, Michelle.

1:45:30.590,1:45:32.080
Thank you so much.

1:45:32.080,1:45:39.050
As a result of our research project, we formulated
recommendations and I’m going to place them

1:45:39.050,1:45:45.100
on the chat because I know that we are tight
on schedule, so I’m not sure that everybody

1:45:45.100,1:45:51.989
could see them, but maybe you can oppose them.

1:45:51.989,1:45:59.880
So, our recommendations are not one size fits
all recipe, but they aim to heal the working

1:45:59.880,1:46:00.880
environment.

1:46:00.880,1:46:03.800
So we are not into coping mechanism.

1:46:03.800,1:46:10.700
We really want to focus on the working environment
and on building a climate of kindness and

1:46:10.700,1:46:12.810
of psychosocial safety.

1:46:12.810,1:46:19.290
They are grouped into different categories,
and I’m going to just give you a few examples

1:46:19.290,1:46:21.840
really quickly.

1:46:21.840,1:46:23.210
First category is training.

1:46:23.210,1:46:31.050
So we really think it’s important to train
the leaders to detect the first signs of the

1:46:31.050,1:46:39.489
stress or of moral challenges in their employees
and to actively listen and support.

1:46:39.489,1:46:41.250
Second key is communicating.

1:46:41.250,1:46:50.170
So opening the gate of open, frequent empathetic
and leader-led team discussions to build awareness

1:46:50.170,1:46:57.120
and prepare for the situations that might
or that will come up.

1:46:57.120,1:47:04.100
Like Michelle says, having all levels of worker
participating in the intervention efforts

1:47:04.100,1:47:11.790
is crucial, and I’m going to end with prioritizing,
prioritizing mental health.

1:47:11.790,1:47:17.830
There are not a lot of resources in the healthcare,
but we cannot keep on pushing back.

1:47:17.830,1:47:21.199
This is a priority among the other priorities.

1:47:21.199,1:47:26.100
So that’s it for me for now.

1:47:26.100,1:47:27.510
Thank you.

1:47:27.510,1:47:29.219
Mahée, thank you so much.

1:47:29.219,1:47:34.300
I think you said that you had dropped the
link in the chat, but I don’t see it.

1:47:34.300,1:47:40.469
So maybe if you want to try that again in
the last few minutes or as well, I’m hoping

1:47:40.469,1:47:48.150
that Sangita can drop the link to the Healthcare
Salute website and socials and so afterwards,

1:47:48.150,1:47:52.940
I hope that everyone here can follow up for
further connection there.

1:47:52.940,1:48:00.260
Margaret, can I end with you in, in terms
of where you see hope, for how workplaces

1:48:00.260,1:48:03.980
are changing and incorporating these discussions
in the workplace?

1:48:03.980,1:48:04.980
Sure.

1:48:04.980,1:48:05.980
Thank you.

1:48:05.980,1:48:09.560
And so we asked healthcare records in the
interview, what is it that you need?

1:48:09.560,1:48:12.560
What would help you?

1:48:12.560,1:48:17.000
And many of these healthcare workers said
we want people to know our stories.

1:48:17.000,1:48:21.270
We want people to hear, we don’t want to have
to keep retelling them.

1:48:21.270,1:48:25.360
And when we go for mental health supports,
for example, that the person at the end of

1:48:25.360,1:48:28.250
the line isn’t crying when they hear our story.

1:48:28.250,1:48:32.110
And that often happens for public safety personnel
and military members.

1:48:32.110,1:48:38.850
They tell their stories to a mental health
professional and they end up comforting the

1:48:38.850,1:48:39.850
mental health professional.

1:48:39.850,1:48:40.850
And that’s difficult, right?

1:48:40.850,1:48:44.659
So we’ve been really fortunate to have funding
from the Public Health Agency of Canada, a

1:48:44.659,1:48:49.530
donation from Homewood Health, Centre of Excellence
on PTSD, and the Canadian Institutes of Health

1:48:49.530,1:48:53.560
Research, which is really hopeful, to see
all these agencies supporting this to develop

1:48:53.560,1:48:58.780
cultural competency or cultural sensitivity
around the experiences of healthcare workers.

1:48:58.780,1:49:05.210
And so, the courage we saw here today of healthcare
workers who told their stories and continuing

1:49:05.210,1:49:11.710
work to really get that knowledge out to the
public, to leaders, to policy makers, and

1:49:11.710,1:49:17.170
to others, we really have the opportunity
to provide supports that are culturally competent

1:49:17.170,1:49:21.550
and what people need and what they’re asking
for, and so that they don’t have to retell

1:49:21.550,1:49:24.370
their stories over and over again.

1:49:24.370,1:49:29.850
Well, thank you so much Margaret, and thank
you Mahée and Michelle.

1:49:29.850,1:49:37.820
And you know, I can see in the chat that there’s
a lot of reaction to the research and the

1:49:37.820,1:49:44.550
information that you’ve shared, and I also
just want to thank every participant who has

1:49:44.550,1:49:50.210
presented or spoken today, and especially
to the hundreds of people who showed up from

1:49:50.210,1:49:55.360
across the country to come and listen and
learn and to participate in the chat as well.

1:49:55.360,1:50:00.210
So Mahée, I think you said this is a priority
among priorities.

1:50:00.210,1:50:05.599
I couldn’t agree more, and I hope that everybody
here has gotten something out of the symposium

1:50:05.599,1:50:08.170
and that you can stay connected as well.

1:50:08.170,1:50:15.260
So there was a wellness slide earlier with
some mental health resources.

1:50:15.260,1:50:18.210
I hope that that can be shared again here.

1:50:18.210,1:50:23.850
And I just want to wish everybody a good day
and thank you so much for taking part.

1:50:23.850,1:50:24.850
Goodbye.

1:50:24.850,1:50:30.860
And thank you to all of you for your service.

1:50:30.860,1:50:31.860
We salute you.