Factsheets

Bedroom for quarantine for patient infected with Covid 19 virus in hospital.

What can I do to take care of myself?

Coping strategies can help you manage stress and assist with healing. Unfortunately, the pandemic has created obstacles for health care providers’ access to resources, like limited time off work and COVID-19 related restrictions (closed gyms, etc.).

It can be hard to find the energy to engage in coping strategies, so having a few go-to tools can be very helpful. Here are some you can begin to put in place right away:

  • Set and keep routines that help with work-life balance. Focus on a healthy diet, enough sleep, exercise, and time with friends and family.
  • Pick up a hobby that gives you pleasure.
  • Set small goals for yourself. These will give you a sense of accomplishment, and signal that you are taking care of yourself.
  • Practice deep breathing. Inhale for four counts, exhale for four counts, practice for four minutes. Deep breathing sends oxygen to the brain and helps relax the body.
  • Positive self-talk. Redirect negative thoughts by reframing them.
  • Visualization. Pay attention to all senses and visualize positive images. For example, imagine the sounds, smells, and sights of a calming scene.
  • Self-care. Go for a walk, engage with your religion/spirituality, journal, read a book, take a nap or bath, listen to music. Do something that feels good!
  • Self-compassion. Show yourself the same kindness you would to a friend who is struggling. Find guided self-compassion exercises here.
  • Mental Health Continuum Model. This tool (below) helps identify your current mental health status and provides relevant resources.
Close up of exhausted nurse in office looking on camera wearing ppe suit

What is the Mental Health Continuum Model?

The Mental Health Continuum Model is a self-assessment tool that checks your mental health status. By giving you the ability to identify changes in your mental health, this tool can increase resilience, reduce stigma, and improve well-being.

Once you’ve used the tool to check-in with yourself, it will show your place on the continuum, and direct you to helpful resources.

Published with the permission of the Canadian Armed Forces.

In the model, you’ll notice four colour blocks:

Green means you’re healthy

Yellow means you’re reacting

Orange means you’re injured

Red means you’re ill

The table below illustrates the Mental Health Continuum Model, and includes some of the thoughts and feelings people might have in each of its colour blocks.

Use the guided self-assessment provided below to help you identify which colour block best represents your current mental health.

Remember, mental health is always changing so you can return to the scale again to see how you have moved on the Continuum.

Note: Signs and indicators in the yellow block of the continuum are normal responses to stress and trauma that can be expected to resolve over time.

The Mental Health Continuum Model: signs and indicators

HealthyReactingInjuredIll
  • Normal mood fluctuations
  • Calm/confident
  • Good sense of humour
  • Takes things in stride
  • Can concentrate/focus
  • Consistent performance
  • Normal sleep patterns
  • Energetic, physically well, stable weight
  • Physically and socially active
  • Performing well
  • Limited alcohol consumption, no binge drinking
  • Limited/no addictive behaviours
  • No trouble/impact due to substance use
  • Nervousness, irritability
  • Sadness, overwhelmed
  • Displaced sarcasm
  • Distracted, loss of focus
  • Intrusive thoughts
  • Trouble sleeping, low energy
  • Changes in eating patterns, some weight gain/loss
  • Decreased social activity
  • Procrastination
  • Regular to frequent alcohol consumption, limited binge drinking
  • Some-to-regular addictive behaviours
  • Limited-to-some trouble/impact due to substance use
  • Anxiety, anger, pervasive sadness, hopelessness
  • Negative attitude
  • Recurrent intrusive thoughts/images
  • Difficulty concentrating
  • Restless, disturbed sleep
  • Increased fatigue, aches, and pain
  • Fluctuations in weight
  • Avoidance, tardiness, decreased performance
  • Frequent alcohol consumption, binge drinking
  • Struggle to control addictive behaviours
  • Increased trouble/impact due to substance use
  • Excessive anxiety, panic attacks, easily enraged, aggressive
  • Depressed mood, numb
  • Non-compliant
  • Cannot concentrate, loss of cognitive ability
  • Suicidal thoughts/intent
  • Cannot fall asleep/stay asleep
  • Constant fatigue, illness
  • Extreme weight fluctuations
  • Withdrawal, absenteeism
  • Can’t perform duties
  • Regular-to-frequent binge drinking
  • Addiction
  • Significant trouble/impact due to substance use

Actions to take at each phase of the Continuum

HealthyReactingInjuredIll
  • Focus on task at hand
  • Break problems into manageable tasks
  • Controlled, deep breathing
  • Nurture a support system
  • Recognize limits, take breaks
  • Get enough rest, food, exercise
  • Reduce barriers to help-seeking
  • Identify and resolve problems early
  • Example of personal accountability
  • Talk to someone, ask for help
  • Tune into own signs of distress
  • Make self-care a priority
  • Get help sooner, not later
  • Maintain social contact, don’t withdraw
  • Follow care recommendations
  • Seek consultation as needed
  • Respect confidentiality
  • Know resources and how to access them

The big four

Goal settingVisualizationSelf-talkTactical breathing
  • Specific: your behaviour
  • Measurable: see progress
  • Attainable: challenging and realistic
  • Relevant: want it or need it
  • Time-bound: set finish time
  • Be calm and relaxed
  • Use all senses
  • See positive mental images
  • Keep it simple
  • Use movement
  • Become aware of self-talk
  • Stop the negative messages
  • Replace with positive
  • Practice thought stopping:
    • * “I can do this
    • * “I am trained and ready
    • * “I will focus on what I can do
  • Rule of four:
    • * Inhale to count of four
    • * Exhale for count of four
    • * Practice for four minutes
  • Breathe into the diaphragm

If you are concerned about signs of poor or declining mental health in yourself or a buddy, get it checked out.

Resources include:

  • Buddies
  • Mental health team
  • Chaplains
  • Leaders/supervisors
  • Crisis or help lines
  • Community mental health services
  • Family doctor

What can I do to take care of myself? Read More »

African american male doctor going upstairs on hospital staircase holding head and worrying

Moral injury & post-traumatic stress

What is moral injury?

Moral injury is the potential outcome of witnessing an event that goes against ones moral beliefs, or participating in the act oneself. Moral injury can also be caused by feeling betrayed by someone you trusted, like a coworker, supervisor, or workplace.

It often results in intense feelings of guilt, shame, disgust, and anger.

What is post-traumatic stress?

Post-traumatic stress (PTS) is a response to traumatic events that one has personally experienced, has learned about happening to a loved one, or has been exposed to. This could include actual or threatened death, serious injury, or sexual violence.

PTS symptoms can include:

  • Reliving the event repeatedly in your mind
  • Having nightmares
  • Avoiding family and friends
  • Having trouble sleeping
  • Losing interest in enjoyable activities
  • Avoiding places and people that remind you of the event

Some people with PTS also experience dissociation. This means that they feel disconnected from themselves, or feel like things happening around them are unreal or unfamiliar.

Though most people who experience a traumatic event will have a strong reaction, many will recover over time. Experiencing trauma doesn’t mean you will develop PTS.

Sad woman with depression working on her problems with help of professional psychologist on therapy session

How has the COVID-19 pandemic affected healthcare providers?

  • The pandemic has exacerbated symptoms of depression, anxiety, post-traumatic stress disorder, sleep disturbance, and moral injury among healthcare providers.
  • Typical coping strategies, such as going to the gym or meeting with friends, were inaccessible due to health restrictions.
  • Even before the pandemic, healthcare providers faced moral challenges in their daily work. COVID-19 has added to these stressors and resulted in widespread exposure to working conditions that put healthcare providers at increased risk of moral harm, such as increased workloads and staffing shortages.
Sad surgeon sitting on floor in corridor

Moral injuries

Healthcare providers have faced many challenges during the pandemic, including:

  • Working with limited resources
  • Witnessing a decline in the quality of care
  • Not allowing families to visit the bedsides of patients with COVID-19

These potentially morally damaging events can lead to:

  • Feelings of guilt, shame, anger, disgust, or betrayal
  • Depression, anxiety, post-traumatic stress disorder
  • Suicidal thoughts or behaviour
  • Burnout
  • A desire to leave the healthcare profession
  • Engaging in potentially risky or dangerous behaviours (e.g., speeding, overspending, self-harm)
  • Loss of sense of identity
  • Changes in religious or spiritual identity
  • Altered vision of a just and good world

Physical reactions

  • Headaches
  • Fatigue/lethargy

Emotional and social reactions

  • Feeling numb or detached from other people, activities or environment
  • Emotional exhaustion
  • Compassion fatigue (a fatigue that occurs when caring for people who are experiencing trauma)
  • Feelings of fear, anger and uncertainty

Functional impairments

  • Some HCPs may experience functional impairments for several days, including decreased ability to perform daily activities (e.g., performing work tasks, standing for long periods of time, walking long distances), difficulty concentrating, and decreased social skills

Moral injury & post-traumatic stress Read More »

Doctors preparing for an operation

Top 10 pandemic stressors for HCPs

Even before the pandemic, healthcare providers faced moral challenges in their work. But for many, working through the pandemic has exposed them to conditions that put them at an increased risk of moral injury and other mental health challenges.

Here are the most common challenges healthcare providers have faced during COVID-19.

  1. Repeatedly watching patients suffer and die from COVID-19.
  2. Taking on the role of family for patients who died alone, and not having time to process and grieve the deaths before continuing to care for others.
  3. Enforcing no-visitor policies while worrying about the risks of having visitors present.
  4. Feeling exhausted and burned out but unable to take time to rest.
  5. Feeling afraid of infection and spreading COVID-19 to family members and others.
  6. Family life is affected because of longer work hours and physical distancing.
  7. Feeling that deployment to COVID-19 units was not fair.
  8. Lack of employer understanding and not having enough resources to do their work.
  9. Feeling misunderstood, like they are living in a different world than non-healthcare workers.
  10. Loss of usual coping strategies, like access to gyms and socializing with loved ones.

What are common responses to stress and trauma?

Healthcare providers have faced many challenging situations during the pandemic. These events lead to an increased risk of developing mental health challenges that are common to experiencing trauma and prolonged stress:

  • moral injury
  • depression
  • anxiety and panic attacks
  • burnout and exhaustion
  • post-traumatic stress injury (PTSI)
  • substance use disorder
  • insomnia
  • suicidal thoughts or behaviours
  • headaches
  • feeling numb or detached from other people, their activities, or their surroundings
  • compassion fatigue
  • emotional exhaustion
  • functional impairments (i.e., poor concentration, decreased ability to perform daily activities, etc.)

This is not a complete list of responses to trauma and stress. There are several other indicators and symptoms associated with these experiences.

Professional psychologist conducting a consultation

Top 10 pandemic stressors for HCPs Read More »