Virtual events

Team of medical workers wearing personal protective equipment against corona virus outbreak

Symposium 2: The path toward recovery

Recorded at McMaster University on January 19, 2023
Transcript

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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

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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

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this is incredibly important,
as it seems that resilience is likely

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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

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how our study was set up.

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So we started off with the recruitment
stage where we invited

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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.

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The first thing they did was fill out
a collection of online questionnaires.

0:14:56.416,0:15:00.041
So a total of 460 health care providers

0:15:00.958,0:15:05.708
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.

Panelists

Portrait of Dr. Margaret McKinnon
Dr. Margaret McKinnon, Homewood Chair in Mental Health and Trauma; Professor, McMaster University

Dr. Margaret McKinnon is Full Professor and Associate Chair, Research in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, where she holds the Homewood Chair in Mental Health and Trauma. She is also the Research Lead for Mental Health and Addictions at St. Joseph’s Healthcare Hamilton and a Senior Scientist at Homewood Research Institute. 

Work in Margaret’s unit focuses on identifying the neural and behavioural correlates of PTSD and trauma-related illnesses and on translating this knowledge to the development and testing of novel treatment interventions aimed at reducing the cognitive and affective sequelae of these conditions. 

A licensed clinical psychologist and clinical neuropsychologist, Margaret has a special interest in military, veteran, and public safety populations (including healthcare providers), and has worked with these groups clinically and in her research program. She has published or in press nearly 150 scientific works. 

Under Margaret’s leadership, the Trauma & Recovery Research Unit is supported by federal and provincial funding from the Public Health Agency of Canada, Canadian Institutes of Health Research, the Canadian Institute for Military and Veterans Health Research, Veterans Affairs Canada, Defence Canada, the PTSD Centre of Excellence, MITACS, and the Workers Safety Insurance Board of Ontario; by a generous donation to Homewood Research Institute from Homewood Health Inc.; and by generous gifts from private foundations including True Patriot Love, the Cowan Foundation, the Military Casualty Support Foundation, the FDC Foundation, and the AllOne Foundation. 

Margaret is a frequent commentator in the media on matters related to PTSD, moral injury, and the impact of trauma on special populations.

Dr. Suzette Brémault-Phillips, Occupational Therapist; Professor, University of Alberta

Dr. Suzette Brémault-Phillips is an Occupational Therapist and Professor in the Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta. She is also Director of the Heroes in Mind Advocacy and Research Consortium (HiMARC), a provincial hub for research, teaching and service in support of military members, veterans, public safety personnel, and their families.

Suzette’s research interests include resilience, wellbeing, and mental health.

Portrait of Dr. Lorraine Smith-MacDonald
Dr. Lorraine Smith-MacDonald, Postdoctoral Fellow, University of Alberta

Dr. Lorraine Smith-MacDonald is a Postdoctoral Fellow within the Heroes in Mind, Advocacy, and Research Consortium (HiMARC) in the Faculty of Rehabilitation Medicine at the University of Alberta. HiMARC is the provincial initiative researching the health and wellbeing of military, veterans, public safety personnel, and their families.

Lorraine’s research focuses on the intersectionality of the mental and spiritual domains of health and specializes in post-traumatic stress disorder and moral injury.

Healthcare providers

Portrait of Eram Chhogala
Eram Chhogala, Registered Nurse

Eram Chhogala is a registered nurse working in trauma, emergency and resuscitation services serving the Greater Toronto Area. She has experience in healthcare for 12 years, including eight as a nurse. She specializes in critical care and vascular care, and has had vast experiences in cardiology, fertility, family and community medicine, and education. She has interests in writing, the arts, and mental health advocacy for healthcare providers.

Portrait of Dr. David Tebb
Dr. David Tebb, Physiotherapist

Dr. David Tebb is a practicing Physiotherapist with Unity Health Toronto (St. Joseph’s site) in Orthopedic / General Surgery and Intensive Care. David has a BSc from Western University and obtained his Doctor of Physical Therapy (DPT) from D’Youville University in 2010. He has practiced throughout the continuum of care in both Canada and the United States, including outpatient orthopedics, acute neurology/ trauma rehab, and most recently, in Acute Care Orthopedic and General Surgery for the past six years.

David also provides expert-witness legal consultation and has special interests in Quality Improvement, most recently being involved with implementation of the Total Joint Day of Surgery Program at St. Joseph’s Health Centre.

In his free time, he likes to spend time with family and friends, playing and watching a variety of sports, and driving his wife crazy learning to play the ukulele.

Portrait of Todd Tran
Todd Tran, Occupational Therapist

Todd Tran currently works as an occupational therapist at Women’s College Hospital in Family Practice and the Women’s Mental Health in Medicine program. His clinical and research area of interest is older adults with early cognitive deficits, technology-based applications among older adults, mindfulness for stress reduction and mental health, and health delivery service such as primary care.

Todd is a Sessional Lecturer (status-only) in the Temerty Faculty of Medicine, Department of Occupational Science & Occupational Therapy, University of Toronto (St. George Campus). He is in the final year of his Ph.D. program at Queen’s University, School of Rehabilitation Therapy in the Aging and Health stream.

Presenters

Portrait of Dr. Kim Ritchie
Dr. Kim Ritchie, Research Associate, Homewood Research Institute

Dr. Kim Ritchie is an Assistant Professor at Trent University and holds an Adjunct position in the Department of Psychiatry and Behavioural Neuroscience at McMaster University. Since 2020, she has been co-leading a national study examining the mental health impacts of COVID-19 on healthcare providers.

In addition, Kim is a Registered Nurse with over 20 years of experience in direct care and clinical leadership roles, primarily focusing on mental health and geriatric mental health. She completed a PhD in Rehabilitation Science from Queen’s University, and currently conducts research on PTSD, trauma, and moral injury in military/veterans, healthcare providers, and public safety personnel. 

Portrait of Mina Pichtikova
Mina Pichtikova, Clinical Research Coordinator, Trauma & Recovery Research Unit, McMaster University

Mina is a graduate of McMaster University’s Honours BSc. Psychology, Neuroscience, and Behaviour program, and is currently pursuing an MA in Clinical and Counselling Psychology at the University of Toronto. She has six years of research experience conducting both quantitative and qualitative research on the topics of PTSD, concurrent disorders, moral injury, borderline personality disorder, traumatic brain injury, and military sexual trauma.

Mina currently works as a Clinical Research Coordinator at the Trauma & Recovery Research Unit.

Portrait of Dr. Dayna Lee-Baggley
Dr. Dayna Lee-Baggley, Registered Clinical Psychologist; Director, Dr. Lee-Baggley and Associates

Dr. Dayna Lee-Baggley is a Registered Clinical Psychologist in British Columbia, Alberta, Ontario, and Nova Scotia. She is the director of Dr. Lee-Baggley and Associates, a virtual health psychology clinic specializing in clinical interventions, training for healthcare providers, and research in health-related issues (e.g., chronic pain, sleep, COVID burnout, PTSD for point-of-care workers).

Dayna worked for almost 15 years in multidisciplinary teams on medical, surgical, and cancer care hospital units providing assessment, therapy, and consultation for patients with chronic and life-threatening health conditions. She also conducts research as an Assistant Professor in the Department of Family Medicine, with a cross appointment in the Department of Psychology & Neuroscience at Dalhousie University and an Adjunct Professor appointment in the Department of Industrial and Organizational Psychology at Saint Mary’s University. She has an active research program on behaviour change, obesity, chronic disease, professional resiliency, and Acceptance and Commitment Therapy.

Dayna has over 45 peer-reviewed publications and over 130 scholarly presentations. She is a Senior Consultant providing healthy workplace interventions for employees, teams, and leaders with Howatt HR Consulting and the Chief of Research for the Howatt HR Applied Workplace Research Institute. She is an internationally recognized trainer in Acceptance and Commitment Therapy. She was the recipient of the 2017 Women of Excellence Award for her contributions to health, sport and wellness (Canadian Progress Club Halifax). She is the author of the book Healthy Habits Suck: How to get off the couch & live a healthy life…even if you don’t want to.

Portrait of Dr. Jaimie Lusk
Dr. Jaimie Lusk, Clinical Psychologist; Professor, Oregon Health Sciences University

Dr. Jaimie Lusk, PsyD, is a Clinical Psychologist working with U.S. veterans at the Salem Vet Center in Salem, Oregon, as well as Professor of Clinical Psychiatry at Oregon Health Sciences University. A combat veteran, she attended the U.S. Naval Academy, served in the U.S. Marine Corps from 2001–2005, and deployed during Operation Iraqi Freedom.

Jaimie began working clinically with veterans in 2010 at the Denver VA, joined VA Portland staff in 2014, and began working at the Salem Vet Center in 2019. She is passionate about facilitating recovery from PTSD and moral injury, as well as readjustment difficulties, through evidence-based cognitive behavioural therapies.

Jaimie has conducted research related to veteran suicidality, traumatic experiences, moral injury, and spirituality. She is a cognitive processing therapy trainer, and offers national trainings and consultation in CPT for clinicians working with veterans suffering from PTSD related to combat and military sexual trauma.

Moderator

Garvia Bailey, Co-founder, Media Girlfriends

Garvia Bailey is a co-founder of Media Girlfriends Inc. Her career in media spans close to two decades as a producer, host, and columnist for the CBC and JazzFM. She is a co-founder of jazzcast.ca, a 24-hour streaming service that amplifies the roots of jazz as an African-American–derived artform.

Garvia is the recipient of the 2019 RTDNA award for opinion writing and a 2017 Silver Medalist at the New York Radio Awards. She is a jurist for the prestigious Canadian Hillman Prize for investigative journalism. Her work is centred around inclusion, care, and excellence in journalism.

With gratitude to Ward 1 Studios and Virtual Producers for producing this event and broadcasting its video feed.

Symposium 2: The path toward recovery Read More »

Town hall 3: Finding our footing

The COVID-19 pandemic has resulted in unprecedented and often devastating new circumstances for healthcare providers (HCPs), leading to an increased need for mental health prevention and early interventions efforts to support this critical workforce.

This one-hour event features:

  • A research presentation about how healthcare providers are coping with the stresses of COVID-19
  • A qualitative analysis of healthcare providers’ experiences of the pandemic
  • A panel discussion with mental health researchers who are studying the pandemic’s effects on providers
Portrait of mixed race male doctor wearing face mask standing in hospital corridor

CONTENT WARNING

During this event, we discuss examples of moral distress, moral injury, and other challenges in the work life and home life of healthcare providers during the COVID-19 pandemic. Some moments may be disturbing for you. It’s fine if you wish to stop watching at any point.

If you require wellness support, we encourage you to follow this link.

Recorded at McMaster University on December 1, 2022
Transcript

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.

Panelists

Portrait of Dr. Margaret McKinnon
Dr. Margaret McKinnon, Homewood Chair in Mental Health and Trauma; Professor, McMaster University

Dr. Margaret McKinnon is Full Professor and Associate Chair, Research in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, where she holds the Homewood Chair in Mental Health and Trauma. She is also the Research Lead for Mental Health and Addictions at St. Joseph’s Healthcare Hamilton and a Senior Scientist at Homewood Research Institute. 

Work in Margaret’s unit focuses on identifying the neural and behavioural correlates of PTSD and trauma-related illnesses and on translating this knowledge to the development and testing of novel treatment interventions aimed at reducing the cognitive and affective sequelae of these conditions. 

A licensed clinical psychologist and clinical neuropsychologist, Margaret has a special interest in military, veteran, and public safety populations (including healthcare providers), and has worked with these groups clinically and in her research program. She has published or in press nearly 150 scientific works. 

Under Margaret’s leadership, the Trauma & Recovery Research Unit is supported by federal and provincial funding from the Public Health Agency of Canada, Canadian Institutes of Health Research, the Canadian Institute for Military and Veterans Health Research, Veterans Affairs Canada, Defence Canada, the PTSD Centre of Excellence, MITACS, and the Workers Safety Insurance Board of Ontario; by a generous donation to Homewood Research Institute from Homewood Health Inc.; and by generous gifts from private foundations including True Patriot Love, the Cowan Foundation, the Military Casualty Support Foundation, the FDC Foundation, and the AllOne Foundation. 

Margaret is a frequent commentator in the media on matters related to PTSD, moral injury, and the impact of trauma on special populations.

Portrait of Dr. Kim Ritchie
Dr. Kim Ritchie, Research Associate, Homewood Research Institute

Dr. Kim Ritchie is an Assistant Professor at Trent University and holds an Adjunct position in the Department of Psychiatry and Behavioural Neuroscience at McMaster University. Since 2020, she has been co-leading a national study examining the mental health impacts of COVID-19 on healthcare providers.

In addition, Kim is a Registered Nurse with over 20 years of experience in direct care and clinical leadership roles, primarily focusing on mental health and geriatric mental health. She completed a PhD in Rehabilitation Science from Queen’s University, and currently conducts research on PTSD, trauma, and moral injury in military/veterans, healthcare providers, and public safety personnel. 

Portrait of Dr. Hugo Schielke
Dr. Hugo Schielke, Trauma Services Development Lead, Homewood Health Centre

Dr. Hugo Schielke, PhD, is the Trauma Services Development Lead for Homewood Health Centre and the Centre’s Traumatic Stress Injury & Concurrent Program in Guelph, Ontario. He specializes in the assessment and treatment of trauma-related disorders, and his work is informed by his post-doctoral fellowship at The Trauma Disorders Program at Sheppard Pratt Health System and his involvement with the California Department of State Hospitals’ Trauma-Informed Care Project.

Hugo’s research is focused on the treatment of trauma-related disorders, psychotherapy process, and the relational components of psychotherapy.

Presenter

Portrait of Mauda Karram
Mauda Karram, Clinical Research Assistant, Trauma & Recovery Research Unit, McMaster University

Mauda is a Clinical Research Assistant in the Trauma & Recovery Research Unit at McMaster University. She completed her undergraduate degree at McMaster in the (Science Honours) Psychology, Neuroscience, and Behaviour (Mental Health Specialization) program with a minor in Theatre and Film Studies.

Currently, Mauda is the project coordinator for the Unit’s moral injury project. She aims to continue her research work on coping and self-care in healthcare workers and public safety personnel throughout the COVID-19 pandemic, in hopes to apply the findings in knowledge mobilization efforts for empirically based resources and supports.

Moderator

Portrait of Amy Van Es
Amy Van Es, Founder, Gooder

Amy Van Es spent the first decade of her career as a digital growth strategist, helping media and tech companies rapidly scale their online presence. But she’s since resolved to spend the next decade fixing what she helped break: the internet. She’s obsessed with this mission.

When she’s not interneting with Gooder, Amy enjoys hiking, sewing, and big bowls of pasta. She dislikes push notifications, peas, and writing in the third person.

With gratitude to McMaster University Faculty of Health Sciences: Continuing Professional Development for broadcasting this event’s video feed.

Town hall 3: Finding our footing Read More »

Coping with losing patient

Symposium 1: COVID’s hidden crisis

Recorded at McMaster University on November 15, 2022
Transcript

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.

Panelists

Portrait of Dr. Margaret McKinnon
Dr. Margaret McKinnon, Homewood Chair in Mental Health and Trauma; Professor, McMaster University

Dr. Margaret McKinnon is Full Professor and Associate Chair, Research in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, where she holds the Homewood Chair in Mental Health and Trauma. She is also the Research Lead for Mental Health and Addictions at St. Joseph’s Healthcare Hamilton and a Senior Scientist at Homewood Research Institute. 

Work in Margaret’s unit focuses on identifying the neural and behavioural correlates of PTSD and trauma-related illnesses and on translating this knowledge to the development and testing of novel treatment interventions aimed at reducing the cognitive and affective sequelae of these conditions. 

A licensed clinical psychologist and clinical neuropsychologist, Margaret has a special interest in military, veteran, and public safety populations (including healthcare providers), and has worked with these groups clinically and in her research program. She has published or in press nearly 150 scientific works. 

Under Margaret’s leadership, the Trauma & Recovery Research Unit is supported by federal and provincial funding from the Public Health Agency of Canada, Canadian Institutes of Health Research, the Canadian Institute for Military and Veterans Health Research, Veterans Affairs Canada, Defence Canada, the PTSD Centre of Excellence, MITACS, and the Workers Safety Insurance Board of Ontario; by a generous donation to Homewood Research Institute from Homewood Health Inc.; and by generous gifts from private foundations including True Patriot Love, the Cowan Foundation, the Military Casualty Support Foundation, the FDC Foundation, and the AllOne Foundation. 

Margaret is a frequent commentator in the media on matters related to PTSD, moral injury, and the impact of trauma on special populations.

Portrait of Dr. Mahée Gilbert-Ouimet
Dr. Mahée Gilbert-Ouimet, Associate Professor, Université du Québec à Rimouski

Dr. Mahée Gilbert-Ouimet is associate professor in Population Health at the Université du Québec à Rimouski. She also holds the Canada Research Chair in Sex and Gender in Occupational Health. Dr. Gilbert-Ouimet received her PhD in epidemiology from Laval University. She also performed a first postdoctoral fellowship in epidemiology at the Institute for Work & Health and a second postdoctoral fellowship in health economics at the Université du Québec à Montréal.

Dr. Gilbert-Ouimet research mainly focuses on the adverse effects of psychosocial stressors at work on the incidence of chronic health problems, and on how to conduct intervention studies aimed at reducing these stressors. Dr. Gilbert-Ouimet has published 45 peer-reviewed articles and realized over a hundred knowledge transfer activities. In the context of the COVID-19 pandemic, she recently issued preliminary guidelines aiming to prevent and manage moral injuries in Canadian frontline healthcare workers. She also authored a Guide of organizational practices favourable to health that is now distributed by the Quebec Ministry of Health and Social Services to all health establishments of the province of Quebec. Dr. Gilbert-Ouimet is also actively involved in developing methods and recommendations aiming to improve sex and gender considerations in health research.

Portrait of Michelle McCarron
Dr. Michelle McCarron, Research Scientist, Saskatchewan Health Authority

Dr. Michelle McCarron is a Research Scientist with the Saskatchewan Health Authority (SHA). She is also an Adjunct Professor in the Faculty of Graduate Studies and Research at the University of Regina, where she is a Sessional Lecturer with the Department of Psychology. Dr. McCarron is a member of the Saskatchewan Centre for Patient-Oriented Research (SCPOR) Affiliated Researcher Alliance and the Canadian Institute for Public Safety Research and Treatment (CIPSRT) Academic, Researcher, and Clinician (ARC) Network. 

Michelle holds a Ph.D. in Experimental and Applied Psychology from the University of Regina. From 2012-2017, she was the Chair of the Research Ethics Board (REB) for the Regina Qu’Appelle Health Region and now serves as the Vice Chair of the SHA REB. Her primary areas of research interest include frontline healthcare worker and Public Safety Personnel (PSP) mental health, evidence-informed decision-making within healthcare and PSP organizations, and research and professional ethics.

Dr. McCarron was the Principal Applicant on a study funded by the Department of National Defence Innovation for Defence Excellence and Security (IDEaS) program, titled “Operationalizing the Concept of Moral Injury within Canadian Frontline Healthcare Workers” and is the Nominated Principal Applicant on a CIHR-funded Mental Wellness in PSP project developing and pilot testing an online “Research 101” course promoting scientific literacy among PSP leadership to support evidence-informed decision-making in the provision of mental health care for frontline PSP.

Healthcare providers

Portrait of Krissha Fortuna
Krissha Fortuna, RPN

Krissha Fortuna is a registered practical nurse who works in long-term care in Ontario.

Portrait of Michelle Johnson
Michelle Johnson, RN

Michelle Johnson is a registered nurse who works in Ontario.

Portrait of Dr. Jennifer Kwan
Dr. Jennifer Kwan, Family Doctor

Dr. Jennifer Kwan tweets from @jkwan_md. Throughout the pandemic’s first many waves, she posted important, accessible data about #COVID19Ontario transmission to her Twitter feed. Dr. Kwan is a cofounder of the Masks4Canada volunteer group and the Doctors for Justice in Long-Term Care (Docs4LTCJustice) campaign.

She is a family doctor who practices in Ontario.

Presenters

Portrait of Dr. Andrea Brown
Dr. Andrea Brown, Research Associate, Trauma & Recovery Research Unit, McMaster University

Dr. Andrea Brown obtained her PhD in Applied Social Psychology from the University of Guelph. In addition to her work in the Trauma and Recovery Research Unit, Dr. Brown has conducted applied research and program evaluation for not-for-profit organizations, regional government, the Department of National Defence, academe, and industry. 

Since 2015, Dr. Brown’s focus has been on mental health and addictions research and evaluation, with a specialty on military sexual trauma (MST) and post-traumatic stress disorder. She is also the Co-Director of the MiNDS Network for MST and the Director of Knowledge Exchange for the Canadian MST Community of Practice. 

In addition to this, Dr. Brown is currently completing a Masters in Psychotherapy at McMaster University.

Portrait of Yuanxin Xue
Yuanxin Xue, Research Assistant, McMaster University

Yuanxin Xue is a medical student at the University of Toronto. He completed his Bachelor of Health Sciences and MSc in Global Health at McMaster University. Yuanxin’s current research focuses on various facets of mental health, perioperative medicine, as well as the intersections between these fields. He currently works as a Research Assistant at the Trauma & Recovery Research Unit.

Moderator

Portrait of Hannah Sung
Hannah Sung, Co-founder, Media Girlfriends

Hannah Sung is a co-founder of Media Girlfriends. Her previous work includes producing award-winning podcasts for The Globe and Mail and the Globe Content Studio, including Colour Code, a podcast about race in Canada, and Stress Test, a podcast about personal finance in the pandemic. She executive produced award-winning podcasts at TVO and The Walrus Lab on social issues, politics, and current affairs. In 2020, she was the Asper Fellow at the University of Western Ontario’s Faculty of Information and Media Studies, where she led a post-graduate journalism class in narrative podcasting.

Hannah began her career in music television at MuchMusic, where she was the host of shows including MuchNews and the live red carpet at the MuchMusic Video Awards.

With gratitude to McMaster University Faculty of Health Sciences: Continuing Professional Development for broadcasting this event’s video feed.

Symposium 1: COVID’s hidden crisis Read More »

Close up shot of female nurse taking an old man hand while they are sitting on the couch

Town hall 2: Work life, home life

The COVID-19 pandemic has resulted in unprecedented and often devastating new circumstances for healthcare providers (HCPs), leading to an increased need for mental health prevention and early interventions efforts to support this critical workforce.

This one-hour event features:

  • A research presentation of preliminary findings about the impact of healthcare providers’ role on family and interpersonal relationships during the COVID-19 pandemic
  • A panel discussion with mental health researchers who are studying the pandemic’s effects on providers
  • An audience question-and-answer period
Young doctor with stethoscope in nursing home

CONTENT WARNING

During this event, we discuss examples of moral distress, moral injury, and other challenges in the work life and home life of healthcare providers during the COVID-19 pandemic. Some moments may be disturbing for you. It’s fine if you wish to stop watching at any point.

If you require wellness support, we encourage you to follow this link.

Recorded at McMaster University on September 15, 2022
Transcript

0:00:00.080,0:00:04.290
Hello everybody. Thanks so much for taking
time in your day to be here with us.

0:00:04.290,0:00:10.650
My name’s Amy Van Es, excuse me, and I will
be your host and moderator for this session.

0:00:10.650,0:00:14.760
I’d like to begin by acknowledging the land
on which McMaster University is located,

0:00:14.760,0:00:19.770
which is the traditional territory of the
Haudenosaunee and Anishinaabe nations,

0:00:19.770,0:00:23.369
and within the lands protected by the Dish
with One Spoon Wampum Belt.

0:00:23.369,0:00:28.580
That wampum uses the symbolism of a dish to
represent the territory and one spoon to represent

0:00:28.580,0:00:33.050
that the people are to share the resources
of the land and only take what they need.

0:00:33.050,0:00:37.480
We seek a new relationship with the original
peoples of this land, one based in honour

0:00:37.480,0:00:38.960
and deep respect.

0:00:38.960,0:00:42.430
May we be guided by love and right action
as we transform our personal and

0:00:42.430,0:00:50.940
institutional relationships with our indigenous
friends and neighbours.

0:00:50.940,0:00:55.120
It is in the same spirit that I welcome all
of you to our second of three town halls.

0:00:55.120,0:00:58.920
Today’s event is focused on the impact of
healthcare provider’s role in their families

0:00:58.920,0:01:01.160
and relationships during the pandemic.

0:01:01.160,0:01:04.510
This event is supported by the Public Health
Agency of Canada as part of their work to

0:01:04.510,0:01:08.920
address PTSD and trauma in those most affected
by COVID-19.

0:01:08.920,0:01:12.790
In this town hall, we will be discussing examples
of healthcare providers who have experienced

0:01:12.790,0:01:17.580
moral distress, moral injury, and other challenges
in their work life and home life during the

0:01:17.580,0:01:18.710
pandemic.

0:01:18.710,0:01:20.960
There will be moments that may be disturbing
to you,

0:01:20.960,0:01:25.710
and it’s totally fine if you wish to excuse
yourself from this event at any point.

0:01:25.710,0:01:30.439
So — excuse me — so over the past two
and a half years, we’ve heard so much about

0:01:30.439,0:01:31.439
the strain on health,

0:01:31.439,0:01:34.540
the healthcare system, and on healthcare providers
due to the pandemic.

0:01:34.540,0:01:39.560
And we owe a debt of gratitude to all the
physicians, nurses, therapists, personal support

0:01:39.560,0:01:44.250
workers, and public safety personnel, who,
despite facing incredible challenges in their

0:01:44.250,0:01:50.469
daily work lives, still found time and courage
to talk to us and share their experiences.

0:01:50.469,0:01:53.820
This research project seeks to shine a light
on the impact that

0:01:53.820,0:01:58.120
the pandemic has had on the mental health
of all those healthcare providers who have

0:01:58.120,0:02:02.289
given so much of themselves to the service
of others and continue to do so.

0:02:02.289,0:02:07.110
The evidence-based resources and tools we
are offering to help build mental health,

0:02:07.110,0:02:11.989
literacy, support, and resiliency are our
healthcare salute, our way of saying

0:02:11.989,0:02:15.459
thank you so much for your service.

0:02:15.459,0:02:16.940
One more thing before we get started.

0:02:16.940,0:02:20.879
I just wanted to let you know that there will
be plenty of time for our speakers to answer

0:02:20.879,0:02:22.959
your questions after the main presentation.

0:02:22.959,0:02:27.050
So if you’d like to submit a question, please
use Zoom’s q and a function,

0:02:27.050,0:02:32.120
and you can find that in the control panel
just below this video.

0:02:32.120,0:02:35.580
And to begin our program today, we’re going
to watch a prerecorded presentation

0:02:35.580,0:02:39.680
by Kim Ritchie and Emily Sullo. In the talk,
they’ll be diving into some findings from

0:02:39.680,0:02:43.870
their research about the effect of COVID-19
on healthcare providers’ relationships.

0:02:43.870,0:02:47.690
So, Dr. Kim Ritchie is a post-doctoral research
fellow in the

0:02:47.690,0:02:51.030
Department of Psychiatry and Behavioral Neurosciences
here at McMaster.

0:02:51.030,0:02:55.920
She holds a PhD in rehabilitation science
from Queens University and is a registered

0:02:55.920,0:02:58.879
nurse with extensive clinical experience in
mental health,

0:02:58.879,0:03:02.239
geriatric mental health and professional practice.

0:03:02.239,0:03:05.870
As I mentioned before, Kim is involved in
this research project that’s meant to develop

0:03:05.870,0:03:07.530
an understanding

0:03:07.530,0:03:11.510
of the unique and shared lived experiences
and psychological impacts among

0:03:11.510,0:03:14.780
healthcare providers resulting from their
work during the pandemic.

0:03:14.780,0:03:17.750
This research will contribute to the development
of novel approaches

0:03:17.750,0:03:22.270
to address the needs of healthcare providers
and public safety personnel.

0:03:22.270,0:03:24.720
We also have with us today Emily Sullo.

0:03:24.720,0:03:29.730
Emily is a graduate of the University of Toronto’s
honours Psychology program, and Western University’s

0:03:29.730,0:03:33.140
Master of Management of Applied Science in
Global Health Systems.

0:03:33.140,0:03:36.049
She has been involved in the field of mental
health for several

0:03:36.049,0:03:38.670
years, working on evidence- and community-based
projects,

0:03:38.670,0:03:41.390
including the development of mobile health
units in rural settings.

0:03:41.390,0:03:46.440
As a research assistant in the Trauma and
Recovery Lab at McMaster, Emily has primarily

0:03:46.440,0:03:50.730
been involved in the development of knowledge
translation deliverables to disseminate research

0:03:50.730,0:03:51.730
findings

0:03:51.730,0:03:54.700
focused on understanding the experience of
healthcare workers

0:03:54.700,0:03:57.870
and public safety personnel during the pandemic.

0:03:57.870,0:04:00.580
Thank you both so much for contributing to
the discussion today,

0:04:00.580,0:04:03.760
and I think we’re ready to take a peek at
the recording.

0:04:03.760,0:04:07.290
Hello and welcome to our second town hall
presentation.

0:04:07.290,0:04:11.830
Today, we’re going to be talking about the
impact of the healthcare provider’s role on

0:04:11.830,0:04:15.349
their family and interpersonal relationships.

0:04:15.349,0:04:19.930
My name is Kim Ritchie and I’m here today
with Emily Sullo and we are both very pleased

0:04:19.930,0:04:26.330
to present some of our preliminary research
findings.

0:04:26.330,0:04:30.180
As we know, COVID-19 has impacted all of our
lives in so many different

0:04:30.180,0:04:35.370
ways, but for healthcare providers, they faced
additional impacts specifically because of

0:04:35.370,0:04:39.160
their role and being on the frontline of the
pandemic,

0:04:39.160,0:04:42.740
serving the public over the past two years.

0:04:42.740,0:04:46.960
For example, healthcare providers have had
significant changes in the way they work,

0:04:46.960,0:04:53.000
including changes to their role, to policies
and to clinical protocols that they follow.

0:04:53.000,0:04:56.240
Many healthcare providers have worked significantly
more hours,

0:04:56.240,0:05:00.960
and some with reduced staffing levels, which
has really contributed towards

0:05:00.960,0:05:05.550
feeling exhausted and some towards burnout.

0:05:05.550,0:05:09.720
Healthcare providers have also had a lot of
fear and uncertainty surrounding the increased

0:05:09.720,0:05:14.330
level of contracting and transmitting COVID
due to the

0:05:14.330,0:05:17.720
higher exposures they face in the course of
their work.

0:05:17.720,0:05:20.490
And on top of all of these challenges, there
was this extra

0:05:20.490,0:05:26.270
layer of stress related to their role and
the impact it had on their own relationships

0:05:26.270,0:05:33.130
with their family, friends, and their colleagues.

0:05:33.130,0:05:36.560
During the pandemic, we’ve been conducting
interviews with healthcare

0:05:36.560,0:05:43.580
providers from across Canada in order to understand
the impact of COVID-19 on their mental health.

0:05:43.580,0:05:48.280
As part of these interviews, we’ve also asked
healthcare providers about the impact of the

0:05:48.280,0:05:52.080
role on their relationships with family, friends,
and colleagues.

0:05:52.080,0:05:55.100
Today, we’ll share some of those results from
interviews

0:05:55.100,0:06:00.680
that we conducted between February, 2021 and
January, 2022.

0:06:00.680,0:06:05.229
For the first theme, healthcare providers
told us that during the

0:06:05.229,0:06:09.110
pandemic, they felt like their work extended
beyond them

0:06:09.110,0:06:12.420
and had a significant impact on their family.

0:06:12.420,0:06:15.580
There was a fear of exposing their families
to COVID because

0:06:15.580,0:06:18.690
of their higher workplace exposure to the
virus.

0:06:18.690,0:06:25.000
And they were also working more hours to accommodate
increased number of people who required healthcare,

0:06:25.000,0:06:31.560
which meant certain adjustments had to be
made within the family.

0:06:31.560,0:06:34.930
Many healthcare providers described having
to physically distance for

0:06:34.930,0:06:39.190
periods of time from family and friends throughout
the pandemic.

0:06:39.190,0:06:43.530
While this occurred primarily in the first
wave of the pandemic,

0:06:43.530,0:06:48.620
it also occurred periodically throughout the
remaining time of the pandemic,

0:06:48.620,0:06:54.710
due to high exposure at work from increased
hospital admission or community transmission.

0:06:54.710,0:06:59.259
And the main reason for this physical distancing
was to protect

0:06:59.259,0:07:03.531
their family and friends from COVID-19 as
they felt they were at

0:07:03.531,0:07:05.810
higher risk through their work.

0:07:05.810,0:07:10.150
And there was a variety of ways that they
physically distanced as described from the

0:07:10.150,0:07:15.780
quote on the screen, some moved out of their
house, into hotels at their own expense,

0:07:15.780,0:07:19.850
into rented trailers, and some lived in their
own cars.

0:07:19.850,0:07:25.300
Others isolated themselves to a specific area
or room within their own house.

0:07:25.300,0:07:30.180
And during these periods, most did not eat,
sleep, hug or interact with

0:07:30.180,0:07:35.770
their families, often for many weeks or even
months for periods of time.

0:07:35.770,0:07:40.830
This also applied to extended families, where
healthcare providers physically distanced

0:07:40.830,0:07:45.340
by not attending traditional family gatherings,
such as birthdays and weddings, even though

0:07:45.340,0:07:48.310
they may have occurred without them.

0:07:48.310,0:07:54.240
Other healthcare providers were excluded from
these events because the family was fearful

0:07:54.240,0:07:58.430
due to their role as a healthcare provider.

0:07:58.430,0:08:03.300
And in response to physically distancing,
some healthcare providers tried to stay connected

0:08:03.300,0:08:10.650
through alternative means such as virtual
calls, social media, or even a telephone call.

0:08:10.650,0:08:14.350
And some of these changes were felt to be
beneficial by

0:08:14.350,0:08:17.660
healthcare workers to maintain these relationships,

0:08:17.660,0:08:22.770
and others indicated that it really just made
them feel more isolated, because it didn’t

0:08:22.770,0:08:31.840
seem to be the same as an in-person visit
or gathering.

0:08:31.840,0:08:35.440
And the other way it was impacted, is that
family members had

0:08:35.440,0:08:42.149
to take on new roles to accommodate increased
work hours or different schedules.

0:08:42.149,0:08:46.240
And also to accommodate periods where the
healthcare workers just felt too exhausted

0:08:46.240,0:08:53.740
and burnt out to be able to fulfil usual roles
in parenting or even in household chores.

0:08:53.740,0:08:57.750
And this is explained in the quote above where
this healthcare provider’s

0:08:57.750,0:09:03.279
husband had to take on additional parental
responsibilities at home to accommodate work

0:09:03.279,0:09:04.399
scheduling.

0:09:04.399,0:09:12.070
But being able to accomplish these usual home
responsibilities was described by the healthcare

0:09:12.070,0:09:13.070
providers

0:09:13.070,0:09:16.370
as they felt very guilty because of it, and
like they had even lost their place

0:09:16.370,0:09:19.450
within the family for even a period of time.

0:09:19.450,0:09:24.940
And then once their work hours reduced or
they no longer had to physically distance,

0:09:24.940,0:09:27.310
there was this period of having to adjust
again

0:09:27.310,0:09:32.660
and even renegotiate some of these rules within
the family.

0:09:32.660,0:09:39.410
Another major theme healthcare providers described
was this overarching

0:09:39.410,0:09:44.330
feeling of never-ending caregiving that became
all-consuming during the pandemic.

0:09:44.330,0:09:50.130
On the one hand, due to the demands the pandemic
placed on healthcare providers,

0:09:50.130,0:09:55.779
they worked more hours and experienced pressure
to place work before their family or themselves.

0:09:55.779,0:10:02.060
This problem existed before the pandemic,
but was exacerbated by it due to the added

0:10:02.060,0:10:06.940
challenges in the workplace, such as worsened
staffing issues.

0:10:06.940,0:10:12.260
And on the other hand, typical familial caregiving
responsibilities became more difficult to

0:10:12.260,0:10:13.320
execute

0:10:13.320,0:10:17.490
due to the added risk placed on vulnerable
groups during this time,

0:10:17.490,0:10:22.310
which led to at-home caregiving feeling like
an extension of their occupational role.

0:10:22.310,0:10:27.330
And this just made it very difficult to escape
from these overwhelming demands.

0:10:27.330,0:10:34.839
When looking at the increased pressure to
prioritise work over family, healthcare providers

0:10:34.839,0:10:40.550
describe two main sources of this pressure,
the first being organisations putting an additional

0:10:40.550,0:10:46.709
pressure on healthcare providers to work more
often, stay over time, come in on dates off,

0:10:46.709,0:10:53.380
and are even denying vacation time because
staff shortages have been exacerbated since

0:10:53.380,0:10:55.519
the beginning of the pandemic.

0:10:55.519,0:11:00.410
In order to meet the care demand of the pandemic,
healthcare providers are needing to make up

0:11:00.410,0:11:01.639
for these gaps.

0:11:01.639,0:11:07.040
However, the healthcare provider themselves
also put pressure on themselves to work these

0:11:07.040,0:11:12.740
extra hours out of a sense of duty and guilt
towards the public and colleagues.

0:11:12.740,0:11:16.550
Healthcare providers experience a contradictory
pressure as well

0:11:16.550,0:11:19.540
from family to reduce their work hours.

0:11:19.540,0:11:24.471
So for example, some healthcare providers
stated that their families wanted them to

0:11:24.471,0:11:25.870
quit their jobs.

0:11:25.870,0:11:31.779
But many healthcare providers said that they
were continuing to work despite these pressures,

0:11:31.779,0:11:34.910
because they believe it is necessary to continue
in order to

0:11:34.910,0:11:37.880
maintain the healthcare system at this time.

0:11:37.880,0:11:42.329
And these pressures create internal tension
for healthcare providers,

0:11:42.329,0:11:46.839
because they’re feeling guilty towards colleagues
for not taking on additional shifts.

0:11:46.839,0:11:53.730
And some of these healthcare providers left
their positions or made a complete role switch,

0:11:53.730,0:11:57.720
because of the toll it had on their physical,
emotional and mental health.

0:11:57.720,0:12:01.860
Many of these individuals felt it was the
only way for them to balance

0:12:01.860,0:12:04.589
work and family, by finding a new role.

0:12:04.589,0:12:08.550
However, it was made clear that this was not
an option for everyone.

0:12:08.550,0:12:12.670
And so those individuals were stuck in a difficult
situation.

0:12:12.670,0:12:17.620
The role of caregiver outside of the workplace
was also not a new

0:12:17.620,0:12:20.280
responsibility specific to the pandemic.

0:12:20.280,0:12:26.130
However, due to the high risk of that COVID
posed to vulnerable loved ones, such as children

0:12:26.130,0:12:32.529
and the elderly, health related care needs
of family members and friends fell to healthcare

0:12:32.529,0:12:37.399
providers, with the expectation that they
would be able to make the best care decisions

0:12:37.399,0:12:39.330
for their loved ones.

0:12:39.330,0:12:44.120
And this added responsibility and pressure
to their caregiving role at home created a

0:12:44.120,0:12:48.710
double burden of family and work caregiving.
And because of this

0:12:48.710,0:12:53.800
caregiving provided outside of the workplace,
became an extension of their professional

0:12:53.800,0:12:59.670
role and contributed to the exhaustion and
stress that many healthcare providers are

0:12:59.670,0:13:01.209
facing during the pandemic.

0:13:01.209,0:13:08.940
The challenges and stressors associated with
the healthcare provider role during the pandemic

0:13:08.940,0:13:15.530
also produced a disconnect between personal
life and work life, such that many healthcare

0:13:15.530,0:13:21.260
providers felt as though they were living
in two worlds that they were unable to reconcile.

0:13:21.260,0:13:25.060
These two worlds that we identified are being
described as

0:13:25.060,0:13:30.399
home world and work world in this presentation.

0:13:30.399,0:13:34.769
So one of the major relationship impacts that
has come out of this theme of living in two

0:13:34.769,0:13:38.620
worlds is an increased connection with colleagues.

0:13:38.620,0:13:41.410
And this is due primarily to two reasons.

0:13:41.410,0:13:45.829
The first is that colleagues provide effective
social support.

0:13:45.829,0:13:51.029
So there’s been a change in work relationships
where healthcare providers are turning more

0:13:51.029,0:13:57.630
frequently to colleagues for social support
because of their shared experiences during

0:13:57.630,0:13:58.630
COVID.

0:13:58.630,0:14:03.000
Other healthcare providers are able to understand
and empathise with the challenges that they’re

0:14:03.000,0:14:08.910
being exposed to and are therefore able to
provide much needed and effective support.

0:14:08.910,0:14:12.399
Additionally, work exposures have led to a
greater collective

0:14:12.399,0:14:18.350
identity with other healthcare providers who
have similar experiences.

0:14:18.350,0:14:21.180
And the other reason is risk of infection.

0:14:21.180,0:14:26.130
Many healthcare providers feel a sense of
reassurance by interacting more with other

0:14:26.130,0:14:30.990
healthcare providers, because they did not
feel they were putting them at any increased

0:14:30.990,0:14:36.970
risk of exposure as everyone is vaccinated
and has similar levels of work related exposure

0:14:36.970,0:14:37.970
already.

0:14:37.970,0:14:43.449
At the same time, healthcare providers told
us that they were

0:14:43.449,0:14:46.880
feeling disconnected from family and friends.

0:14:46.880,0:14:52.600
So due to healthcare providers’ exposure to
challenging situations at work, they’re having

0:14:52.600,0:14:55.019
a difficult time.

0:14:55.019,0:15:01.839
Relating to family and friends and vice versa,
which has made this more difficult for healthcare

0:15:01.839,0:15:06.100
providers to turn to family and friends for
support.

0:15:06.100,0:15:10.150
There’s also the additional fear of sharing
these experiences with family

0:15:10.150,0:15:15.640
in case it traumatises them, which produces
further barriers for communication between

0:15:15.640,0:15:17.380
the two.

0:15:17.380,0:15:22.649
And the lockdown restrictions limited healthcare
provider’s exposure to family and friends

0:15:22.649,0:15:28.290
contributing to this gap between healthcare
providers and loved ones.

0:15:28.290,0:15:31.369
There’s also been increased conflict reported
amongst family

0:15:31.369,0:15:38.500
and friends due to different opinions on vaccinations
masks, government rules, et cetera, leading

0:15:38.500,0:15:43.360
to many healthcare providers cutting off or
limiting relationships for their own mental

0:15:43.360,0:15:44.360
health.

0:15:44.360,0:15:51.690
So just to go over some of the key findings,
the role of healthcare

0:15:51.690,0:15:57.460
providers have impacted home life during the
pandemic specifically due to physical distancing

0:15:57.460,0:16:01.600
requirements and a need for role changes.

0:16:01.600,0:16:05.360
The increased caregiving demands of a healthcare
provider at home and

0:16:05.360,0:16:11.399
work during the pandemic, felt all consuming
and contributed to additional stress and exhaustion

0:16:11.399,0:16:13.209
on healthcare providers.

0:16:13.209,0:16:18.220
The numerous work-related challenges healthcare
providers face

0:16:18.220,0:16:22.819
during the pandemic have led to them feeling
as though though they are living in two worlds

0:16:22.819,0:16:27.579
that they’re unable to reconcile, specifically
the work world and the home world.

0:16:27.579,0:16:33.029
With that I would like to thank you all for
your time today.

0:16:33.029,0:16:39.350
And also thank our valued healthcare providers,
who have and continue to serve on the front

0:16:39.350,0:16:41.300
lines of the pandemic.

0:16:41.300,0:16:44.009
Thank you all very much.

0:16:44.009,0:16:46.250
Thank you for sharing your research, Kim and
Emily.

0:16:46.250,0:16:47.370
We really appreciate it.

0:16:47.370,0:16:52.529
so we’re gonna move into the live discussion
portion of our event today.

0:16:52.529,0:16:56.470
This is a chance to really get into the nitty
gritty and understand the complexities and

0:16:56.470,0:16:57.899
nuances of today’s topic.

0:16:57.899,0:17:02.329
We’re gonna jump right in with a few questions,
but it’s not too late to ask yours.

0:17:02.329,0:17:04.970
If you have a question of your own, all you
have to do is pop it

0:17:04.970,0:17:08.429
in the chat or the q and a box and I’ll get
to it.

0:17:08.429,0:17:13.480
I’d like to welcome to the live discussion
today, Margaret McKinnon, Heidi Cramm,

0:17:13.480,0:17:17.309
Kelly Hassall, Kim Ritchie and Emily Sullo.

0:17:17.309,0:17:20.630
I was hoping each of you could take a moment
to introduce yourselves and tell us a little

0:17:20.630,0:17:25.059
bit about your involvement in the project
or you know, through what lens you’re answering

0:17:25.059,0:17:27.100
the questions from today.

0:17:27.100,0:17:29.290
And Margaret, I was hoping we could start
with you and

0:17:29.290,0:17:31.510
perhaps you could pass it to the next person.

0:17:31.510,0:17:32.650
Thank you so much, Amy.

0:17:32.650,0:17:36.830
So my name is Margaret McKinnon, I’m a clinical
psychologist and I also serve as

0:17:36.830,0:17:41.020
a professor in the Department of Psychiatry
and Behavioural Neurosciences at McMaster.

0:17:41.020,0:17:45.690
I was incredibly privileged throughout the
pandemic to provide mental health supports

0:17:45.690,0:17:47.420
to healthcare workers.

0:17:47.420,0:17:50.830
So being on the COVID unit, being on the ICU
units,

0:17:50.830,0:17:54.220
and also leading communities of practice for
healthcare workers.

0:17:54.220,0:17:59.920
And I will say, without any reservation that
we heard, I heard repeatedly about the impact

0:17:59.920,0:18:05.190
of pandemic service by healthcare workers
on their relationships with families.

0:18:05.190,0:18:08.440
And I’m, I’m really pleased that we have the
opportunity to highlight this impact because

0:18:08.440,0:18:12.520
I think sometimes it’s missed when we talk
about the impact that this pandemic has had

0:18:12.520,0:18:17.570
on those who serve, including healthcare workers,
but also public safety personnel and their

0:18:17.570,0:18:21.179
families who really gave services well as
sacrificed during the pandemic.

0:18:21.179,0:18:25.669
Maybe I’ll turn it over now to Kelly to introduce
herself.

0:18:25.669,0:18:27.169
Good morning everybody.

0:18:27.169,0:18:28.850
My name’s Kelly Hassall.

0:18:28.850,0:18:33.020
I’m the clinical resource leader of respiratory
therapy here at St. Joseph’s Healthcare in

0:18:33.020,0:18:34.120
Hamilton.

0:18:34.120,0:18:38.440
I’m coming at this from the lens of a respiratory
therapist that has been in acute care in the

0:18:38.440,0:18:42.230
front lines, and I had an opportunity to work
with respiratory therapists throughout Ontario

0:18:42.230,0:18:45.310
and Canada throughout the various phases of
the pandemic.

0:18:45.310,0:18:49.640
I’m also a mother of two children who have
gone from ages five

0:18:49.640,0:18:53.230
to eight, and they are now turning, well,
one was five at the start and was now

0:18:53.230,0:18:55.940
eight, and the other one was eight is now
11.

0:18:55.940,0:18:58.090
So I’ve had that opportunity as well.

0:18:58.090,0:19:01.980
And then, we were very fortunate to be linked
with Margaret and her team,

0:19:01.980,0:19:07.580
very early on in the pandemic, to discuss
the concept of moral injury within respiratory

0:19:07.580,0:19:08.580
therapists. This was something

0:19:08.580,0:19:12.400
that had not been really addressed very much
to date, so we’ve been very, very fortunate

0:19:12.400,0:19:16.700
to have that assistance throughout this time.

0:19:16.700,0:19:25.110
Maybe I’ll switch to Kim Ritchie now, if I
may.

0:19:25.110,0:19:27.580
Thank you so much, Kelly.

0:19:27.580,0:19:29.720
So it’s my pleasure to be here.

0:19:29.720,0:19:34.120
I think Amy so kindly introduced us at the
beginning too, but I’ll just add

0:19:34.120,0:19:39.659
my role has for the project has been, I guess,
mostly lead for the project in

0:19:39.659,0:19:40.940
terms of the research part.

0:19:40.940,0:19:44.870
And I’ve had the privilege of talking to over
a hundred

0:19:44.870,0:19:49.770
healthcare providers since the beginning of
the pandemic and through each wave.

0:19:49.770,0:19:55.200
And so we really, really value all of the
information that’s been shared

0:19:55.200,0:19:56.200
with us.

0:19:56.200,0:20:01.809
But the impact on the family was one of the
really early themes that arose and has

0:20:01.809,0:20:03.060
remained consistent.

0:20:03.060,0:20:06.890
And it really brings home the fact that, you
know,

0:20:06.890,0:20:11.110
we all belong to, to — greater than our
work,

0:20:11.110,0:20:14.270
and that if things are going on at work, it
impacts our family.

0:20:14.270,0:20:21.870
And I think the pandemic really had a profound
impact on healthcare providers

0:20:21.870,0:20:26.520
and by extension to their family because of
the types of service that they had and the

0:20:26.520,0:20:32.559
amount of work that they actually had to do
in terms of hours during the pandemic

0:20:32.559,0:20:33.770
and serving.

0:20:33.770,0:20:36.280
So we are really happy to be here today in
order to

0:20:36.280,0:20:41.100
highlight this for the rest of everyone else.

0:20:41.100,0:20:44.590
And I’ll pass it over to Heidi.

0:20:44.590,0:20:46.679
Hi, I’m Heidi Cramm.

0:20:46.679,0:20:53.049
I’m an occupational therapist by training,
but primarily I’ve been a researcher around

0:20:53.049,0:20:58.790
families, across populations that really experience
occupational risk and requirement, and that’s

0:20:58.790,0:21:01.670
what we’ve been trying to reframe through
the research group.

0:21:01.670,0:21:04.000
I’m leading the Families Matter research group
and really

0:21:04.000,0:21:10.730
trying to understand the dimensions of lifestyle
that come with certain kinds of jobs.

0:21:10.730,0:21:14.480
And so when we think of military, we think
about public safety personnel.

0:21:14.480,0:21:19.720
We’ve been building a whole way of understanding
the impacts of families.

0:21:19.720,0:21:24.659
With that lens of occupational risk and requirement
because we could see how easy

0:21:24.659,0:21:30.270
it extends into the healthcare worker field
and how much there’s blurring of of these

0:21:30.270,0:21:33.000
kinds of experiences and how much we can learn.

0:21:33.000,0:21:36.900
I will say I was absolutely struck by the
findings and how

0:21:36.900,0:21:43.919
much they represent the ongoing experience
in so many ways of the families of public

0:21:43.919,0:21:45.140
safety personnel.

0:21:45.140,0:21:50.679
All of those things become quite amplified
and quite explicit and undeniable — quite

0:21:50.679,0:21:58.909
in your face through the risks of COVID, but
also the counter measures and the impact that

0:21:58.909,0:22:03.840
that’s had on the day to day functioning of
the family, especially during longer periods

0:22:03.840,0:22:04.929
of pay lockdown.

0:22:04.929,0:22:08.049
So I’ve got many, many thoughts.

0:22:08.049,0:22:09.100
Fantastic presentation.

0:22:09.100,0:22:10.169
So interesting.

0:22:10.169,0:22:11.260
Thank you.

0:22:11.260,0:22:12.350
Emily.

0:22:12.350,0:22:15.620
Yes. Thank you.

0:22:15.620,0:22:17.809
Hi, all.

0:22:17.809,0:22:21.360
I’m Emily Sullo and I’m honoured to be here
today.

0:22:21.360,0:22:26.030
I’m a research assistant in the Trauma and
Recovery Lab at McMaster,

0:22:26.030,0:22:31.840
and I’m coming from this — as being involved
in the project mostly through

0:22:31.840,0:22:37.960
creating knowledge translation materials that
are presenting our findings to the public

0:22:37.960,0:22:43.650
to spread awareness about what healthcare
providers and public safety personnel

0:22:43.650,0:22:47.380
have been experiencing during the pandemic.
But I also have

0:22:47.380,0:22:54.150
been working alongside the team on the research
portion of it, of the project.

0:22:54.150,0:22:59.000
And it’s great to be here today.

0:22:59.000,0:23:00.000
Thank you.

0:23:00.000,0:23:01.000
Thank you everyone.

0:23:01.000,0:23:02.679
So I wanna just jump right into it.

0:23:02.679,0:23:07.210
So it was mentioned in the presentation that
some healthcare workers felt they’ve lost

0:23:07.210,0:23:11.789
their place in the family because they weren’t
able to do normal household duties or the

0:23:11.789,0:23:12.789

0:23:12.789,0:23:15.840
you know, what was normal before the pandemic,
household duties.

0:23:15.840,0:23:21.050
Ashley in the chat actually beat me to connecting
— [to] making the link between healthcare

0:23:21.050,0:23:23.289
providers during the pandemic and military
families.

0:23:23.289,0:23:28.610
So Heidi, I know you’ve done extensive research
with military professionals about life after

0:23:28.610,0:23:29.610
service.

0:23:29.610,0:23:34.799
So what I’m wondering is, can families truly
go back to how it was

0:23:34.799,0:23:35.799
pre-pandemic?

0:23:35.799,0:23:39.020
And if they can, what is it that they can
do to begin rebuilding?

0:23:39.020,0:23:43.610
Thanks for your question, and I mean, I don’t
think any of

0:23:43.610,0:23:48.490
us can go back to life truly pre-pandemic,
so I don’t really think it’s an option.

0:23:48.490,0:23:52.529
I think that many things have evolved and
changed, and one of the things that we’ve

0:23:52.529,0:23:56.880
learned, and it’s been so interesting when
we think about these occupational risks and

0:23:56.880,0:24:01.380
requirements in relation to military families
and then in relation to public safety personnel,

0:24:01.380,0:24:02.750
there are some differences.

0:24:02.750,0:24:07.350
When you work in communities where you live,
it does change

0:24:07.350,0:24:11.799
the experience of you in your home and your
connection to your community.

0:24:11.799,0:24:17.520
One of the biggest pressures for public safety
personnel and for healthcare workers

0:24:17.520,0:24:19.710
are things like shift work.

0:24:19.710,0:24:27.779
And the shift work means that you have to
do pretty persistent ongoing transitions in

0:24:27.779,0:24:29.870
and out of home and work.

0:24:29.870,0:24:33.289
And so we hear, and we’ve heard in your findings,
that there’s

0:24:33.289,0:24:39.380
a maintenance of these two selves that for
you to be adaptive in one context, you may

0:24:39.380,0:24:43.440
not be able to be that same self and adaptive
in the same.

0:24:43.440,0:24:46.450
And how do you rapidly transition back and
forth?

0:24:46.450,0:24:53.440
So when we, we look at military families and
how military families adapt to changes in

0:24:53.440,0:24:58.970
roles, rhythms, and routines, when their family
members are away for extended periods.

0:24:58.970,0:25:01.309
Public safety families, healthcare workers,
do not have

0:25:01.309,0:25:04.909
that time pressed in the same kind of way.

0:25:04.909,0:25:07.470
They have rapid in out transitions.

0:25:07.470,0:25:14.510
This can be extraordinarily draining on both
sides because essentially, and as a fire spouse,

0:25:14.510,0:25:18.880
I can speak to this as a very long term experience
with this.

0:25:18.880,0:25:25.440
How do you actually — as an occupational
therapist, I find it fascinating around roles,

0:25:25.440,0:25:26.440
rhythms,

0:25:26.440,0:25:28.940
routines, connection, time use, all of these
things.

0:25:28.940,0:25:36.169
How do you simultaneously say while you’re
not here, we function this way and we’re capable

0:25:36.169,0:25:42.020
and competent and we don’t need you cause
we can’t need you because we have to structure

0:25:42.020,0:25:43.440
it a way that that is.

0:25:43.440,0:25:47.180
But then as soon as you come back in, we have
to repopulate

0:25:47.180,0:25:48.679
and now be able to do that.

0:25:48.679,0:25:52.950
And so this has, this plays out in families
in different kinds of ways, depending upon,

0:25:52.950,0:25:57.779
say if you have young children, if you have
elder care, if you have a spouse with a career

0:25:57.779,0:26:04.250
that competes for kind of resources and time
and flexibility, you see how much those lifestyle

0:26:04.250,0:26:05.760
strains can really play out.

0:26:05.760,0:26:09.010
So I think one of the, one of the biggest
strains is the

0:26:09.010,0:26:10.649
transition in and out.

0:26:10.649,0:26:11.649
Margaret?

0:26:11.649,0:26:14.490
Oh, Margaret, I see your hand up.

0:26:14.490,0:26:16.840
Oh, sorry, I just saw her hand.

0:26:16.840,0:26:18.120
I’m just answering hands now.

0:26:18.120,0:26:19.120
Sorry, Amy.

0:26:19.120,0:26:21.980
Now Heidi, I just want to say, you know, I
have the privilege of —

0:26:21.980,0:26:24.750
I’m the Homewood chair of mental health and
trauma, and I have the privilege of working

0:26:24.750,0:26:27.320
with the Guardians Program at Homewood. And
that

0:26:27.320,0:26:31.549
is one of the things we hear consistently
from public safety personnel, is that that

0:26:31.549,0:26:37.559
transition from being at a call, being in
a difficult situation, driving home, and the

0:26:37.559,0:26:43.590
second that you open that door, you suddenly
have to be a father, a mother, a, you know,

0:26:43.590,0:26:48.100
a spouse, when you’ve just left, for example,
an accident that’s been horrific — and seeing

0:26:48.100,0:26:51.120
children who have been injured, or children
who have been killed.

0:26:51.120,0:26:53.740
And when I was on the units during the pandemic,

0:26:53.740,0:26:58.960
one of those powerful things that I could
say to healthcare workers was that, I understand

0:26:58.960,0:27:04.130
that you’re living in a different world right
now, and you could just see, people, how they

0:27:04.130,0:27:05.130
react to that.

0:27:05.130,0:27:07.940
And then to follow up with that by saying,
I know that

0:27:07.940,0:27:11.960
you’re living in a different world than your
family, than your friends, and then people

0:27:11.960,0:27:16.660
who are not healthcare providers and your
life experience is different.

0:27:16.660,0:27:18.280
What you’re seeing is different.

0:27:18.280,0:27:21.909
It’s very hard for other, other people to
know or understand.

0:27:21.909,0:27:24.809
For example, proning an older adult where
it takes eight

0:27:24.809,0:27:28.049
people to turn over an older adult.

0:27:28.049,0:27:31.870
And that may be very painful for the older
adult when that’s happening.

0:27:31.870,0:27:35.970
Where it may be the case that, you know, that
that older adult has said, I don’t want further

0:27:35.970,0:27:36.970
care.

0:27:36.970,0:27:42.530
But families understandably wanting to hold
onto hope are saying, I want my, my mom or

0:27:42.530,0:27:44.130
my dad to be treated.

0:27:44.130,0:27:46.789
So I really feel that, that belief as well,
that,

0:27:46.789,0:27:50.940
you know, if, healthcare workers tell their
stories, which Emily was talking about, that

0:27:50.940,0:27:53.230
they may traumatise their family members at
home.

0:27:53.230,0:27:57.740
And so they live — and we hear that from
public safety personnel all the time, on the

0:27:57.740,0:27:58.740
units

0:27:58.740,0:28:02.149
at Homewood, and in our research that, you
know, if I tell my story, I’m going to hurt

0:28:02.149,0:28:03.149
somebody

0:28:03.149,0:28:04.149
by telling it.

0:28:04.149,0:28:06.240
And so you see people cleaving onto other
healthcare

0:28:06.240,0:28:09.630
workers is a way of being able to tell and
share their stories.

0:28:09.630,0:28:14.050
They, they are family, much like in public
safety personnel and in the military, those

0:28:14.050,0:28:17.360
who you serve with are also your family.

0:28:17.360,0:28:22.419
And the word, the word family in the professions
in which we serve, you know, means those who

0:28:22.419,0:28:27.390
by whom you related by blood or by adoption,
but also those people with whom you serve.

0:28:27.390,0:28:32.260
I know, Kelly, if you’ve thought about that
based

0:28:32.260,0:28:36.120
on your own experience — I know you’ve done
a lot of work around this with your colleagues

0:28:36.120,0:28:37.779
in respiratory therapy.

0:28:37.779,0:28:41.750
Yeah, and sorry, just because I’m — could
you just reframe

0:28:41.750,0:28:44.169
exactly what the question is that you wanted
me to address?

0:28:44.169,0:28:46.169
Just cause I’m all over the map now.

0:28:46.169,0:28:48.260
I don’t think — yeah, I, I know that we’ve
talked

0:28:48.260,0:28:53.030
about, with respiratory therapists, I’ve seen
how your profession holds together as a family.

0:28:53.030,0:28:55.310
There’s the impact on your family at home
and then

0:28:55.310,0:28:56.364
there’s an impact on your family at work as
well.

0:28:56.364,0:29:01.190
And I don’t know, do you have any thoughts
about how the pandemic impacted on that?

0:29:01.190,0:29:05.330
Yeah, I think it’s interesting because we
do work as an inter-professional

0:29:05.330,0:29:09.779
team, so we do move throughout the organisation
and we do work with all the different teams,

0:29:09.779,0:29:13.660
but we all come back to our home base and
this is where we have our safe space,

0:29:13.660,0:29:18.090
where we discuss and talk about all the challenges
that we’re having.

0:29:18.090,0:29:22.060
And I think that also ties into your commitment
because you don’t want to let your family

0:29:22.060,0:29:26.880
down and you know how hard it is if you’re
not going into work the next day.

0:29:26.880,0:29:29.299
And at the beginning of the pandemic, there
was a stigma that if

0:29:29.299,0:29:32.490
you ended up with COVID and couldn’t come
in to help out your team, it’s because you

0:29:32.490,0:29:33.490
did something wrong.

0:29:33.490,0:29:34.490
Yep.

0:29:34.490,0:29:35.490
I remember.

0:29:35.490,0:29:36.490
Yep. And, and, and —

0:29:36.490,0:29:40.470
you knew that dread and that cycle, and thinking
about if — I know for me, for example,

0:29:40.470,0:29:46.880
if I was gonna let one of my children go somewhere
or have someone come in to help, what were

0:29:46.880,0:29:49.390
the risks that I was putting on my family?

0:29:49.390,0:29:52.029
What were the risks I was technically putting
on my team?

0:29:52.029,0:29:53.029
Mm-hmm.

0:29:53.029,0:29:54.029
And so that

0:29:54.029,0:29:57.910
sense there of that commitment sort of is
very unique.

0:29:57.910,0:30:02.480
And then my spouse, for example, is not in
healthcare.

0:30:02.480,0:30:07.240
So completely different context, and how much
do you share, do you not share?

0:30:07.240,0:30:13.019
And how do you make it — [make] them understand
that that potential commitment that you feel

0:30:13.019,0:30:17.010
to this group of people that are being paid
to be there like you are?

0:30:17.010,0:30:18.010
Absolutely.

0:30:18.010,0:30:22.950
We, we would hear often from healthcare workers
that, you know, even to take a break on the

0:30:22.950,0:30:27.559
unit — so to take 15 or 20 minutes for yourself
meant letting down the team.

0:30:27.559,0:30:32.669
Or to go home and not take another shift,
or to not come in the next day when you were

0:30:32.669,0:30:34.920
exhausted, it felt like letting your family
down.

0:30:34.920,0:30:41.250
At the same time in going home to your family,
your nuclear family, there’s nothing left.

0:30:41.250,0:30:42.760
“I have nothing left.

0:30:42.760,0:30:47.290
At this point, I can’t be a mom right now
to my two year old child.

0:30:47.290,0:30:51.940
I can’t right now, go home and be a partner
because I have given everything that I have

0:30:51.940,0:30:56.000
on this unit, and not wanting to let that
family, that work family down.”

0:30:56.000,0:31:06.860
So, Margaret, I’m curious what sort of strategies
healthcare providers can use both at home

0:31:06.860,0:31:07.880
and at work.

0:31:07.880,0:31:12.630
So I was hoping maybe you could speak to some
strategies they could use at work and perhaps,

0:31:12.630,0:31:17.279
Kelly, maybe you have some tips on how they
might be able to cope at home with

0:31:17.279,0:31:22.260
that sort of 24 7 demand for caregiving.

0:31:22.260,0:31:26.529
I think one thing that we would say, and it’s
a very old adage, but it’s a true one, is

0:31:26.529,0:31:27.779
that we’re

0:31:27.779,0:31:31.169
not able to help others until we put the oxygen
mask on ourselves.

0:31:31.169,0:31:32.169
Right?

0:31:32.169,0:31:34.830
And that sometimes we just need to hear that,
right?

0:31:34.830,0:31:39.820
We need to hear that we have — we deserve
to be taken care of.

0:31:39.820,0:31:42.539
We deserve to have a break.

0:31:42.539,0:31:48.280
And taking that time, having self-compassion,
which is very, very hard because so many people

0:31:48.280,0:31:50.659
are relying on you as a healthcare worker.

0:31:50.659,0:31:55.130
It’s patients, it’s your colleagues, it’s
your family.

0:31:55.130,0:31:57.539
And just keeping in mind that without taking
the time

0:31:57.539,0:32:03.539
for yourself to have a break to heal, you
won’t be able to care for others in the way,

0:32:03.539,0:32:05.169
in the most optimal way.

0:32:05.169,0:32:09.299
And that’s one really important thing for
us to remember as healthcare workers

0:32:09.299,0:32:13.159
to remember that we’re deserving of the very
best.

0:32:13.159,0:32:18.460
That we have brought Canadians through to
what we hope will soon be the other side of

0:32:18.460,0:32:20.030
this pandemic.

0:32:20.030,0:32:25.450
That we’ve had the opportunity to serve, and
that reinforces our identity as healthcare

0:32:25.450,0:32:26.450
workers.

0:32:26.450,0:32:31.279
Many of us got into these professions, whether
it be as clinicians, now as researchers, we

0:32:31.279,0:32:32.399
came here to serve.

0:32:32.399,0:32:36.120
And what we did do during this pandemic was
serve.

0:32:36.120,0:32:39.430
We — I work a lot, like Heidi, with the
military — and Kim, and you know, there’s

0:32:39.430,0:32:40.430
a way that

0:32:40.430,0:32:42.919
we honour the military with it: “We salute
you.

0:32:42.919,0:32:45.299
We thank you for your service.”

0:32:45.299,0:32:47.480
And to healthcare workers, we say the same
thing.

0:32:47.480,0:32:48.960
We salute you.

0:32:48.960,0:32:51.669
We thank you for your service.

0:32:51.669,0:32:56.340
And you know, of course, either for some people
it will reach to the point where, you know,

0:32:56.340,0:33:01.799
this is really starting the impact, the mental
health impact of the pandemic is impacting,

0:33:01.799,0:33:02.970
you know, your daily activities.

0:33:02.970,0:33:06.940
It’s impacting your mental health to the level
that you’re experiencing just stress.

0:33:06.940,0:33:12.580
And it’s very important to also seek out resources,
mental health resources, again, knowing that

0:33:12.580,0:33:15.600
you deserve that care.

0:33:15.600,0:33:17.120
And so we have a series of resources here.

0:33:17.120,0:33:21.830
But the first place to really start, if you’re
feeling that you know this is, is causing

0:33:21.830,0:33:26.091
you a great deal of distress, is impacting
your daily life, is to reach out to your family

0:33:26.091,0:33:30.260
physician to book that appointment, to seek
help.

0:33:30.260,0:33:33.170
They’ll be able to refer you on to the sources
in

0:33:33.170,0:33:37.549
your community of support to help you out
themselves and really support you.

0:33:37.549,0:33:41.750
So that’s also another important lifeline
for healthcare workers.

0:33:41.750,0:33:44.190
And really important to reach out.

0:33:44.190,0:33:46.130
Kim and Heidi and others, and Kelly, I don’t
know

0:33:46.130,0:33:48.590
what your thoughts are around — and Emily
— thoughts about other ways that people

0:33:48.590,0:33:49.590
can

0:33:49.590,0:33:54.280
cope, but I did want to highlight reaching
out for those mental health resources where

0:33:54.280,0:33:56.429
needed.

0:33:56.429,0:33:58.580
Heidi?

0:33:58.580,0:34:01.710
I think one of the things that we can see
and we can learn

0:34:01.710,0:34:06.409
from the work around these transitions with
other populations is that when people come

0:34:06.409,0:34:11.070
home and they may have nothing left in the
tank, they may feel like empty shells and

0:34:11.070,0:34:17.109
they’re expected to just kind of transition
in, is that before there’s that kind of an

0:34:17.109,0:34:21.060
often, I mean, we’re, we’re well far into
it now, so there’s no before, but thinking

0:34:21.060,0:34:28.330
that there often needs to be a transitional
allowance for that individual.

0:34:28.330,0:34:31.830
So rather than come in and have, here’s the
updates on everything

0:34:31.830,0:34:34.410
with the kids, you need to do this.

0:34:34.410,0:34:38.190
And the handover, because so many, especially
when there’s shifts, there’s a baton that

0:34:38.190,0:34:41.020
goes between people who are living in the
home.

0:34:41.020,0:34:44.450
So now I did my thing, I’m going to work,
you do this thing.

0:34:44.450,0:34:51.629
So recognising that for you to be able to
effectively

0:34:51.629,0:34:56.179
it’s not a decompress, it’s almost like a
recompress, like you, there’s a recombobulation

0:34:56.179,0:35:04.810
piece here where people need to find a way
through whatever strategy to be less deplenished.

0:35:04.810,0:35:07.150
So that replenishment is so important, right?

0:35:07.150,0:35:10.660
But they’re not going to get it if, when they
come in the house, there’s another set of

0:35:10.660,0:35:13.790
expectations and they have to do that mental
shift.

0:35:13.790,0:35:18.680
People talk about the drive is very helpful.

0:35:18.680,0:35:23.460
To do that transition and to think about what
are the things that you do in that transition?

0:35:23.460,0:35:28.599
It might be that you use that 20 minutes in
the car, that hour in the car, to actually

0:35:28.599,0:35:33.720
listen to something that takes your mind completely
out of work and resets you.

0:35:33.720,0:35:37.000
It might be something that you do that’s more
meditative or gratitude

0:35:37.000,0:35:41.511
based or whatever works for you as a person,
and that there’s also an agreement when you

0:35:41.511,0:35:44.220
come home that there’s a transitional plan.

0:35:44.220,0:35:48.010
So it might be if you’ve had a really hard
day, there’s something at the door that you

0:35:48.010,0:35:53.010
pick up so that your spouse or partner recognises
“not now.”

0:35:53.010,0:35:55.390
And not now does not mean it’s you.

0:35:55.390,0:35:59.440
So, because it’s so easy to interpret that
kind of difficulty

0:35:59.440,0:36:05.079
as behavioural, relational, and interpersonal,
and that just makes things worse after all.

0:36:05.079,0:36:11.680
So where are there, like just if I pick up
the pink thing, that means I need 15 minutes.

0:36:11.680,0:36:14.550
I’m going in and going into the bathroom,
closing the door.

0:36:14.550,0:36:19.230
I need some quiet time, nobody — just give
me 15 minutes.

0:36:19.230,0:36:22.220
But those strategies need to be talked about.

0:36:22.220,0:36:23.220
Mm-hmm.

0:36:23.220,0:36:24.220
And healthcare

0:36:24.220,0:36:29.460
workers in a very giving way, are not giving
to self.

0:36:29.460,0:36:33.041
So that self-compassion that Margaret — you
know, it’s like first responders to our public

0:36:33.041,0:36:36.640
safety community, they’re happy to help somebody
else.

0:36:36.640,0:36:42.420
But accepting help and seeing that for them
to give help to others, they have to help

0:36:42.420,0:36:52.900
self, is such a mind warping concept that
doesn’t feel possible, but it’s beyond foundationally

0:36:52.900,0:36:54.200
required.

0:36:54.200,0:36:57.700
Without that, they just continue to be, be
like Humpty Dumpty

0:36:57.700,0:36:59.150
versions of themselves.

0:36:59.150,0:37:00.150
Yep.

0:37:00.150,0:37:04.140
And you know how you think about the, the
impact of trauma and stress on the body.

0:37:04.140,0:37:08.010
And so, you know, some of this is in our heads,
but some of it is also in our bodies, right?

0:37:08.010,0:37:15.349
So how do we give our bodies that space to
calm down, to lower the arousal, to be present

0:37:15.349,0:37:16.730
in the moment?

0:37:16.730,0:37:18.349
And I’m thinking as you’re talking about this
transitional

0:37:18.349,0:37:23.790
period of, for example, sitting in a soft
chair, feeling the chair around you, putting

0:37:23.790,0:37:29.359
your feet on the ground, feeling that sensation
of the feet that are on the ground, holding

0:37:29.359,0:37:34.520
onto an object like a stress ball, even where
you’re holding it and paying attention and

0:37:34.520,0:37:39.490
moving it, and allowing both your mind to
calm down, but also your body to calm down

0:37:39.490,0:37:40.490
at the same time.

0:37:40.490,0:37:42.420
I think that’s excellent advice, Heidi.

0:37:42.420,0:37:43.790
Thank you.

0:37:43.790,0:37:45.290
Sometimes it’s when you come home, the first
thing you do

0:37:45.290,0:37:50.580
is take the dog out for a 15 minute walk,
and then you have the pet, you have the nature,

0:37:50.580,0:37:57.900
you have the physical activity, and you have
also a, a routine way to then switch — because

0:37:57.900,0:38:02.220
otherwise it’s, it, it becomes quite too much.

0:38:02.220,0:38:05.619
And that plays out in the family, in, in all
kinds of ways

0:38:05.619,0:38:11.430
that aren’t positive for either the, the,
the worker or the family members.

0:38:11.430,0:38:12.430
Mm-hmm.

0:38:12.430,0:38:14.250
Kim, did you have something to add?

0:38:14.250,0:38:16.230
I see you’ve unmuted yourself.

0:38:16.230,0:38:17.230
Yeah.

0:38:17.230,0:38:18.230
Thank you.

0:38:18.230,0:38:22.359
One of the things that we’ve had quite a few
healthcare providers tell us over the

0:38:22.359,0:38:28.270
last number of months is having somebody just
to check on them, just to ask them how they’re

0:38:28.270,0:38:34.920
doing and, and to go past kind of that surface
answer of everything’s fine and then to, to

0:38:34.920,0:38:39.000
really an authentically want to engage into
a discussion with them: like, you know, how

0:38:39.000,0:38:40.000
are you really doing?

0:38:40.000,0:38:42.170
Like, I’m here to listen to you.

0:38:42.170,0:38:47.550
And whether that person is a family member,
a friend, a colleague, a manager, supervisor,

0:38:47.550,0:38:52.960
like just creating that space of knowing that
you have somebody to go to, that somebody

0:38:52.960,0:38:59.190
you can really talk to and, and receive support
— be heard first and have that space

0:38:59.190,0:39:01.030
and then receive their support.

0:39:01.030,0:39:03.270
They, we’ve heard that’s been invaluable.

0:39:03.270,0:39:09.030
So a lot of people who have that have created
these sort of support little

0:39:09.030,0:39:12.540
groups so they know they have somebody to
go to when they need to talk.

0:39:12.540,0:39:14.200
But that’s not everybody of course.

0:39:14.200,0:39:20.700
And so just I think one of the other things
in terms of things that recommendations

0:39:20.700,0:39:25.640
is to find ways to reach out to healthcare
providers, whether you’re a family member

0:39:25.640,0:39:28.380
or, you know, in a workplace.

0:39:28.380,0:39:31.319
How can we help support that and create those,

0:39:31.319,0:39:33.810
safe groups to support each other?

0:39:33.810,0:39:34.810
Mm-hmm.

0:39:34.810,0:39:35.810
Excellent.

0:39:35.810,0:39:36.810
Thank you.

0:39:36.810,0:39:39.060
I have one more comment too.

0:39:39.060,0:39:43.440
Amy, one thing that we’ve certainly heard
in the research is that Kim’s been leading

0:39:43.440,0:39:46.921
is that, you know, we hear this from public
safety personnel, from military members as

0:39:46.921,0:39:52.140
well, often people are looking for coping
resources when they go home, and so those

0:39:52.140,0:39:57.369
coping resources can take very healthy forms
and they can sometimes take on unhealthy forms

0:39:57.369,0:39:58.369
as well.

0:39:58.369,0:40:02.180
So, increased use of alcohol, for example,
which is that we’re hearing a lot about that

0:40:02.180,0:40:07.640
and the research that we’re doing, particularly
among healthcare workers and just being aware

0:40:07.640,0:40:13.000
of and sensitive to, to knowing, have I increased
the number of drinks I’m having after work?

0:40:13.000,0:40:14.790
Is it having an impact on my relationships?

0:40:14.790,0:40:17.340
Is it having an impact on me?

0:40:17.340,0:40:22.450
I think being aware of that is really important
because, unfortunately, people often want

0:40:22.450,0:40:23.950
to numb out and not be present.

0:40:23.950,0:40:30.920
It’s a way of escaping inescapable stress,
and so can we find healthy coping mechanisms

0:40:30.920,0:40:35.800
to help take the place of some of those more
unhealthy coping mechanisms that can creep

0:40:35.800,0:40:38.619
in during stressful periods like this.

0:40:38.619,0:40:41.870
And again, when that is becoming problematic,
not feeling

0:40:41.870,0:40:47.569
shame and reaching out for help, it is actually
in fact very courageous and brave to seek

0:40:47.569,0:40:49.300
out the help that you need.

0:40:49.300,0:40:54.450
And you’re setting a beautiful example for
your children and for others when you seek

0:40:54.450,0:40:58.089
out help for your mental health concerns,
including addiction.

0:40:58.089,0:41:00.920
That is true bravery and courage.

0:41:00.920,0:41:04.960
We have another audience question that I would
love to

0:41:04.960,0:41:06.820
direct to Emily.

0:41:06.820,0:41:11.150
And the question comes from Ashley, and it
is, I know you mentioned there were tensions

0:41:11.150,0:41:16.400
around views and values related to vaccination
and public safety measures within families.

0:41:16.400,0:41:21.790
What kind of impact did this politicisation
of pandemic measures have on healthcare workers?

0:41:21.790,0:41:26.270
They say that they’re thinking specifically
of protests outside hospitals as well as the

0:41:26.270,0:41:28.640
outpouring of support for healthcare workers.

0:41:28.640,0:41:29.640
Mm-hmm.

0:41:29.640,0:41:31.420
Yeah, it’s a great question.

0:41:31.420,0:41:36.560
And so we already kind of covered that in
the presentation when talking about how

0:41:36.560,0:41:43.610
the political views were a major contributor
to this distancing between healthcare workers

0:41:43.610,0:41:48.910
and their loved ones, because it just created
extra tension within those relationships that

0:41:48.910,0:41:53.810
made it difficult for healthcare providers
to interact with them.

0:41:53.810,0:41:57.040
And so they felt the need to kind of create
these barriers,

0:41:57.040,0:42:05.380
of these boundaries on conversations or to
just restrict relationships altogether.

0:42:05.380,0:42:10.040
But we did through this analysis on family
and relationships,

0:42:10.040,0:42:14.720
we started looking at a little bit about what
healthcare providers were saying

0:42:14.720,0:42:21.359
with their relationship to the greater public
and how they’re feeling with the media,

0:42:21.359,0:42:24.339
the government, et cetera, kind of those larger
relationships.

0:42:24.339,0:42:29.119
And one of the biggest things that kind of
came out of that, or comments that came

0:42:29.119,0:42:35.420
out of that were feeling like they had to
shoulder the blame of these mandates and

0:42:35.420,0:42:37.150
restrictions that are being placed.

0:42:37.150,0:42:42.300
So not, not just with the public, but also
direct comments from loved ones as well

0:42:42.300,0:42:47.890
as, you know putting that blame on the healthcare
providers when they really didn’t

0:42:47.890,0:42:52.540
have so much say in what was being put in
place.

0:42:52.540,0:42:56.960
And so there was a lot of hurt and confusion,
especially with

0:42:56.960,0:43:01.960
that, you know, outpouring of support for
healthcare providers at the beginning

0:43:01.960,0:43:08.440
of the pandemic where everyone’s saying they’re
heroes and celebrating their

0:43:08.440,0:43:11.589
role and contributions to the community.

0:43:11.589,0:43:19.300
But then the shift kind of later into the
pandemic towards you know, you’re

0:43:19.300,0:43:24.270
causing this and having those protests outside
of hospitals where you know,

0:43:24.270,0:43:27.170
that support kind of disappeared.

0:43:27.170,0:43:30.829
And the other comments that we kind of heard
about were

0:43:30.829,0:43:36.670
that they’re carrying the burden of maintaining
safety within the community.

0:43:36.670,0:43:40.770
So they went to extremes to ensure that their

0:43:40.770,0:43:47.390
you know, taking care of their loved ones,
restricting their interactions with

0:43:47.390,0:43:52.520
others so that they weren’t putting them at
exposed risk — extra risk —

0:43:52.520,0:43:57.290
because of the risk associated with their
role.

0:43:57.290,0:44:01.990
But as everyone else kind of once the restrictions
were

0:44:01.990,0:44:06.819
lifted, were able to continue maybe going
out and felt a little bit more comfortable

0:44:06.819,0:44:10.220
doing the, having those social interactions
again.

0:44:10.220,0:44:16.060
Healthcare providers were struggling to find
out how to do that within their

0:44:16.060,0:44:20.900
own homes as well, without putting their loved
ones at risk.

0:44:20.900,0:44:25.150
And this is all kind of compounded then by
the media and,

0:44:25.150,0:44:31.070
you know, feeling like they’re being misunderstood
or maybe misrepresented or not being represented

0:44:31.070,0:44:33.480
very well in the, in the media.

0:44:33.480,0:44:41.109
And so it’s just difficult for family, friends
in the public to then relate to what

0:44:41.109,0:44:42.200
they’re going through.

0:44:42.200,0:44:46.800
And so it’s just all these compounding factors
coming together

0:44:46.800,0:44:52.230
to create this distancing and the — that
two worlds kind of disconnect.

0:44:52.230,0:44:53.470
Yeah, absolutely.

0:44:53.470,0:44:58.630
And Heidi, did you want to add to that?

0:44:58.630,0:44:59.730
Absolutely.

0:44:59.730,0:45:03.930
Because from the family’s perspective, this
we know from the different sectors and the

0:45:03.930,0:45:10.580
— we’ve done four different syntheses on
trying to understand the experiences and

0:45:10.580,0:45:13.430
the impacts of the families across sectors.

0:45:13.430,0:45:17.089
And one of the things that comes that really
plainly is this

0:45:17.089,0:45:20.640
construct of identities is very complex.

0:45:20.640,0:45:26.340
And there is a social kind of conference of
expectations, responsibility and blame on

0:45:26.340,0:45:27.859
the families.

0:45:27.859,0:45:33.290
And so sometimes that can be like a positive
social capital, and sometimes that can actually

0:45:33.290,0:45:37.730
be quite negative, aggressive, antagonistic.

0:45:37.730,0:45:38.730
And what it does

0:45:38.730,0:45:45.280
is takes families who are already kind of
out of sync with the kind of nine to five

0:45:45.280,0:45:50.260
folk because of the nature of shift work often
— and it certainly through COVID, through

0:45:50.260,0:45:56.130
the, you know, extreme workloads for healthcare
workers — so they’re already feeling

0:45:56.130,0:45:57.130
that out of sync.

0:45:57.130,0:46:01.960
And then they’re, you know, we’ve heard families
talk about feeling like they’re pariahs

0:46:01.960,0:46:04.150
and that they become kind of an extension
of risk.

0:46:04.150,0:46:05.150
Mm-hmm.

0:46:05.150,0:46:06.150
So it’s a very

0:46:06.150,0:46:11.460
fascinating concept to try to get our heads
around and it’s so important because, you

0:46:11.460,0:46:16.490
know, one of the things that we know is protective
for people is social support and social support

0:46:16.490,0:46:19.260
where you really feel like someone’s got your
back.

0:46:19.260,0:46:23.080
Not like if you feel like you go to the, the
supermarket and,

0:46:23.080,0:46:28.520
you know, someone accosts you because your
spouse is a healthcare worker and you

0:46:28.520,0:46:33.040
have a different set of rules and expectations
that everybody else is free from.

0:46:33.040,0:46:36.609
So there’s so many layers, and so to Margaret’s
points about,

0:46:36.609,0:46:43.190
you know, you know, there’s so many similarities
around this from military veteran public safety,

0:46:43.190,0:46:47.760
and one of the things that we’ve come to really
see is that families are serving alongside

0:46:47.760,0:46:50.180
and taking up all these consequences.

0:46:50.180,0:46:53.670
And if we want people who are in these jobs
with high

0:46:53.670,0:46:59.710
risk and requirements to be retained, we have
to support the families, not only to support

0:46:59.710,0:47:02.430
that person, but also to support themselves.

0:47:02.430,0:47:06.430
Because families matter in their own right.

0:47:06.430,0:47:08.910
And we need, we need that explicit attention.

0:47:08.910,0:47:09.910
Thank you.

0:47:09.910,0:47:12.030
Yeah, Heidi, I couldn’t agree more.

0:47:12.030,0:47:16.820
And you know, our own research suggests that
one in two Canadian healthcare workers are

0:47:16.820,0:47:20.160
considering leaving their clinical positions
right now.

0:47:20.160,0:47:23.950
And that tells us, we know about staffing
shortages, we know that we don’t sometimes

0:47:23.950,0:47:27.440
even have ambulances to send right now.

0:47:27.440,0:47:33.609
And we really need to hold onto this vital
workforce that just underpins our society.

0:47:33.609,0:47:34.730
How do you know?

0:47:34.730,0:47:39.410
Heidi and I were at an event last week and
you know, the speaker opened by saying, we

0:47:39.410,0:47:44.000
as Canadians, we just always knew that somebody
was coming, that the ambulance was coming,

0:47:44.000,0:47:48.600
or that the hospital doors were open and that
if we went to ER, you know, we would be taken

0:47:48.600,0:47:49.600
care of.

0:47:49.600,0:47:52.910
And we’re in a situation right now that is
perilous across the country.

0:47:52.910,0:47:54.430
This simply is not the case.

0:47:54.430,0:47:56.520
In some parts of Canada, it’s not.

0:47:56.520,0:48:01.859
Right, including, you know, including in our
capital, where the paramedic service has gone

0:48:01.859,0:48:05.940
to code zero, which means there are no ambulances
to send.

0:48:05.940,0:48:10.180
And so we really do need to do everything
we can to support this workforce.

0:48:10.180,0:48:13.980
We’d also say, you know, the term hero has
been

0:48:13.980,0:48:16.020
very, very difficult.

0:48:16.020,0:48:20.000
For some people that’s a very painful term
to hear, and I think as Canadians we

0:48:20.000,0:48:25.420
need to be cautious in how we use that term
because hero assumes things about people that

0:48:25.420,0:48:28.079
they don’t necessarily want to hear about
themselves.

0:48:28.079,0:48:31.130
And so I just always say in using the word
hero to be cautious.

0:48:31.130,0:48:37.200
I mean, how we use that and to, and to recognise
bravery and service, but maybe sometimes to

0:48:37.200,0:48:43.170
not use that word, that can be very difficult
for some people to hear.

0:48:43.170,0:48:46.340
And Margaret, I’m just wondering, we have
I would like to be

0:48:46.340,0:48:50.500
conscious of time, but perhaps if we could
take sort of two minutes to address this question

0:48:50.500,0:48:52.599
that’s come up more than once in the chat.

0:48:52.599,0:48:57.430
And it’s sort of, to me it’s the elephant
in the room, which is a lot of these issues

0:48:57.430,0:48:59.580
are actually at a systems level.

0:48:59.580,0:49:02.720
And I’m just going to read one of the participant’s
questions

0:49:02.720,0:49:07.579
because I feel they framed it perfectly, which
is they require a systems level response,

0:49:07.579,0:49:09.510
not an individual response, right?

0:49:09.510,0:49:14.550
So by telling individuals their only action
is to work on things at an individual level,

0:49:14.550,0:49:19.740
it feels like it’s putting the responsibility
on them for larger systemic failures.

0:49:19.740,0:49:23.520
And I’m just wondering if you could speak
to that a little bit.

0:49:23.520,0:49:31.369
What can healthcare institutions do to begin
to relieve some of this pressure

0:49:31.369,0:49:32.369
that they’re feeling.

0:49:32.369,0:49:34.000
I’m going to make one quick comment.

0:49:34.000,0:49:37.440
I’m going to turn over to Kim because I know
she has a lot of experience around this and

0:49:37.440,0:49:39.820
the work that she’s been leading.

0:49:39.820,0:49:42.210
You know, oftentimes, when we talk about the
mental

0:49:42.210,0:49:47.160
health impacts of the pandemic on healthcare
workers, what we talk a lot about is the levels

0:49:47.160,0:49:52.880
of PTSD, depression, anxiety, increased use
of alcohol, and so on.

0:49:52.880,0:49:56.720
And that can be very shaming for healthcare
workers because it talks — it’s really saying

0:49:56.720,0:50:01.680
you as an individual have developed a mental
health condition and some people will feel

0:50:01.680,0:50:03.000
as if, you know, “I’m weak.

0:50:03.000,0:50:04.710
Other people didn’t experience this.

0:50:04.710,0:50:05.710
Why?

0:50:05.710,0:50:06.780
Why have I experienced this?”

0:50:06.780,0:50:12.030
And it, as you say, it ignores those broader
system levels issues, which have given rise

0:50:12.030,0:50:17.570
to increases in PTSD and depression and anxiety
and alcohol use among healthcare workers.

0:50:17.570,0:50:22.990
And we really, it’s, as the audience members
have said, we need to focus on those system-levels

0:50:22.990,0:50:23.990
issues.

0:50:23.990,0:50:28.130
And we have to be very cautious when we talk
about mental health impacts as a pandemic

0:50:28.130,0:50:32.530
at the individual level because again, it
ignores those broader system level issues

0:50:32.530,0:50:36.510
that have led to, in many instances, this
rise in mental health conditions.

0:50:36.510,0:50:40.869
And I’ll just turn it over to Kim, cause I
know again, Kim, you have a lot of experience

0:50:40.869,0:50:43.609
around this…with the healthcare workers.

0:50:43.609,0:50:45.170
Thanks, Margaret.

0:50:45.170,0:50:51.339
Yeah, I appreciate the question because we’ve
— this has really emerged as one of

0:50:51.339,0:50:55.510
the biggest things that we’ve learned through
the course of our research.

0:50:55.510,0:51:00.770
And, you know, as we said, we’ve had a lot
of interviews and everybody pretty much

0:51:00.770,0:51:03.240
has spoken to this same thing.

0:51:03.240,0:51:06.309
And what we’ve heard is that healthcare workers

0:51:06.309,0:51:14.329
they’re, they really feel that a lot of the
a lot of the things that may have worked

0:51:14.329,0:51:21.870
prior — so self help through, you know,
various means of things for themselves, such

0:51:21.870,0:51:27.359
as meditation that may have been given through
a program at work or, you know, some of the

0:51:27.359,0:51:33.359
types of pizza parties and stuff like that
we’re always really sort of well received,

0:51:33.359,0:51:35.540
but that isn’t enough.

0:51:35.540,0:51:38.420
And that’s not helping right now.

0:51:38.420,0:51:42.410
And so they’re really looking to have the
next level, to

0:51:42.410,0:51:47.760
have the org — things reconstructed at the
systems level and at the organisation level.

0:51:47.760,0:51:55.130
And that the organisation takes on the the
added responsibility for caring for their

0:51:55.130,0:52:01.109
employees’ mental health and prioritising
it even, so that healthcare providers — you

0:52:01.109,0:52:04.220
know, they put their patients before themselves.

0:52:04.220,0:52:09.020
They put their families before themselves
and they don’t think of themselves.

0:52:09.020,0:52:13.830
And so when we talk to them about self-compassion,
you can see it’s uncomfortable for them.

0:52:13.830,0:52:16.980
But you know, we talk about how important
it is.

0:52:16.980,0:52:21.720
But what they really want is to have that
caring come from the organisations so that

0:52:21.720,0:52:26.460
the organisations have the structures embedded
within it to care for them.

0:52:26.460,0:52:29.000
And the ways that they’re saying that they
would feel

0:52:29.000,0:52:33.790
cared for is by having a lot more mental health
support.

0:52:33.790,0:52:39.980
So for example, having somebody they could
call who is a formal mental health

0:52:39.980,0:52:45.040
support on the units or in the building so
that they can go there during the course

0:52:45.040,0:52:50.900
of their work and just sit down and talk with
someone so that they’re not having to make

0:52:50.900,0:52:56.270
time in their home time to talk to someone
or through, you know, additional expenses

0:52:56.270,0:52:57.270
and so on.

0:52:57.270,0:52:59.300
They want somebody readily available.

0:52:59.300,0:53:04.950
And I think we really have a responsibility
to recognise that healthcare providers, similar

0:53:04.950,0:53:11.520
to military and, and public safety, as we
said, their jobs themselves, take a toll on

0:53:11.520,0:53:12.640
their mental health.

0:53:12.640,0:53:16.540
So there is a responsibility now to recognise
that

0:53:16.540,0:53:21.710
at a systems level, it’s not — and not put
the responsibility on the person.

0:53:21.710,0:53:22.710
Yeah.

0:53:22.710,0:53:24.230
It’s the responsibility of the system.

0:53:24.230,0:53:25.230
Margaret?

0:53:25.230,0:53:26.230
Yeah.

0:53:26.230,0:53:27.230
I’ll just very quickly jump in.

0:53:27.230,0:53:31.680
I will say one lesson that we learned certainly
at St. Joseph’s Healthcare in Hamilton and

0:53:31.680,0:53:35.970
at St. Mary’s Hospital in Kitchener, is that
having mental health supports directly on

0:53:35.970,0:53:38.049
the units is very valuable.

0:53:38.049,0:53:41.579
Sometimes healthcare workers don’t have time
to go to the library.

0:53:41.579,0:53:43.010
They don’t have time to go downstairs.

0:53:43.010,0:53:48.390
At one point I sat in the storage room when
nurses and other healthcare workers on

0:53:48.390,0:53:52.510
the unit changed their masks because it was
the only time they had to talk to someone

0:53:52.510,0:53:55.790
about the difficulties that they were facing,
the mental health difficulties.

0:53:55.790,0:53:59.210
I was there for nearly 36 hours with those,
those individuals.

0:53:59.210,0:54:03.960
And so having mental health supports directly
on the units — that is as simple as going

0:54:03.960,0:54:06.800
and sitting at the at the nursing station
and just saying, “I’m here.

0:54:06.800,0:54:08.830
I recognise you’re living in a different world.

0:54:08.830,0:54:09.830
I’m here to talk to you.”

0:54:09.830,0:54:15.250
And that may just be a two-minute or five-minute
conversation, but it’s helpful to know

0:54:15.250,0:54:19.099
that the organisation cares and that there’s
somebody right there on the unit for them

0:54:19.099,0:54:23.100
in the moment, to support them wherever that
may be.

0:54:23.100,0:54:24.800
Yeah, absolutely.

0:54:24.800,0:54:31.160
So with that, I’m conscious of time, so I
I am going to end the panel discussion.

0:54:31.160,0:54:32.640
Thank you so much to all the panelists.

0:54:32.640,0:54:33.980
That was so insightful.

0:54:33.980,0:54:37.680
I personally approached today’s topic from
a learner’s perspective.

0:54:37.680,0:54:41.040
So I’m not a healthcare provider or a researcher
in this field.

0:54:41.040,0:54:43.740
I have family who are.

0:54:43.740,0:54:47.460
But I thank you so much today, panelists and
projectors.

0:54:47.460,0:54:51.750
This town hall really helped me begin to put
myself in healthcare provider’s shoes and

0:54:51.750,0:54:53.840
understand more what they’ve gone through.

0:54:53.840,0:54:57.880
And I think that’s just all what we need a
little more of right now is empathy.

0:54:57.880,0:54:58.880
Right?

0:54:58.880,0:55:00.210
So thank you so much.

0:55:00.210,0:55:03.950
And with that, I would love to pass the mic
to Margaret for, for

0:55:03.950,0:55:05.470
our closing remark.

0:55:05.470,0:55:06.809
Thanks, Amy.

0:55:06.809,0:55:11.940
You know, I just want to end on a very positive
note in thanking healthcare workers

0:55:11.940,0:55:13.320
for their service.

0:55:13.320,0:55:15.030
We salute you.

0:55:15.030,0:55:16.030
We thank you.

0:55:16.030,0:55:20.299
We recognise the impact on your life and on
the lives of your family.

0:55:20.299,0:55:25.000
And we know you’ve made — you and your families
have made tremendous sacrifices during this

0:55:25.000,0:55:26.000
pandemic.

0:55:26.000,0:55:27.000
And we just

0:55:27.000,0:55:29.780
want to continue to honour you, as we know
all Canadians do.

0:55:29.780,0:55:31.920
And to thank you for your service.

Panelists

Portrait of Dr. Margaret McKinnon
Dr. Margaret McKinnon, Homewood Chair in Mental Health and Trauma; Professor, McMaster University

Dr. Margaret McKinnon is Full Professor and Associate Chair, Research in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, where she holds the Homewood Chair in Mental Health and Trauma. She is also the Research Lead for Mental Health and Addictions at St. Joseph’s Healthcare Hamilton and a Senior Scientist at Homewood Research Institute. 

Work in Margaret’s unit focuses on identifying the neural and behavioural correlates of PTSD and trauma-related illnesses and on translating this knowledge to the development and testing of novel treatment interventions aimed at reducing the cognitive and affective sequelae of these conditions. 

A licensed clinical psychologist and clinical neuropsychologist, Margaret has a special interest in military, veteran, and public safety populations (including healthcare providers), and has worked with these groups clinically and in her research program. She has published or in press nearly 150 scientific works. 

Under Margaret’s leadership, the Trauma & Recovery Research Unit is supported by federal and provincial funding from the Public Health Agency of Canada, Canadian Institutes of Health Research, the Canadian Institute for Military and Veterans Health Research, Veterans Affairs Canada, Defence Canada, the PTSD Centre of Excellence, MITACS, and the Workers Safety Insurance Board of Ontario; by a generous donation to Homewood Research Institute from Homewood Health Inc.; and by generous gifts from private foundations including True Patriot Love, the Cowan Foundation, the Military Casualty Support Foundation, the FDC Foundation, and the AllOne Foundation.

Margaret is a frequent commentator in the media on matters related to PTSD, moral injury, and the impact of trauma on special populations.

Portrait of Dr. Heidi Cramm
Dr. Heidi Cramm, Associate Professor, School of Rehabilitation Therapy, Queen’s University; Research Lead, Families Matter Research Group; Research Advisory, Canadian Institute for Military & Veteran Health Research 

Trained as an occupational therapist, Dr. Heidi Cramm is an Associate Professor in the School of Rehabilitation Therapy at Queen’s University. Her program of research involves the mental health of military families, veterans and their families, and public safety personnel; health system access and navigation for military families and veterans; and trauma.

Portrait of Kelly Hassall
Kelly Hassall, Clinical Resource Leader, Respiratory Therapy, St. Joseph’s Healthcare Hamilton

Presenters

Portrait of Dr. Kim Ritchie
Dr. Kim Ritchie, Research Associate, Homewood Research Institute

Dr. Kim Ritchie is an Assistant Professor at Trent University and holds an Adjunct position in the Department of Psychiatry and Behavioural Neuroscience at McMaster University. Since 2020, she has been co-leading a national study examining the mental health impacts of COVID-19 on healthcare providers.

In addition, Kim is a Registered Nurse with over 20 years of experience in direct care and clinical leadership roles, primarily focusing on mental health and geriatric mental health. She completed a PhD in Rehabilitation Science from Queen’s University, and currently conducts research on PTSD, trauma, and moral injury in military/veterans, healthcare providers, and public safety personnel. 

Emily Sullo, Graduate Student (MMASc), Trauma & Recovery Research Unit, McMaster University

Emily Sullo is currently a research assistant in the Trauma and Recovery Research Unit and will be beginning her PhD in Clinical Psychology at McMaster University in Fall 2023. She received her Honours Bachelor of Science in Psychology from the University of Mississauga (’20) and her Master of Management of Applied Science in Global Health Systems at Western University (’21). 

Prior to joining the research unit, Emily was involved in the development of evidence- and community-based mental health and addictions projects, including the development of mobile health units in a rural setting. Currently, Emily has primarily been involved in research focused on understanding the experiences of healthcare workers and public safety personnel during the COVID-19 pandemic and in the development of knowledge mobilization deliverables.

Moderator

Portrait of Amy Van Es
Amy Van Es, Founder, Gooder

Amy Van Es spent the first decade of her career as a digital growth strategist, helping media and tech companies rapidly scale their online presence. But she’s since resolved to spend the next decade fixing what she helped break: the internet. She’s obsessed with this mission.

When she’s not interneting with Gooder, Amy enjoys hiking, sewing, and big bowls of pasta. She dislikes push notifications, peas, and writing in the third person.

With gratitude to McMaster University Faculty of Health Sciences: Continuing Professional Development for broadcasting this event’s video feed.

Town hall 2: Work life, home life Read More »

Fatigued woman nurse hospital worker surgeon doctor in protective wear

Town hall 1: Everybody hurts

The COVID-19 pandemic has resulted in unprecedented and often devastating new circumstances for healthcare providers (HCPs), leading to an increased need for mental health prevention and early interventions efforts to support this critical workforce.

This one-hour event features:

  • A presentation that provides a brief overview of moral injury and moral distress and shares early research findings
  • A panel discussion with mental health researchers who are studying the pandemic’s effects on healthcare providers
  • An audience Q&A session
Fatigued woman nurse hospital worker surgeon doctor in protective wear

CONTENT WARNING

During this event, we discuss examples of moral distress, moral injury, and other challenges in the work life and home life of healthcare providers during the COVID-19 pandemic. Some moments may be disturbing for you. It’s fine if you wish to stop watching at any point.

If you require wellness support, we encourage you to follow this link.

Recorded at McMaster University on July 7, 2022
Transcript

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Hello everyone. Hello, hello. Welcome 
come on in. Thanks so much for taking time 

0:00:05.340,0:00:08.760
in your day to be here with us. My 
name is Amy Van Es and I’m going to  

0:00:08.760,0:00:15.660
be your host and discussion moderator today for
this session. I’d like to begin by acknowledging  

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the land on which McMaster University is
located which is the traditional territory  

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of the Haudenosaunee and Anishinaabe 
Nations and within the lands 

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protected by the Dish with One Spoon 
Wampum Belt. The wampum uses the  

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symbolism of a dish to represent the
territory and one spoon to represent  

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the people who share the resources of 
the land and only take what they need. 

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We seek a new relationship with the 
original peoples of this land one based  

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in honour and deep respect. May we be
guided by love and right action as we  

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transform our personal and institutional 
relationships with our Indigenous 

0:00:48.300,0:00:52.980
friends and neighbours. It’s in 
the same spirit that I welcome  

0:00:52.980,0:00:56.880
you all of you to the first of three
town halls on moral injury and moral  

0:00:56.880,0:01:00.840
distress in healthcare providers during 
the COVID-19 pandemic. This work is 

0:01:00.840,0:01:04.200
supported by the Public Health Agency of 
Canada as part of their work to address  

0:01:04.200,0:01:09.540
PTSD and trauma in those most affected
by COVID-19. Over the past two and a half  

0:01:09.540,0:01:12.840
years we’ve heard so much about the strain 
on the healthcare system and on the health 

0:01:12.840,0:01:17.400
care providers due to the pandemic. We owe a 
debt of gratitude to all of the physicians,  

0:01:17.400,0:01:21.600
nurses. Therapists, personal
support workers, and public safety  

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personnel who, despite facing incredible 
challenges in their daily work lives, 

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still found time and courage to talk 
to us and share their experiences. 

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So this research project seeks to shine 
a light on the impact that the pandemic  

0:01:36.480,0:01:39.120
has had on the mental health of all
those healthcare providers who have  

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given so much of themselves to the service 
of others and continue to do so today. 

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The evidence-based resources and tools we are 
offering to help build mental health literacy,  

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supports and resiliency
are our healthcare salute,  

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our way of saying thank you 
so much for your service. 

0:01:58.260,0:02:02.160
So oh so one more thing actually before we 
get into the meat and potatoes of today’s  

0:02:02.160,0:02:04.560
topic. I wanted to let you know 
that there will be time for our 

0:02:04.560,0:02:08.220
speakers to answer questions towards 
the end of the hour, so feel free to  

0:02:08.220,0:02:11.820
put the put them in the chat or use the Q&A
function and someone on our team will take  

0:02:11.820,0:02:16.980
note of them and we can address them later 
on. So to begin our program today we’re 

0:02:16.980,0:02:21.660
going to first watch a pre-recorded presentation 
by Kim Ritchie and Andrea D’Alessandro,  

0:02:21.660,0:02:24.900
both who join us live today
as well. In the talk they’ll be  

0:02:24.900,0:02:28.260
diving into some findings from their recent 
research about moral injury and healthcare 

0:02:28.260,0:02:32.520
providers during the pandemic. I’m going to tell 
you a little bit about each of them before we uh  

0:02:32.520,0:02:36.360
before we go into the recording so
Dr Kim Ritchie is a postdoctoral  

0:02:36.360,0:02:39.720
research fellow in the Department of 
Psychiatry and Behavioural Neurosciences 

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here at McMaster. She holds a PhD in 
Rehabilitation Science from Queen’s  

0:02:43.860,0:02:47.340
University and is a registered nurse
with extensive clinical experience  

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in mental health, geriatric mental 
health, and professional practice. 

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As I mentioned before, Kim is involved in this 
research project meant to develop an understanding  

0:02:55.980,0:03:00.300
of the unique and shared lived experiences and
psychological impacts among healthcare  

0:03:00.300,0:03:03.900
providers resulting from their 
work during the pandemic. This

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research will contribute toward 
the development of novel approaches  

0:03:06.540,0:03:10.200
to address the needs of healthcare 
providers and public safety personnel

0:03:10.200,0:03:15.540
during and after the pandemic. Andrea 
D’Alessandro also joins us. Andrea

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is a graduate student of the Neuroscience 
Program also here at McMaster.  

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Her thesis focuses on Respiratory

0:03:21.300,0:03:25.080
Therapists’ mental health and experiences 
with moral injury during the pandemic.  

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Beyond her thesis, work she’s a core

0:03:26.760,0:03:30.600
member of the COVID-19 related moral 
injury and healthcare workers and  

0:03:30.600,0:03:32.820
public safety personnel research team in the

0:03:32.820,0:03:36.540
Trauma and Recovery Lab. I was 
joking with everybody earlier that  

0:03:36.540,0:03:39.120
the titles are a mouthful, so please forgive

0:03:39.120,0:03:45.840
me if I am bungling any of them. Thank you both so 
much for contributing to the discussion today and

0:03:45.840,0:03:48.000
I think we’re ready to take 
a peek at the recording.  

0:03:48.540,0:03:50.820
Hi, thank you so much for the introduction.

0:03:50.820,0:03:55.500
We’re really pleased to give you a 
very brief overview of moral injury  

0:03:55.500,0:03:57.900
and moral distress today along with some of our

0:03:57.900,0:04:03.060
early research findings. As 
everyone knows COVID-19 has impacted

0:04:03.060,0:04:07.320
all of our lives in so many ways 
and for health care providers there  

0:04:07.320,0:04:09.480
have been additional impacts as they’ve really

0:04:09.480,0:04:14.760
served the public in their healthcare 
over the past two years. Moral injury and

0:04:14.760,0:04:17.820
moral distress have drawn 
increasing attention during  

0:04:17.820,0:04:21.240
the pandemic. Although there’s not one unifying

0:04:21.240,0:04:26.400
definition of these terms, they generally 
refer to being involved in or witnessing

0:04:26.400,0:04:32.760
situations that transgress moral values. 
And although many moral challenges were

0:04:32.760,0:04:37.800
present in healthcare providers’ work 
prior to the pandemic, COVID-19 has

0:04:37.800,0:04:41.700
introduced new situations that 
have really presented challenges  

0:04:41.700,0:04:44.880
for healthcare providers as they’ve really strived

0:04:44.880,0:04:50.520
to continue providing the same 
high-quality care while adapting to

0:04:50.520,0:04:51.900
an ever-changing situation.  

0:04:53.220,0:04:57.540
It’s important here to also mention 
that not everyone who experiences these

0:04:57.540,0:05:02.940
types of morally challenging situations 
will develop moral injury or moral

0:05:02.940,0:05:07.260
distress but for those who do, they 
tend to have a range of emotional,  

0:05:07.260,0:05:10.440
physiological, and cognitive impacts such

0:05:10.440,0:05:16.140
as feelings of shame, guilt, 
anger, PTSD and/or depression,

0:05:16.140,0:05:21.000
disruptions in sleep, feelings of 
worthlessness or powerlessness,

0:05:21.000,0:05:27.000
lost in trust of self or others, 
impairments in both work and at home,

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increased substance use, and 
increased risk of suicide.

0:05:32.040,0:05:37.860
Since February 2021, we’ve 
been conducting interviews  

0:05:37.860,0:05:41.160
with healthcare providers 
from across Canada in order to

0:05:41.160,0:05:47.340
understand the impact of COVID-19 on their 
mental health. In our study we asked healthcare

0:05:47.340,0:05:50.280
providers to tell us about the 
types of situations they faced  

0:05:50.280,0:05:53.400
during the pandemic that really have transgressed

0:05:53.400,0:05:57.600
or challenged their moral values 
and beliefs. We’ll briefly share a  

0:05:57.600,0:05:59.880
few of these findings with you today along with a

0:05:59.880,0:06:01.380
quote from the healthcare providers.  

0:06:02.160,0:06:06.120
Throughout the pandemic, and in 
particular during lockdown periods, many

0:06:06.120,0:06:10.320
hospitals had policies that restricted 
visitors from coming to the hospital.

0:06:11.340,0:06:15.060
Although these policies were intended to 
protect patients and staff from infection,  

0:06:15.060,0:06:18.240
many of our participants perceived that

0:06:18.240,0:06:23.220
these policies were a violation of their 
moral values of having family members

0:06:23.220,0:06:29.220
present at end of life and that believed that some 
exceptions should be made in these circumstances.

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Because family couldn’t be there,  

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many healthcare providers stepped in 
and they replaced family at end of life

0:06:36.900,0:06:40.620
holding the hand of these patients. This was also  

0:06:40.620,0:06:43.260
very emotionally difficult 
for healthcare providers to

0:06:43.260,0:06:48.960
take on this role. Healthcare providers 
also told us, and many of these in

0:06:48.960,0:06:51.480
critical care units, they said that morally  

0:06:51.480,0:06:55.320
challenging situations were ones 
that involved decisions around

0:06:55.320,0:07:00.660
resuscitation or prolonged ventilation. 
In these situations healthcare

0:07:00.660,0:07:03.840
providers told us that they felt 
the care that they were actually  

0:07:03.840,0:07:07.020
delivering was denying the patient a peaceful and

0:07:07.020,0:07:12.780
dignified death. Also many healthcare 
providers told us that they experienced drastic

0:07:12.780,0:07:17.760
increases in their workload and this was across 
multiple care settings during the pandemic

0:07:18.300,0:07:23.760
and even more so during times when 
community transmission of COVID was high

0:07:23.760,0:07:28.620
resulting in increased hospital 
emissions. The moral challenges  

0:07:28.620,0:07:30.840
in this situation occurred when patients

0:07:30.840,0:07:34.140
suffered harm from healthcare 
providers’ inability to what  

0:07:34.140,0:07:38.100
they perceived was inadequate 
care or stresses on care from

0:07:38.100,0:07:45.000
high workload and low staffing. We were also told 
about multiple instances of bullying, harassment

0:07:45.000,0:07:49.140
by healthcare providers from 
colleagues or even leadership,  

0:07:49.140,0:07:52.980
and this really left them feeling 
incompetent and demoralized.

0:07:53.580,0:07:59.400
We were also told about an increase in 
violence coming from patients, visitors, and

0:07:59.400,0:08:03.060
families and this was mostly 
during times when there was  

0:08:03.060,0:08:06.240
visitor restrictions or changes in the patient’s

0:08:06.240,0:08:12.360
care. The last area we’ll cover today 
is that many healthcare providers talked

0:08:12.360,0:08:16.380
about moral challenges related 
to decisions made by healthcare  

0:08:16.380,0:08:19.320
organizations. They felt that some of

0:08:19.320,0:08:21.600
these decisions may have negatively impacted  

0:08:21.600,0:08:25.080
patient care when it came to bed 
or even equipment allocation.

0:08:26.040,0:08:28.020
Healthcare providers in these situations  

0:08:28.020,0:08:32.040
perceived a disconnect between the 
values of management and hospital

0:08:32.040,0:08:36.300
leadership, and those of frontline 
healthcare providers. This resulted  

0:08:36.300,0:08:38.700
in feelings of betrayal. Now we’ll turn

0:08:38.700,0:08:43.980
it over to Andrea, who will share some 
of our other results. Thank you, Kim.

0:08:44.880,0:08:48.240
In addition to interviewing 
healthcare workers throughout 2021,  

0:08:48.240,0:08:50.580
we also ask Canadian healthcare workers to

0:08:50.580,0:08:53.700
complete an anonymous survey online. On this slide  

0:08:53.700,0:08:56.640
here I’m showing you some of 
our data of a subset of our

0:08:56.640,0:09:00.000
healthcare workers, so among 
respiratory therapists. We wanted  

0:09:00.000,0:09:02.280
to understand if respiratory therapists were

0:09:02.280,0:09:06.660
considering leaving their positions 
during the COVID-19 pandemic. What  

0:09:06.660,0:09:09.660
we found was that in the spring of 2021 one in

0:09:09.660,0:09:12.720
four of the respiratory therapists 
that we surveyed were considering  

0:09:12.720,0:09:14.640
leaving their position due to moral distress.

0:09:15.240,0:09:17.820
Interestingly those who were considering leaving  

0:09:17.820,0:09:22.200
were characterized by greater adverse 
psychological outcomes. So those

0:09:22.200,0:09:26.220
considering leaving scored significantly 
higher in terms of symptoms of depression,  

0:09:26.220,0:09:28.440
anxiety, moral distress and

0:09:28.440,0:09:34.560
PTSD. Interestingly when we ran predictive 
models to understand factors that may

0:09:34.560,0:09:36.960
increase someone’s likelihood of considering  

0:09:36.960,0:09:40.980
leaving, we learned that having 
considered leaving a position in

0:09:40.980,0:09:43.260
the past and endorsing system-related  

0:09:43.260,0:09:46.740
sources of moral distress (so that’s 
distress coming from organizational

0:09:46.740,0:09:51.240
factors like low staffing or low 
resources) along with PTSD symptoms,  

0:09:51.240,0:09:54.000
these three predictors actually increase the

0:09:54.000,0:09:56.400
odds of current consideration to leave  

0:09:56.400,0:10:00.540
but what this analysis also revealed 
was that the contribution of the mental

0:10:00.540,0:10:03.600
health variables in predicting 
intention to leave was very,  

0:10:03.600,0:10:06.960
very low and actually past 
consideration was the driving

0:10:06.960,0:10:10.860
factor in terms of whether the respiratory 
therapist was currently considering leaving.  

0:10:11.760,0:10:13.560
These results tell us that although

0:10:13.560,0:10:15.540
the respiratory therapists who are considering  

0:10:15.540,0:10:19.500
leaving may be in need of even 
further psychological support

0:10:19.500,0:10:22.500
than their colleagues who are not 
considering leaving. This tells  

0:10:22.500,0:10:26.760
us that we perhaps need to look outside 
the individual level to understand why

0:10:26.760,0:10:29.640
respiratory therapists were 
considering leaving. We need  

0:10:29.640,0:10:32.040
to look to organizational factors: those factors

0:10:32.040,0:10:34.200
that may have been consistent between considering  

0:10:34.200,0:10:37.080
living in the past and also at 
the time of our data collection.

0:10:38.580,0:10:43.440
This work among respiratory therapists will be 
replicated among a broader sample of healthcare

0:10:43.440,0:10:46.980
workers to better understand the 
extent of turnover expected and  

0:10:46.980,0:10:49.380
to understand those factors related to turnover.

0:10:51.480,0:10:53.640
This will be a very timely work because the  

0:10:53.640,0:10:56.400
preliminary results that we’ve 
gathered in the latter half of

0:10:56.400,0:11:02.760
2021 tell us that almost half of the 216 
healthcare workers that we surveyed were

0:11:02.760,0:11:09.420
considering leaving their positions. 
As our results indicate the potential

0:11:09.420,0:11:12.540
role that an organization may play in assisting  

0:11:12.540,0:11:15.420
their healthcare workers in terms 
of their mental health and in

0:11:15.420,0:11:16.740
retaining these healthcare workers,  

0:11:16.740,0:11:20.640
we wanted to better understand healthcare 
workers’ perspectives on how their

0:11:20.640,0:11:22.680
organizations and leaders can best support them.  

0:11:23.640,0:11:27.780
In our interviews healthcare workers 
made many recommendations for how their

0:11:27.780,0:11:30.720
organizations and leaders 
can support them. Firstly,  

0:11:30.720,0:11:33.900
healthcare workers want to 
be listened to and validated.

0:11:33.900,0:11:36.240
Healthcare workers want their leaders to know  

0:11:36.240,0:11:39.660
about their experiences during the 
pandemic and the impact that the

0:11:39.660,0:11:44.640
pandemic has had in them and on their 
families as well. This could include arranging

0:11:44.640,0:11:45.900
reflective listening sessions,  

0:11:45.900,0:11:50.100
asking questions to really understand the 
impacts and then validating healthcare

0:11:50.100,0:11:55.440
workers experiences. Healthcare workers know that 
their leaders don’t have quick fixes for many

0:11:55.440,0:11:58.020
of the complex problems that 
they faced during the pandemic,  

0:11:58.020,0:12:01.440
but they need to be supported 
by being heard valued and

0:12:01.440,0:12:08.280
understood. Secondly our healthcare workers want 
to be questioned about what their needs are.

0:12:08.280,0:12:11.520
Healthcare workers are aware 
that they have stressful jobs  

0:12:11.520,0:12:14.580
and they want supports to be able to perform those

0:12:14.580,0:12:18.060
jobs well. During our interviews 
healthcare workers told us that  

0:12:18.060,0:12:20.220
having access to long-term mental health

0:12:20.220,0:12:22.620
supports was one of the most important tools  

0:12:22.620,0:12:26.040
that they believed could improve 
their mental health. Importantly

0:12:26.040,0:12:30.120
these supports need to be informed 
about their role as a healthcare worker;  

0:12:30.120,0:12:32.220
to understand the types of challenges that

0:12:32.220,0:12:33.780
may be unique to their line of work.  

0:12:35.340,0:12:39.060
Finally it’s important that 
healthcare workers are acknowledged in

0:12:39.060,0:12:41.580
terms of the inherent occupational moral  

0:12:41.580,0:12:44.700
stressors that they face daily and 
especially during the pandemic.

0:12:44.700,0:12:48.000
Difficult ethical situations 
are part of most healthcare  

0:12:48.000,0:12:51.720
occupations and can’t always 
be removed from the job, but

0:12:51.720,0:12:54.240
providing healthcare workers 
with adequate training for these  

0:12:54.240,0:12:58.560
situations will be important to prepare 
our healthcare workers. When morally or

0:12:58.560,0:13:00.300
ethically challenging situations arise,  

0:13:00.300,0:13:04.740
discussing them in an open way within 
teams will promote awareness and

0:13:04.740,0:13:07.920
connection among team members and 
remind them that they’re not alone.  

0:13:08.640,0:13:10.740
Now this list is by no means exhaustive

0:13:10.740,0:13:14.700
and further recommendations can be 
found in our moral injury infographic.

0:13:17.340,0:13:19.380
Altogether our research shows that healthcare  

0:13:19.380,0:13:22.980
workers have indeed faced a range 
of moral challenges related to

0:13:22.980,0:13:26.220
their occupation during the 
pandemic. Most of the events  

0:13:26.220,0:13:28.260
that have been described really centered around

0:13:28.260,0:13:32.880
situations that involved a risk or 
potential risk to harm to a patient.

0:13:33.540,0:13:35.220
This may indeed be the moral value that’s  

0:13:35.220,0:13:38.100
transgressed for healthcare 
workers in these situations.

0:13:38.100,0:13:41.880
Further research is needed 
to identify interventions  

0:13:41.880,0:13:45.240
for moral injury and distress 
and to understand the long-term

0:13:45.240,0:13:48.780
Impacts, both psychological and in 
terms of leaving one’s profession.  

0:13:49.320,0:13:51.420
Our research team is dedicated to

0:13:51.420,0:13:55.680
continuing this research and we will continue 
to advocate for our vital healthcare workers.

0:13:57.000,0:14:00.420
With that I’d like to thank you 
for your time today and also thank  

0:14:00.420,0:14:02.820
all of the healthcare workers who participated in

0:14:02.820,0:14:07.680
our study so far. We thank you for your service 
on the front lines of the pandemic. Thank you.

0:14:07.680,0:14:11.460
Thank you for sharing your research Kim 
and Andrea. I really appreciate having  

0:14:11.460,0:14:14.460
your perspective from what you’ve 
learned to this discussion today.

0:14:14.460,0:14:20.880
I’m approaching today’s topic of moral 
injury from a learner’s perspective. I’m

0:14:20.880,0:14:23.700
not a doctor and the topic 
is relatively new to me,  

0:14:23.700,0:14:26.640
so as a member of the public 
living through the pandemic

0:14:26.640,0:14:29.400
it’s hard to grasp just how 
much healthcare providers have  

0:14:29.400,0:14:34.380
given themselves to the care of our 
loved ones during the pandemic. In

0:14:34.380,0:14:40.860
this moment I’m finding myself overwhelmed 
with this feeling of intense gratitude. So if

0:14:40.860,0:14:45.060
you’re in the audience and you’re on the front 
lines, thank you so much for your service

0:14:47.280,0:14:51.240
We’re going to move into the live 
discussion portion of our event today.

0:14:51.240,0:14:54.180
This is a chance to get into the 
nitty-gritty and understand the  

0:14:54.180,0:14:58.320
complexities and nuances of moral injury 
through the lens of work during the

0:14:58.320,0:15:03.300
pandemic. I’d like to welcome Margaret 
McKinnon, Alex Heber, Kim Ritchie and

0:15:03.300,0:15:06.840
Andrea D’Alessandro. I was hoping 
each of you could take a moment  

0:15:06.840,0:15:08.400
to introduce yourselves and tell us a little about

0:15:08.400,0:15:12.540
your involvement in the project and I was 
thinking Margaret maybe we could start with you.  

0:15:13.320,0:15:15.660
Thank you so much Amy and again I just want to

0:15:15.660,0:15:21.180
echo your comments. This project is deliberately 
called “Healthcare Salute: Thank you for your

0:15:21.180,0:15:25.800
Service” and we are so appreciative of 
healthcare workers across the country

0:15:25.800,0:15:29.640
for the sacrifices that they and 
their families have made over the  

0:15:29.640,0:15:32.160
pandemic. We recognize they have been tremendous.

0:15:33.180,0:15:35.400
My name is Margaret McKinnon. 
I’m the Homewood Chair in Mental  

0:15:35.400,0:15:38.400
Health and Trauma and a professor in the 
Department of Psychiatry and Behavioural

0:15:38.400,0:15:41.520
Neurosciences at McMaster University. I’m also a  

0:15:41.520,0:15:44.340
clinical psychologist. I serve as the 
research lead for the mental health

0:15:44.340,0:15:49.500
and addictions research program at St Joseph 
Healthcare Hamilton and I’m a senior scientist at

0:15:49.500,0:15:53.580
Homewood Research Institute. I’ve 
had the privilege of being on the  

0:15:53.580,0:15:56.220
ICU units and COVID units over the course of

0:15:56.220,0:15:58.920
the pandemic to provide mental health supports and  

0:15:58.920,0:16:02.760
really much of that what we saw on 
those units was the motivation for

0:16:02.760,0:16:06.420
this work. To see the suffering of healthcare 
workers and also really wanting to help  

0:16:07.620,0:16:09.120
in these difficult situations.

0:16:14.340,0:16:21.720
Alex, would you like to go next? 
Sure, thanks Amy. My name is Alexandra

0:16:21.720,0:16:27.480
Heber and I am currently the Executive 
Director of the Canadian Institutes for

0:16:27.480,0:16:32.700
Pandemic Health Education and Response, 
which is a knowledge hub that we’re

0:16:32.700,0:16:39.060
creating to host and kind of bring 
together the information from

0:16:39.060,0:16:45.180
a number of projects that have been 
funded by the Public Health Agency of

0:16:45.180,0:16:51.720
Canada, as Amy described at the beginning. 
I’m doing that work and this is one

0:16:51.720,0:16:58.740
of those projects. I’m also currently on 
secondment for my regular job which is Chief

0:16:58.740,0:17:03.000
Psychiatrist at Veterans Affairs 
Canada and I’m also a veteran of  

0:17:03.000,0:17:06.000
the Canadian Armed Forces 
and an associate professor

0:17:06.000,0:17:10.200
at McMaster University. I’m very, 
very honored to be here today.

0:17:11.940,0:17:18.300
Thank you both so much for being here. Kim did you 
want to add a little bit of context too? I know I

0:17:18.300,0:17:22.320
introduced you, but you know it’s 
your time to introduce yourself.

0:17:24.300,0:17:30.780
Thank you so much Amy. My 
name is Kim Ritchie and I’ve

0:17:30.780,0:17:34.080
also had the pleasure of 
being part of this project,  

0:17:34.080,0:17:38.040
it’s really been such a 
privilege. I work as a Research

0:17:38.040,0:17:40.980
Associate in the Trauma and 
Recovery Lab at McMaster University.  

0:17:42.540,0:17:46.560
We really started this project
over a year ago.  

0:17:47.340,0:17:49.740
It’s been a just a wonderful journey

0:17:51.000,0:17:56.160
throughout the pandemic and we’ve really 
felt it as part of our role, part of

0:17:56.160,0:18:01.860
our service towards the pandemic to try 
to capture the stories of healthcare

0:18:01.860,0:18:08.580
providers. To try to understand enough to 
advocate for them throughout the pandemic and what

0:18:08.580,0:18:11.520
they have been going through. Ultimately to thank  

0:18:11.520,0:18:15.000
them for their service and to 
let them know we hear you and

0:18:15.000,0:18:20.340
we really just want to give you a lot 
of gratitude for what they’ve done

0:18:20.340,0:18:27.060
and the stories that we’ve heard throughout. 
Thank you, Kim, for being here. Andrea

0:18:27.060,0:18:27.960
would you like to introduce yourself?  

0:18:28.560,0:18:32.220
Yes, thank you Amy. My name is Andrea 
d’Alessandro and I’m a graduate student,

0:18:32.220,0:18:33.420
one of Margaret’s students,  

0:18:33.420,0:18:38.340
at McMaster. I’ll be starting in the Research 
and Clinical Training stream this fall for my

0:18:38.340,0:18:42.120
PhD. I’ve had the privilege to 
work with this wonderful team,  

0:18:42.660,0:18:44.880
Alex, Margaret, Kim and all the rest of our

0:18:44.880,0:18:48.840
amazing colleagues. Echoing what 
my colleagues have said today, it  

0:18:48.840,0:18:50.580
really has been a privilege to be a part of this

0:18:50.580,0:18:53.820
meaningful work and to get to know 
healthcare workers on the front lines,  

0:18:53.820,0:18:55.920
to hear their stories and to be able to

0:18:55.920,0:18:59.460
amplify their voices so we can 
ensure that they’re well supported.

0:19:00.720,0:19:05.160
Again, a huge thank you to our healthcare workers.

0:19:06.420,0:19:09.300
Wonderful. Well thank you all for being here. I’m  

0:19:09.300,0:19:12.600
really excited to get into the 
nuance and complexity of this

0:19:12.600,0:19:16.260
topic because I know you all have a wealth of 
knowledge to share with our audience today.  

0:19:17.160,0:19:18.360
I’d love to start the conversation

0:19:19.020,0:19:25.980
by defining moral injury, to situate it 
within the context of this project. Dr. Heber

0:19:25.980,0:19:27.360
I was wondering if you could start us off by  

0:19:27.360,0:19:31.140
helping define what moral injury 
is and where it comes from? Sure,

0:19:31.140,0:19:35.100
thanks Amy. And this is really 
going to add to what Kim and  

0:19:35.100,0:19:38.520
Andrea have already explained in their previous

0:19:38.520,0:19:45.060
remarks. I’m going to try and put it 
in a context, in a bit of a historical

0:19:45.060,0:19:51.060
context. This was a term that was first 
developed by those who were looking

0:19:51.060,0:19:58.080
after soldiers who were returning 
from war zones and combat zones. The

0:19:58.080,0:20:03.000
term itself was first used by 
those who were helping veterans

0:20:03.720,0:20:08.880
from the Vietnam war, so 
it’s been around for a long

0:20:08.880,0:20:14.700
time. It was used to describe

0:20:16.200,0:20:22.800
what soldiers were suffering from who found 
themselves involved in situations that

0:20:22.800,0:20:28.500
contravened their own moral codes or 
ethical beliefs. So in addition to any

0:20:28.500,0:20:30.840
other traumatic situations they may have found,  

0:20:31.380,0:20:35.160
there was something that was still 
haunting these folks when they

0:20:35.160,0:20:42.240
returned from war. It was often to do 
with either witnessing situations or being

0:20:42.240,0:20:49.680
in situations where they felt either they 
were powerless to intervene or they couldn’t

0:20:49.680,0:20:55.800
help when somebody else was injured 
or killed, or they saw abuse of other

0:20:55.800,0:21:00.540
people in the war zone. Sometimes it also involved

0:21:00.540,0:21:04.500
feelings of betrayal by their chain of command or  

0:21:04.500,0:21:07.980
leadership. The most striking 
thing about it is that these

0:21:07.980,0:21:13.140
were feelings that really stayed 
with the person and haunted them.

0:21:13.140,0:21:19.140
An example is to think about for those of you 
who know anything about the story of General

0:21:19.140,0:21:25.260
Romeo Dallaire who still suffers from 
moral injury after his experiences of

0:21:25.260,0:21:31.080
leadership in the 1990s in Rwanda where 
he was powerless to stop the slaughter of

0:21:31.080,0:21:37.860
thousands of the residents there. He still 
talks about this moral injury that he suffers

0:21:37.860,0:21:43.140
from. Now we’re seeing these 
same kinds of reactions in

0:21:43.140,0:21:47.100
healthcare workers who served 
on the front lines of COVID 19,  

0:21:47.100,0:21:50.520
often struggling with feelings of having

0:21:50.520,0:21:57.000
been powerless, feeling very distressed 
that they weren’t able to provide for their

0:21:57.000,0:22:01.980
patients what they felt they wanted 
to, for a number of reasons: often

0:22:01.980,0:22:04.080
because of the overwhelming number of patients,  

0:22:04.080,0:22:09.060
how ill the patients were, as 
well as that there just weren’t

0:22:09.060,0:22:14.700
enough of them. Again, that moral distress

0:22:14.700,0:22:20.280
and moral injury also often takes the 
form of feelings of anger and betrayal

0:22:20.280,0:22:27.000
towards their own leadership, who they feel let 
them down, or to their institutions. I think

0:22:27.000,0:22:32.280
Margaret, because of her work 
on the front lines providing

0:22:32.280,0:22:35.385
support to many of these healthcare workers,  

0:22:35.385,0:22:38.040
is going to talk a little 
bit about specific examples.

0:22:39.000,0:22:44.100
Thank you so much Alex. You know right 
from the very beginning of this pandemic,  

0:22:44.100,0:22:45.420
it’s been clear that healthcare

0:22:45.420,0:22:47.700
workers are essentially on war footing.  

0:22:48.540,0:22:51.720
We recognize that the levels of 
distress that many are experiencing are

0:22:51.720,0:22:54.900
very similar to what our military members see in  

0:22:54.900,0:22:58.200
the combat theatre. That’s 
been really an evocative

0:22:58.200,0:23:00.660
understanding of how difficult some of these  

0:23:00.660,0:23:04.380
situations have been. We have 
heard, for example, situations

0:23:04.380,0:23:07.440
Where, due to a shortage of 
personal protective equipment,  

0:23:07.440,0:23:10.200
some healthcare workers were 
asked to wear their masks

0:23:10.200,0:23:13.860
for two weeks and then turn them 
over when they became dirty.  

0:23:14.760,0:23:16.920
You could imagine when you’re risking the

0:23:16.920,0:23:19.380
safety of yourself and, for 
many healthcare workers,  

0:23:19.380,0:23:22.680
even more critically the safety 
of their families to come to

0:23:22.680,0:23:27.900
Work, many felt that they weren’t 
receiving the support or the duty of

0:23:27.900,0:23:31.260
care that that institution had to them. These have  

0:23:31.260,0:23:34.320
been really difficult stories 
to hear, but even more so to

0:23:34.320,0:23:39.540
experience for those on the front line. 
We also know that, as Kim had mentioned,

0:23:39.540,0:23:43.440
many healthcare workers were 
put in that role of becoming  

0:23:43.440,0:23:46.080
essentially family members 
for patients on the units.

0:23:46.860,0:23:50.580
So there were things that we had 
to do throughout the pandemic to  

0:23:50.580,0:23:53.340
protect the safety and the security of the health

0:23:53.340,0:23:55.500
care system and for the greater good,  

0:23:55.500,0:23:59.880
but these were incredibly difficult things 
and some of them did not feel morally

0:23:59.880,0:24:02.640
right to our health care workers. A good example  

0:24:02.640,0:24:06.420
of that would be having to 
turn away the parents of a

0:24:06.420,0:24:09.720
dying child because, at that 
early point in the pandemic,  

0:24:09.720,0:24:13.440
parents and visitors were 
not allowed into the room. We

0:24:13.440,0:24:20.160
certainly heard about these situations. During 
the time I spent on the front lines and also from

0:24:20.160,0:24:23.700
the stories we’ve heard, often 
healthcare workers perceived the  

0:24:23.700,0:24:26.640
care that was being offered as being futile and in

0:24:26.640,0:24:32.220
some cases it was. Healthcare workers were caught 
in that difficult position between families who

0:24:32.220,0:24:38.760
understandably want to hold on to hope for their 
loved ones and providing care that is invasive and

0:24:38.760,0:24:40.320
sometimes painful where, for example,  

0:24:40.320,0:24:46.260
it would take seven people to prone or turn 
over an elderly individual in an attempt

0:24:46.260,0:24:52.200
to help with their COVID illness. 
These were really difficult situations

0:24:52.200,0:24:55.200
for health care and in some cases healthcare  

0:24:55.200,0:24:58.500
workers really communicated to us that 
they felt that it was like torture,

0:24:58.500,0:25:03.240
and that is a very evocative 
term. It’s one that’s hard to hear

0:25:04.200,0:25:09.240
but it is the experience of healthcare workers 
and they’re left with this lingering distress.

0:25:09.240,0:25:14.700
In particular we found moral distress or moral 
injury surrounding some of these situations.

0:25:16.740,0:25:23.700
Thank you for that context Margaret and for the 
really concrete examples of what it was like in

0:25:23.700,0:25:30.840
in the units. Alex, my follow-up question 
is from a clinical perspective: how can

0:25:30.840,0:25:37.080
healthcare workers know if they’re experiencing 
moral injury? And Kim I’d love to learn

0:25:37.080,0:25:42.900
more about what you found in your research 
about this as well. Sure so let me begin.

0:25:44.280,0:25:51.120
I think some of the things that people 
feel are what we’ve been describing, so

0:25:55.200,0:25:57.120
most of us when we go through a

0:25:57.120,0:26:02.880
traumatic or difficult situation, we will 
have a few days, sometimes up to a few

0:26:02.880,0:26:07.860
Weeks, where we’re still very distressed 
by that situation. We may have nightmares,  

0:26:07.860,0:26:09.420
we may have difficulty sleeping,

0:26:09.420,0:26:16.200
we may find that we are reminded of the 
situation, it is popping back into our heads

0:26:16.200,0:26:20.640
at strange times. But generally

0:26:20.640,0:26:28.260
within a few weeks to a couple of months, 
that fades into the background for most

0:26:28.260,0:26:34.740
people. But for some people a lot of 
those experiences and the feelings that

0:26:34.740,0:26:39.840
went along with them, they just 
don’t fade. They linger on, and

0:26:40.680,0:26:46.440
especially people who felt they 
were in these morally compromising

0:26:46.440,0:26:53.880
situations that did not fit with their 
own ethical and moral beliefs and

0:26:53.880,0:26:58.260
Standards, they’re left struggling with that.

0:26:59.640,0:27:03.900
In a way we can compare it to 
an unresolved grief reaction

0:27:03.900,0:27:09.060
where people just can’t get over it 
and they continue to think about it.

0:27:10.920,0:27:15.180
They’re often feeling guilty for 
things they had no control over.

0:27:16.800,0:27:22.260
Then there’s another situation where they had 
faith that those they report to, that their

0:27:22.260,0:27:27.000
leadership would be there in these times 
to help out and take care and make sure

0:27:27.000,0:27:33.960
that they were protected. But what happens 
instead is they feel abandoned. That’s

0:27:33.960,0:27:40.860
another strong part of moral 
injury. When people have these

0:27:40.860,0:27:46.260
feelings at first and then they fade, we 
call it more moral distress. But when those

0:27:46.260,0:27:51.780
feelings last and we just can’t seem to 
get over them, then we will call that

0:27:51.780,0:27:57.360
moral injury. Sometimes what 
can be helpful for people is

0:27:57.360,0:28:02.760
having trusted colleagues. A good team of people,

0:28:02.760,0:28:11.160
that can be helpful. We created a 
project at the beginning of COVID-19 for

0:28:11.160,0:28:15.240
frontline workers. At that time, 
we wondered how are we going to  

0:28:15.240,0:28:19.740
help these people remain okay, ready to work

0:28:19.740,0:28:26.400
and not suffering from some of these aftereffects. 
It was really interesting: when we went and

0:28:26.400,0:28:32.700
asked them “what were the most important 
things for them to feel they’d be able to cope

0:28:32.700,0:28:37.980
through COVID and all the changes that 
were occurring?”, the number one thing we

0:28:37.980,0:28:41.820
were told was “that I feel my leader has my back”.

0:28:43.500,0:28:48.900
I think that’s why we’re coming back 
to that betrayal part of moral injury,  

0:28:48.900,0:28:51.600
that betrayal that people end up feeling.

0:28:52.620,0:28:56.520
Right at the beginning of COVID 
they were telling us that and

0:28:56.520,0:29:04.440
even now, a couple of years later, that they need 
leaders to be there, to step up, to support their

0:29:04.440,0:29:07.440
people. We know this can be helpful for them.  

0:29:07.440,0:29:11.760
I’m going to pass it over to Kim 
because I think she’s got a lot of good

0:29:11.760,0:29:16.560
examples to add to this. Thanks 
so much, Alex that was fantastic.

0:29:17.880,0:29:22.800
We’ve heard a lot in our 
interviews exactly what Alex was

0:29:22.800,0:29:27.900
describing. A lot of healthcare 
providers have talked about this

0:29:28.440,0:29:35.820
ruminating over what they have had to do 
or maybe what they’ve seen or what type

0:29:35.820,0:29:37.020
of situation they’ve been in,  

0:29:37.020,0:29:42.000
and that rumination just doesn’t seem to 
go away. It comes to the point where it’s

0:29:42.000,0:29:48.120
overwhelming and an emotional impact 
comes with it. We’ve heard a lot about

0:29:48.900,0:29:53.340
healthcare providers feeling very 
angry as well. Going back to what  

0:29:53.340,0:29:56.160
Alex mentioned about anger towards the system,

0:29:56.160,0:30:02.880
towards leadership, towards just 
COVID in in general and the types of

0:30:02.880,0:30:09.060
situations they’ve been faced with and feeling 
very let down by the healthcare system as a whole.

0:30:09.780,0:30:12.600
Keeping in mind that prior to the pandemic,  

0:30:12.600,0:30:16.200
healthcare providers were very 
used to making very difficult and

0:30:16.200,0:30:18.360
challenging and morally challenging decisions,  

0:30:18.360,0:30:23.520
but this is different. There’s 
a new added layer on top of

0:30:23.520,0:30:30.840
what was already a challenging situation, 
an under resourced situation. Those

0:30:30.840,0:30:37.080
situations have become worse, amplified. 
Healthcare providers told us COVID has

0:30:37.080,0:30:41.460
made what was there already even 
worse than it is than it was before.

0:30:47.040,0:30:48.540
The other thing that we’ve heard

0:30:48.540,0:30:53.520
a lot about is a sense of negative 
self-talk, negative beliefs about yourself,

0:30:54.900,0:30:59.640
where you might say to yourself 
“I’m a bad nurse” or “I’m a bad

0:30:59.640,0:31:05.280
physician” because of what I’ve done 
or what I’ve seen. It’s trying to

0:31:05.940,0:31:12.900
understand that it’s the situation that you’re 
placed in and trying to recognize that that’s

0:31:12.900,0:31:18.000
part of the talk. The only other 
thing I’ll just add to Alex’s comments

0:31:19.260,0:31:23.400
is that we’ve heard from healthcare providers 
that they feel like they’re living in two worlds:

0:31:26.280,0:31:31.140
they go to work and they’re in 
essentially, as Margaret said, almost in a

0:31:31.140,0:31:37.320
war zone and then they come home. 
They’re trying to function in these

0:31:37.320,0:31:42.420
two worlds. We hear a lot about these 
disruptions and functioning where

0:31:42.420,0:31:45.540
they feel they can no longer 
parent or they can no longer  

0:31:45.540,0:31:49.140
be a spouse or the family member they were before.

0:31:49.140,0:31:52.920
It really shakes your sense of 
self in trying to navigate back  

0:31:52.920,0:31:55.800
and forth between these two worlds that are so

0:31:55.800,0:32:03.120
drastically different. You don’t have a way to 
kind of reconcile them. Kim and maybe Andrea

0:32:03.120,0:32:06.960
as well, I’d love to hear 
your perspective on what are

0:32:08.040,0:32:14.940
healthcare workers saying is helpful once they 
acknowledge that this is this is the way they’re

0:32:14.940,0:32:15.440
feeling?

0:32:20.700,0:32:25.620
Healthcare providers have a 
very strong sense of caring for

0:32:25.620,0:32:31.440
others and they want to serve 
others. They prioritize the needs of

0:32:31.440,0:32:35.880
of the people they care for, the 
families and the patients they care for,  

0:32:36.720,0:32:38.520
especially during the pandemic. As we’ve

0:32:38.520,0:32:46.020
said, they were living in this world that was so 
different, working days and hours and weeks on

0:32:46.020,0:32:51.180
end without breaks, without vacation. Many 
more hours than they may have done before.

0:32:52.560,0:32:56.760
One of the first things is a 
sense of self-compassion. We  

0:32:56.760,0:32:59.340
talk a lot about self-compassion in our

0:32:59.340,0:33:06.540
work. Self-compassion is a term that 
has been around for many years and is

0:33:06.540,0:33:11.940
now being applied to healthcare workers more 
and more, as we’re starting to realize this  

0:33:12.540,0:33:14.400
sense of serving others

0:33:14.400,0:33:19.800
and the need to prioritize your own

0:33:19.800,0:33:25.860
needs too. Self-compassion is about 
being compassionate towards yourself, the

0:33:25.860,0:33:28.020
same way you would be towards someone else. Giving  

0:33:28.020,0:33:31.980
yourself that sense of empathy and 
humanity that you would to your

0:33:31.980,0:33:36.960
patients or your families or your 
friends. That’s one of the first things.

0:33:42.120,0:33:44.820
Many, many times during the interviews,

0:33:44.820,0:33:50.940
healthcare providers said that when they 
completed some of our surveys on moral

0:33:50.940,0:33:56.160
injury, that’s when they first understood 
what they were feeling, which gave them

0:33:56.160,0:34:02.700
a way to understand it. I think that as 
we become more familiar with the term

0:34:02.700,0:34:09.300
“moral injury,” as we talk about it in in 
our healthcare organizations and amongst our

0:34:09.300,0:34:12.900
leadership, then it gives a way to frame what the  

0:34:12.900,0:34:16.800
experience is. I think that’s 
really helpful. It gives us

0:34:16.800,0:34:19.920
a way to understand what 
you’re feeling. Healthcare  

0:34:19.920,0:34:22.020
workers have said that is really helpful for

0:34:22.020,0:34:26.940
them. Andrea, I know, has lots to share with you.

0:34:26.940,0:34:30.120
Yes thank you Kim. I think you said that so well,  

0:34:30.120,0:34:33.780
really giving yourself permission 
as a healthcare worker to

0:34:33.780,0:34:37.740
take care of yourself. It’s so easy 
to be focused on caring for others:  

0:34:37.740,0:34:40.140
that’s part of the heart 
and the humanity for a lot

0:34:40.140,0:34:40.860
of our health care workers,  

0:34:40.860,0:34:46.320
that’s why they got into the field. But in 
these times, recognizing when you may be

0:34:46.320,0:34:48.780
in moral distress or experiencing a moral injury,  

0:34:48.780,0:34:53.040
recognizing that you need to take care 
of yourself and doing that. Something

0:34:53.040,0:34:55.860
we’ve heard a lot about from 
our healthcare workers in our  

0:34:55.860,0:34:58.560
interviews was coping strategies or just self-care

0:34:58.560,0:35:01.500
strategies. Not surprisingly,  

0:35:01.500,0:35:05.100
a lot of health care workers found this 
very difficult to do during the pandemic.

0:35:05.100,0:35:08.280
As Kim mentioned, healthcare workers are often  

0:35:08.280,0:35:10.800
working through stressful 
situations in their field.

0:35:10.800,0:35:16.500
That’s not new, but what was new 
were the barriers: maybe someone

0:35:16.500,0:35:20.220
typically would go to the gym or would 
go out for social time with friends,  

0:35:20.220,0:35:22.500
but with lockdown periods that wasn’t

0:35:22.500,0:35:25.260
Possible in many cases. Additionally,  

0:35:25.260,0:35:28.560
with the added stress and the 
amplified nature of the stress

0:35:28.560,0:35:30.900
during the pandemic, a lot of 
our healthcare workers said  

0:35:30.900,0:35:33.840
that they couldn’t even find the bandwidth or the

0:35:33.840,0:35:35.640
energy to take care of themselves even if  

0:35:35.640,0:35:39.600
perhaps they had done it prior 
to the pandemic. We really see

0:35:39.600,0:35:43.680
in these conversations the need 
to help our healthcare workers  

0:35:43.680,0:35:46.320
create a plan say “What can I do? What can I turn

0:35:46.320,0:35:50.700
to? Who can I call? How can I 
check in with myself?” In our  

0:35:50.700,0:35:52.920
group and in our project we’re developing tools,

0:35:53.940,0:35:55.620
such as the mental health continuum,  

0:35:55.620,0:36:00.060
to allow healthcare workers to read 
common signs of different levels

0:36:00.060,0:36:03.420
of stress, to see where they fit in 
and provide them with supports that  

0:36:03.420,0:36:05.820
would work best for them, to help them to get the

0:36:05.820,0:36:09.480
help that they need. There are 
many tools and we’ll continue  

0:36:09.480,0:36:11.460
to work to make those readily available for our

0:36:11.460,0:36:15.780
healthcare workers. Wonderful 
thank you both. Yes, Alex go ahead.

0:36:18.060,0:36:20.040
Sorry, I’m just reading some of the comments,  

0:36:20.040,0:36:23.340
which made me think of a few more 
things to add if you don’t mind.

0:36:25.500,0:36:29.820
One of the things, Kim mentioned this 
certainly when we were talking earlier, is

0:36:29.820,0:36:33.780
acknowledgement. First of 
all, I think the fact that  

0:36:33.780,0:36:37.080
we are acknowledging this and we are now looking

0:36:37.080,0:36:42.420
at it and saying this exists, there is 
an issue here for healthcare workers.

0:36:42.420,0:36:44.760
It’s for good reason that 
they’re feeling this way.  

0:36:44.760,0:36:48.780
This acknowledgement is the first step to people

0:36:48.780,0:36:53.400
starting to feel better and to also 
get help with how they’re feeling.

0:36:54.000,0:36:59.940
Reframing or, as Kim mentioned, 
self-compassion is really

0:36:59.940,0:37:06.120
important. Why do people suffer from 
moral injury? It’s because they are

0:37:06.120,0:37:11.700
people who care. That’s why they’re struggling 
with these things. These are people who care

0:37:11.700,0:37:14.400
so much about other people and that’s that is a  

0:37:14.400,0:37:19.140
good thing, but it’s not good when 
you suffer. They’re basically very

0:37:19.140,0:37:25.980
good people. Also, and this was commented 
on two times in the chat, having

0:37:25.980,0:37:32.040
supportive and present leadership, that 
your leaders are there with you telling

0:37:32.040,0:37:34.500
you you’re doing a good job and supporting  

0:37:34.500,0:37:38.760
you when things don’t go well, 
that’s incredibly important for

0:37:38.760,0:37:46.260
people. And social support, having people 
who are able to work in teams that get

0:37:46.260,0:37:49.380
to know each other, who can support each other, is

0:37:52.020,0:37:57.120
certainly a way to help prevent 
some of this from happening.

0:37:57.120,0:38:04.260
I know in healthcare that often it just wasn’t 
possible, that sometimes the fracturing of

0:38:04.260,0:38:11.160
that ability to be working in a consistent team 
over time also contributed to these problems.

0:38:11.160,0:38:18.000
Of course, for some people, sometimes getting some 
professional help, some support, some guidance

0:38:18.000,0:38:23.520
some counselling, is very, very 
helpful. Margaret go ahead.

0:38:23.520,0:38:24.660
Thank you so much.  

0:38:25.380,0:38:30.360
You know one thing I just wanted to comment on is 
that this is happening for our front line and it’s

0:38:30.360,0:38:35.940
happening for our leaders too. Just to acknowledge 
the pain and suffering as well of leaders who are

0:38:35.940,0:38:41.580
often put in difficult situations, having 
to make impossible, truly impossible

0:38:41.580,0:38:45.240
choices. We want to acknowledge 
the suffering of everyone,  

0:38:45.240,0:38:48.180
recognizing that moral 
distress and moral injury has

0:38:48.180,0:38:53.940
been a big part of the picture for our leaders 
too. I often think of healthcare as a family and I

0:38:53.940,0:38:55.740
think one of the big challenges we’re facing right  

0:38:55.740,0:38:58.260
now is “how do we put our 
family back together again?”

0:39:01.200,0:39:07.500
Absolutely and I think that’s sort of 
the perfect segue to zoom out for a

0:39:07.500,0:39:13.260
moment and talk about the healthcare system 
in general. Self-care and compassion for

0:39:13.260,0:39:15.900
yourself as a healthcare 
worker is of course important,  

0:39:15.900,0:39:18.720
but also you need to be working 
within a supportive system

0:39:20.880,0:39:25.080
to really truly thrive in in the 
environment you’ve chosen to work in.

0:39:27.060,0:39:31.860
I’ve actually seen this in the comments as well, 
I think Stephen commented that you know all these

0:39:31.860,0:39:34.440
factors that we’re discussing today were important  

0:39:34.440,0:39:38.040
pre-pandemic but they’re 
essential now. I’m wondering

0:39:38.700,0:39:44.220
Margaret what do you think 
these stressors, like turnover,

0:39:44.220,0:39:49.380
short staffing effects of moral injury, 
what does this mean for the healthcare

0:39:49.380,0:39:56.220
industry moving forward? Thank you. I think part 
of the moral distress that is a rising right

0:39:56.220,0:40:00.360
now is around our inability in 
some cases to provide adequate  

0:40:00.360,0:40:03.300
care. We know that many units are running

0:40:03.300,0:40:04.740
short-staffed right now.  

0:40:05.700,0:40:09.240
We’re seeing that many people who are 
very junior to the field are being put

0:40:09.240,0:40:15.240
in positions that would typically be reserved for 
more senior healthcare workers. If we think about

0:40:15.240,0:40:17.160
the continuity of our healthcare system,  

0:40:17.160,0:40:21.240
we know that when we did our initial 
survey of all healthcare workers,

0:40:21.240,0:40:25.620
so all professions across Canada, we 
saw during the delta wave that about

0:40:26.340,0:40:28.260
one in four were considering leaving their  

0:40:28.260,0:40:32.760
clinical position. When we repeated 
this survey during Omicron, what we

0:40:32.760,0:40:37.560
found was in fact one in two healthcare workers 
were considering leaving their positions.

0:40:38.100,0:40:42.000
Past evidence suggests that among those 
who considered leaving their positions,  

0:40:42.000,0:40:43.320
about one-third did leave.

0:40:44.520,0:40:50.700
We cannot afford at this point to lose 
any of our health care workers, let

0:40:50.700,0:40:55.560
alone those who are experiencing this moral 
distress and this moral injury right now.

0:40:56.340,0:41:01.500
Andrea’s work and other work shows that this is 
really driving a lot of what is making people

0:41:01.500,0:41:06.060
consider leaving their profession. I 
think addressing, as Alex was saying,

0:41:07.740,0:41:13.500
giving people words for their experiences, 
providing supports, it’s a way of helping

0:41:13.500,0:41:16.680
individual healthcare workers 
and leaders. It’s also a way  

0:41:16.680,0:41:19.680
of ensuring continuity essentially of our

0:41:19.680,0:41:22.260
health care system, which really is in a perilous  

0:41:22.260,0:41:26.280
situation right now. Again we 
want to say you know we’re so

0:41:26.280,0:41:31.440
grateful to everyone who served. We 
understand those who left positions

0:41:31.440,0:41:33.540
because this was incredible suffering.  

0:41:34.080,0:41:37.740
We really want to support those who 
remain on the front line and in the

0:41:37.740,0:41:41.700
leadership positions because they are 
such a precious resource to Canada.

0:41:48.720,0:41:54.060
In your presentation earlier, Kim, 
we heard a bit from healthcare

0:41:54.060,0:41:57.900
workers about how their employers 
can support them. I’m wondering  

0:41:57.900,0:42:00.060
what other strategies healthcare providers

0:42:00.060,0:42:03.480
suggested could be done at that 
organizational level to support them.

0:42:05.880,0:42:11.220
Thank you. Just adding on to 
the comments that Margaret

0:42:11.220,0:42:18.360
made and that Alex made earlier, we’ve heard from 
healthcare providers that many of them really do

0:42:18.360,0:42:24.480
want to get mental health supports. 
They understand that their job is

0:42:24.480,0:42:29.220
stressful normally and they 
understand that during COVID it has

0:42:29.220,0:42:35.040
just become so much more stressful. 
They find that there’s so many

0:42:35.040,0:42:41.220
barriers in place to getting the types 
of supports that they need. One thing

0:42:41.220,0:42:46.800
that would be really important to look 
at is how do we get really accessible

0:42:47.940,0:42:51.180
supports that can get through 
some of these barriers. Some  

0:42:51.180,0:42:53.220
of the barriers we’ve heard about are that

0:42:53.220,0:43:00.180
healthcare providers, especially those who work 
part-time or casual, don’t have a lot of benefits

0:43:00.180,0:43:05.160
or they don’t have a lot of ability to 
get these types of healthcare support,  

0:43:05.160,0:43:06.540
so they want them to be

0:43:06.540,0:43:11.760
accessible and available. The 
other thing we’ve heard about is

0:43:11.760,0:43:16.860
that they really want the types of 
supports that they get to be tailored.

0:43:23.160,0:43:24.240
We’ve asked the healthcare providers 
that we’ve interviewed “what

0:43:24.240,0:43:27.720
is the most important thing for you to get mental  

0:43:27.720,0:43:30.180
health support?” “If you were to 
get mental support, “What would be

0:43:30.180,0:43:34.140
what would be the most important part 
of that?” and almost everybody has  

0:43:34.140,0:43:37.140
said you have to know the type of work I do and

0:43:37.140,0:43:39.480
the types of situations that I’ve been in during  

0:43:39.480,0:43:43.380
the pandemic. I think that’s 
an added component in terms of

0:43:43.380,0:43:49.920
mental health supports: that we have to 
educate those who provide mental health support

0:43:49.920,0:43:55.620
to understand these things about COVID 
and about the type of work they do in

0:43:55.620,0:43:59.160
order for healthcare providers to feel 
that they’re heard and understood,  

0:43:59.160,0:44:02.100
and not having to repeat things

0:44:02.820,0:44:08.700
over and over. The last thing is having 
long-term mental health supports.

0:44:12.360,0:44:15.000
Something I’ve really learned during this study

0:44:15.000,0:44:21.780
is that that there is a need for 
long-term support for many healthcare

0:44:21.780,0:44:27.300
providers because of the stressful nature of 
their jobs. Many healthcare providers have

0:44:27.300,0:44:30.240
said you know I want to be 
able to do my job better,  

0:44:30.240,0:44:33.240
or not I guess not so much 
better, but to be able to

0:44:34.920,0:44:40.200
also manage my stress and the 
types of mental health strain

0:44:40.200,0:44:44.100
that the work causes even outside 
of the pandemic. I think we really,  

0:44:44.640,0:44:46.560
as a healthcare system, have to look

0:44:46.560,0:44:51.480
at that now too. How can we better support 
our healthcare providers’ mental health?

0:44:54.480,0:44:58.980
Absolutely, thank you. I’m so 
sorry I have a fire alarm going off

0:44:58.980,0:45:04.680
in the background. I don’t know if you can hear 
it. Can you? I’m so sorry, I don’t know what’s

0:45:04.680,0:45:11.700
happening. I’m just going to keep moving here, but 
I really apologize if it’s loud. I think that’s

0:45:11.700,0:45:16.920
a that’s a perfect observation 
to end this fireside chat on.

0:45:17.640,0:45:23.760
Oh, Margaret’s got some things. I just 
wanted to add with respect to mental health

0:45:23.760,0:45:25.680
supports for healthcare workers,  

0:45:25.680,0:45:31.020
one thing in the St. Joseph’s Healthcare 
system in Hamilton and at St. Mary’s in

0:45:31.020,0:45:32.640
Waterloo and also at Homewood Health,  

0:45:32.640,0:45:37.320
we’ve been providing on unit supports 
to healthcare workers. I think this is

0:45:37.320,0:45:44.100
really important. The first time I 
was on a COVID unit, I was actually in

0:45:44.100,0:45:47.340
the storage closet, so I had 
about 36 hours at the hospital,  

0:45:47.340,0:45:50.700
much of that was spent in 
the closet on the unit. When

0:45:50.700,0:45:53.040
nurses and staff came in to change their masks,  

0:45:53.040,0:45:57.600
that was the only time that they 
had for mental health supports.

0:45:58.380,0:46:03.240
That wasn’t the fault of an organization, it’s 
just the way that it was. Things are so hectic.

0:46:03.960,0:46:07.200
There’s really no substitute for 
sitting down on a nursing station,  

0:46:07.200,0:46:10.560
being present, allowing people to come to

0:46:10.560,0:46:14.700
speak to you. One of the most powerful things 
that we could say, as Kim was mentioning, was

0:46:15.480,0:46:17.520
“I recognize that you’re living in a different  

0:46:17.520,0:46:20.580
world right now from people who 
are not involved in health care

0:46:21.660,0:46:27.300
and that your experience is very different when 
you go home. It may be hard to talk about, others

0:46:27.300,0:46:30.840
can’t appreciate or understand 
the circumstances that you face”,  

0:46:30.840,0:46:33.420
and I think for our healthcare workers many don’t

0:46:33.420,0:46:35.820
have time to go to the library or to go to other  

0:46:35.820,0:46:39.960
parts of the hospital. We need to be 
with them and be present on the units

0:46:39.960,0:46:42.720
to provide those supports. 
That’s a really important  

0:46:42.720,0:46:45.360
thing that we’ve learned in Hamilton and Guelph on

0:46:45.360,0:46:51.600
providing supports for healthcare 
workers. Absolutely and I think

0:46:53.040,0:46:59.100
that is also the perfect segue 
into the Q&A session. I see that 

0:46:59.100,0:47:01.980
we have some questions from 
healthcare workers themselves that  

0:47:01.980,0:47:06.060
we’re going to address today. That’s
kind of it for me, I’m going to pass  

0:47:06.060,0:47:10.260
to Teresa, but I wanted to thank you all 
so much for chatting with me and helping 

0:47:10.260,0:47:15.120
me learn about moral injury today. 
I will pass it to you, Teresa. 

0:47:15.780,0:47:20.100
Well thank you very much Amy for your time 
and excellent skills. I’m going to have to 

0:47:20.760,0:47:26.340
recruit you to be a webinar host; 
you’ve got some superpowers there. 

0:47:28.020,0:47:33.060
Amy, I’ll keep you on the stage for now 
to round out the number of people here. 

0:47:36.060,0:47:45.240
If everyone could maybe share in the chat and
and also out loud where can learn more about your  

0:47:45.240,0:47:47.160
research and the data that’s been
presented here. 

0:47:54.900,0:47:59.040
I could start if that’s all right. 
Through our funding from the 

0:47:59.040,0:48:04.920
Public Health Agency of Canada, we are mounting 
a website called Healthcare Salute: Thank you for 

0:48:04.920,0:48:08.220
your service. This will include 
information available in both French  

0:48:08.220,0:48:13.380
and English about the research study,
about resources for healthcare workers,  

0:48:13.380,0:48:18.060
and provide more education around 
moral injury and post traumatic stress 

0:48:18.060,0:48:23.100
injuries. We’ll also have a 
trauma-informed training course 

0:48:23.100,0:48:27.840
for people who wish to support healthcare 
workers or for healthcare workers themselves.  

0:48:28.680,0:48:30.120
We’re going to be
working to enhance  

0:48:30.120,0:48:34.560
cultural sensitivity around 
these issues, seeking to 

0:48:34.560,0:48:38.490
understand the experiences of healthcare 
workers through their own words. We  

0:48:38.490,0:48:42.240
will have video recordings of healthcare
workers speaking about their experiences  

0:48:42.240,0:48:46.980
and in-depth reflection exercises for 
those who are watching the videos to 

0:48:46.980,0:48:51.420
relate it to their own experiences. 
To teach about terms using plain  

0:48:51.420,0:48:54.660
language because we recognize that a
healthcare worker at five o’clock or  

0:48:54.660,0:48:58.440
three o’clock in the morning may be 
Googling “moral injury” and “COVID 19 

0:48:58.440,0:49:03.600
Pandemic” and we don’t want a long description. 
What we want is something that’s accessible 

0:49:04.680,0:49:07.800
and easy to use. This website 
will provide a lot of information  

0:49:07.800,0:49:12.360
about this. We’ve also been publishing our
work and we could send out links to that that work  

0:49:12.360,0:49:17.640
as well. Finally we did prepare a briefing note
for the Canadian government that summarizes these  

0:49:17.640,0:49:22.380
findings and we’ll be able to share that with
participants. There are also some  

0:49:22.380,0:49:26.700
recommendations surrounding these 
findings. That’s very exciting, I 

0:49:26.700,0:49:31.680
think the website is going to be huge. 
Do let us know and I’ll help boost it and 

0:49:31.680,0:49:36.900
promote it with my social media 
presence. Alex, please go ahead. 

0:49:37.740,0:49:45.240
Just to add to that, as I mentioned earlier, I’m 
going to be creating also a web presence that is 

0:49:45.240,0:49:53.460
going to have a host as well and link to
what’s being created in this project,  

0:49:53.460,0:49:57.780
as well as to a number of other 
projects that have been funded by Public 

0:49:57.780,0:50:04.380
Health Agency of Canada. Our website is not up 
yet; it’s probably going to be about another month 

0:50:04.380,0:50:10.260
but it will have this whole host of 
resources as well. The name of it is, 

0:50:10.260,0:50:16.380
the easiest way is to remember the 
acronym which is cipher c i p h e r. This 

0:50:16.380,0:50:21.720
will be the acronym for that website 
and we will link to all of Margaret’s  

0:50:21.720,0:50:24.660
resources as well. Excellent,
this is great. I’m going move on to  

0:50:24.660,0:50:29.520
the next question. An anonymous 
attendee asks “you noted that 

0:50:29.520,0:50:34.080
participants needed to feel their leaders 
at their back. What is the impact of  

0:50:34.080,0:50:36.900
leaders working from home and
not being visible alongside  

0:50:36.900,0:50:41.640
their frontline staff? I found that staff 
feel resentful and more disconnected from 

0:50:41.640,0:50:45.300
Leadership, especially higher-level leadership 
because the leaders are working from home.”  

0:50:45.840,0:50:50.580
Any thoughts on that dilemma?
I’ll go to Andrea, she was nodding.  

0:50:52.740,0:50:54.960
Yes,I think what was said in that 

0:50:54.960,0:50:58.200
comment is exactly what we heard from 
healthcare workers in our interviews,  

0:50:58.200,0:51:02.400
that that was a key source of some of
that betrayal, that part of moral  

0:51:02.400,0:51:06.540
injury where a lot of workers on the front 
lines. Respiratory therapists, physicians, 

0:51:06.540,0:51:09.780
nurses, they’re telling us that they 
have certain needs and experiences,  

0:51:09.780,0:51:14.580
yet decisions are coming from higher up from
people who aren’t there. They’re not  

0:51:14.580,0:51:18.060
seeing exactly what they’re seeing, 
they’re not made fully aware of the 

0:51:18.060,0:51:22.080
concerns and maybe why a certain policy 
or procedure doesn’t make any sense or is  

0:51:23.160,0:51:24.960
elevating stress or
putting the workers  

0:51:24.960,0:51:29.460
out further risk. I think that comes back 
to what we were discussing earlier about 

0:51:29.460,0:51:34.620
the need to listen to the healthcare 
worker. Organization leaders need  

0:51:34.620,0:51:38.820
to simply ask “what can I do to
support you? How can I help you?”  

0:51:39.360,0:51:43.920
and facilitate those discussions about 
creating a space for the frontline 

0:51:43.920,0:51:48.300
workers to share their concerns, to have 
the time to question these different  

0:51:48.300,0:51:51.240
policies/procedures coming up
that maybe they disagree with.  

0:51:51.780,0:51:55.440
If I could comment a bit further in that 
Andrea. Thank you for that great answer. 

0:51:56.220,0:52:00.540
We know that the risks of COVID 
19 were not evenly distributed and  

0:52:00.540,0:52:04.200
that’s a really important thing for
organizations and individuals to  

0:52:04.200,0:52:08.040
acknowledge. There were those who served 
at the very front line who took on the 

0:52:08.040,0:52:12.600
greatest risk for their families and for 
themselves, and that’s an important piece  

0:52:12.600,0:52:16.200
that we can acknowledge. We also know
that for people who were at home,  

0:52:16.200,0:52:20.100
many of them also suffered in the sense 
that they felt guilty that they weren’t 

0:52:20.100,0:52:25.740
there. When we talk about putting 
our family back together again, I 

0:52:25.740,0:52:28.500
think there are some things that we 
just need to have in the open to talk  

0:52:28.500,0:52:34.920
about and help us to come back together.
I think there’s a lot of stress trying  

0:52:34.920,0:52:40.380
to manage things when you can’t
see, and I do think that that’s  

0:52:41.460,0:52:45.360
a challenge. I think that a lot of
people probably had some moral injury even  

0:52:46.860,0:52:49.500
just doing it over Zoom, knowing 
that they’d want to get in 

0:52:49.500,0:52:54.660
there but that’s probably not the best place 
for them. That disconnect can be really hard and 

0:52:54.660,0:53:00.240
even, as you point out, that sharing of 
those perspectives will be important. We  

0:53:00.240,0:53:04.260
have a couple more minutes. I’m
going to ask one more question 

0:53:08.640,0:53:10.380
and this one comes from an ICU nurse,  

0:53:11.040,0:53:19.200
Annie, who has been for the past 14
years a high senior and then she’s transitioned 

0:53:19.200,0:53:24.240
into being an RN psychotherapist. She 
finds that a lot of the co-workers prefer 

0:53:24.240,0:53:30.300
the support of other co-workers, more of a 
grassroots, someone that’s at your elbow, that 

0:53:30.300,0:53:34.200
understands you, that has been going 
through that, versus a third party.  

0:53:34.920,0:53:39.720
I think this probably goes along with
the lack of trust and fractured faith  

0:53:39.720,0:53:43.440
in individuals who don’t have the same 
similar lived experience. What are your 

0:53:43.440,0:53:49.080
thoughts on this and how do we, as 
bedside nurses or leaders, better support 

0:53:49.080,0:53:53.220
these kind of programs for healthcare 
practitioners and professionals?  

0:53:54.120,0:54:01.500
Thank you very much.
We’re going to go to Alex. 

0:54:03.600,0:54:08.340
Let me start out with that one. 
First of all, I think that that is 

0:54:08.340,0:54:15.780
such an important issue. Margaret and Kim 
touched on this earlier, that whole issue 

0:54:15.780,0:54:22.560
of what we call cultural competency. That 
when therapists, when helpers, are trying to 

0:54:22.560,0:54:26.340
help somebody in a particular 
profession, it’s really important  

0:54:26.340,0:54:36.960
that they have some sense of how a person’s work
life and home are affected by the work life. We 

0:54:36.960,0:54:42.000
found that, again if I go back to my military 
experience, that that was really critical. 

0:54:44.700,0:54:50.820
We had people working with our 
folks who really understood what it 

0:54:50.820,0:54:55.500
was like to be in the military. I think 
for healthcare workers this has become  

0:54:55.500,0:54:59.100
more and more of an issue,
especially with the crisis  

0:54:59.100,0:55:06.180
occurring. Yes, cultural competency and
Margaret mentioned that one of the parts  

0:55:06.180,0:55:12.900
of this project is going to be to create
some resources for therapists to help them  

0:55:12.900,0:55:16.380
become more culturally competent in
the world of healthcare workers.  

0:55:18.840,0:55:24.180
Alright, excellent, very snappy. I love
it. All of you should be on talk shows  

0:55:24.180,0:55:30.240
more often. I love it and I think that
there’s just a lot out there right now  

0:55:31.260,0:55:35.340
that we need to digest and it
sounds like there is an upcoming webinar,  

0:55:35.340,0:55:40.860
webinar number two, that all of you are 
invited back to come and interact with 

0:55:40.860,0:55:45.720
us more. Please watch out for that advertising 
for Healthcare Salute Town Hall number two,  

0:55:45.720,0:55:48.480
September 15th. You can
mark it in your calendar,  

0:55:48.480,0:55:54.360
10 to 11 a.m. “Family Interpersonal Impacts”. 
That’s going to be really important so please, 

0:55:54.360,0:55:59.280
please, please jump on in that one. 
It might be a good one to bring 

0:55:59.280,0:56:04.320
a family member or others who have 
been your supports because I think  

0:56:04.320,0:56:09.120
we need to salute all of them as well.
I think that this has been fantastic.  

0:56:09.120,0:56:11.640
We’re going to go to Margaret 
for some closing remarks and then 

0:56:11.640,0:56:16.920
maybe I will also ask Andrea – you have a slide 
with some information that you’re going to share  

0:56:16.920,0:56:21.720
as well so if you want to pop that
up. I really just wanted to conclude  

0:56:21.720,0:56:28.080
by saying thank you again to those who
serve. We really want to also acknowledge  

0:56:28.080,0:56:32.520
that what happened over the past two and a
half years has also occurred within a unique  

0:56:32.520,0:56:36.780
historical context where 
we’ve learned about issues 

0:56:36.780,0:56:40.440
surrounding residential schools and 
the discovery of the bodies of innocent  

0:56:40.440,0:56:44.100
children. We’ve had the murder of George
Floyd and there’s been a historic context  

0:56:44.100,0:56:47.400
that also surrounds this. I 
recognize that many healthcare 

0:56:47.400,0:56:52.980
workers from equity deserving groups went to 
work with not only the burden of the pandemic,  

0:56:52.980,0:56:55.980
but also the current social
Context. We want to really  

0:56:55.980,0:57:00.120
acknowledge that and we will be talking 
about that more as we go forward with 

0:57:00.120,0:57:06.600
this work. We want to also thank our funders who 
helped us to do this research: the Atlas Institute 

0:57:06.600,0:57:10.800
which was formerly known as the Center for 
Excellence on PTSD, Homewood health made an  

0:57:10.800,0:57:13.440
incredibly generous donation to the
Homewood Research Institute,  

0:57:13.440,0:57:18.120
CIHR has been a big supporter, and finally 
the Public Health Agency of Canada for their 

0:57:18.120,0:57:22.800
support to move this this work forward. 
And we just want to thank all of you 

0:57:22.800,0:57:27.300
for your service. That word is 
really meaningful to us here. 

0:57:27.840,0:57:30.960
We’ve worked with the Canadian military, 
we’ve had the privilege of working with  

0:57:30.960,0:57:34.980
the Canadian military, with veterans,
with public safety personnel, all who  

0:57:34.980,0:57:39.120
have also served selflessly throughout 
this pandemic. The word “service” means 

0:57:39.120,0:57:44.340
something to us. We just want to thank you for 
that service that you’ve given, both you and  

0:57:44.340,0:57:47.280
your families, throughout this
pandemic. Thank you.  

0:57:49.140,0:57:52.800
And thank you so much to all of you for
spending the time with us today.  

0:57:54.480,0:57:58.740
I’m just going to give a shout out again 
here to all of you for the great work 

0:57:58.740,0:58:02.640
that you’re doing and I’m hoping that 
people in the audience will feel their  

0:58:02.640,0:58:08.280
gratitude as well and express it and
participate in your research. For all  

0:58:08.280,0:58:11.070
of you who may not know what that 
little squiggle thing in the corner 

0:58:11.070,0:58:14.820
corner is. Probably you do know by now, 
but you can take your phone, open up the  

0:58:14.820,0:58:19.920
camera and you should just put that in the
middle of the shot and it should actually  

0:58:19.920,0:58:23.640
open a hyperlink to be able 
to go ahead and participate in 

0:58:23.640,0:58:29.640
this. We’ve also put a bunch of 
other information about how you can 

0:58:30.300,0:58:35.760
give us feedback about today. I’m going to 
pop that link in the chat as well. We’re 

0:58:35.760,0:58:40.980
really excited to have all of you join 
us. The webinar has been recorded, 

0:58:40.980,0:58:48.000
there’ll be some post-production, and then we’ll 
be putting it on the websites that we’re making. 

0:58:48.660,0:58:53.520
It’ll be shareable on YouTube. We’re 
just really excited to have all of you  

0:58:53.520,0:58:56.880
engaged in this way, so thank you so
much for all your time. Thank you,  

0:58:56.880,0:59:01.560
Teresa. We will also provide simultaneous 
French translation on the recording as 

0:59:01.560,0:59:07.080
well for anyone who would like to watch 
this video in French. Thank you, Teresa, 

0:59:07.080,0:59:09.540
for your support. And Amy: 
thank you to our wonderful host,  

0:59:09.540,0:59:15.780
thank you so much. Thank you for having me
The pre-registration, someone has asked,  

0:59:17.040,0:59:20.460
is not available yet but just hold the
time your calendar and keep an eye out  

0:59:20.460,0:59:24.660
for our social media. I’m sure you 
won’t miss it and we’ll be in touch.

Panelists

Portrait of Dr. Margaret McKinnon
Dr. Margaret McKinnon, Homewood Chair in Mental Health and Trauma; Professor, McMaster University

Dr. Margaret McKinnon is Full Professor and Associate Chair, Research in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, where she holds the Homewood Chair in Mental Health and Trauma. She is also the Research Lead for Mental Health and Addictions at St. Joseph’s Healthcare Hamilton and a Senior Scientist at Homewood Research Institute. 

Work in Margaret’s unit focuses on identifying the neural and behavioural correlates of PTSD and trauma-related illnesses and on translating this knowledge to the development and testing of novel treatment interventions aimed at reducing the cognitive and affective sequelae of these conditions. 

A licensed clinical psychologist and clinical neuropsychologist, Margaret has a special interest in military, veteran, and public safety populations (including healthcare providers), and has worked with these groups clinically and in her research program. She has published or in press nearly 150 scientific works. 

Under Margaret’s leadership, the Trauma & Recovery Research Unit is supported by federal and provincial funding from the Public Health Agency of Canada, Canadian Institutes of Health Research, the Canadian Institute for Military and Veterans Health Research, Veterans Affairs Canada, Defence Canada, the PTSD Centre of Excellence, MITACS, and the Workers Safety Insurance Board of Ontario; by a generous donation to Homewood Research Institute from Homewood Health Inc.; and by generous gifts from private foundations including True Patriot Love, the Cowan Foundation, the Military Casualty Support Foundation, the FDC Foundation, and the AllOne Foundation. 

Margaret is a frequent commentator in the media on matters related to PTSD, moral injury, and the impact of trauma on special populations.

Portrait of Dr. Alexandra Heber
LCol (ret’d) Alexandra Heber, MD FRCPC CCPE

Dr. Alexandra Heber has over 35 years’ experience working in mental health, first as a nurse, then as a psychiatrist. After a decade working with HIV+ clients and leading an Assertive Community Treatment Team in Toronto, she enrolled in the Canadian Armed Forces in 2006, and deployed to Afghanistan in 2009–10. In 2016, she became inaugural Chief of Psychiatry for Veterans Affairs Canada. In 2019, she was a member of the Chief Coroner’s Expert Panel on Police Officer Deaths by Suicide in 2018.

She worked closely with the Public Health Agency of Canada to develop the 2019 Federal Framework on PTSD. In March 2020, she led a Task Force for the Canadian Institute for Public Safety Research and Treatment to create online resilience supports for first-responders and public safety personnel during the COVID-19 pandemic, the COVID-19 Readiness Resource Project.

Currently, Dr. Heber is leading creation of a Knowledge Hub, the Canadian Institutes for Pandemic Health Education and Response (CIPHER), a federally-funded project to curate and mobilize mental health resources for frontline workers affected by COVID-19.

Dr. Heber has written two online courses on PTSD treatment, using a trauma-informed approach. She has presented and published nationally and internationally on mental health and disaster response in military, veteran, and first-responder populations. She co-chairs the Canadian Military Sexual Trauma Community of Practice, and she is Lead Author on the Glossary of Terms 3.0.

Dr. Heber is an Associate Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University.

Presenters

Portrait of Dr. Kim Ritchie
Dr. Kim Ritchie, Research Associate, Homewood Research Institute

Dr. Kim Ritchie is an Assistant Professor at Trent University and holds an Adjunct position in the Department of Psychiatry and Behavioural Neuroscience at McMaster University. Since 2020, she has been co-leading a national study examining the mental health impacts of COVID-19 on healthcare providers.

In addition, Kim is a Registered Nurse with over 20 years of experience in direct care and clinical leadership roles, primarily focusing on mental health and geriatric mental health. She completed a PhD in Rehabilitation Science from Queen’s University, and currently conducts research on PTSD, trauma, and moral injury in military/veterans, healthcare providers, and public safety personnel. 

Portrait of Andrea D'Alessandro-Lowe
Andrea D’Alessandro-Lowe, Graduate Student (MSc), Trauma & Recovery Research Unit, McMaster University

Andrea is a Graduate Student in the Neuroscience program at McMaster University where she is co-supervised by Dr. Margaret McKinnon and Dr. Randi McCabe. Her MSc thesis focuses on respiratory therapists’ mental health and experiences with moral injury during the COVID-19 pandemic. Beyond her thesis work, she is a core member of the Trauma & Recovery Research Unit’s research team for COVID-19–related moral injury in healthcare providers and public safety personnel.

Moderator

Portrait of Amy Van Es
Amy Van Es, Founder, Gooder

Amy Van Es spent the first decade of her career as a digital growth strategist, helping media and tech companies rapidly scale their online presence. But she’s since resolved to spend the next decade fixing what she helped break: the internet. She’s obsessed with this mission.

When she’s not interneting with Gooder, Amy enjoys hiking, sewing, and big bowls of pasta. She dislikes push notifications, peas, and writing in the third person.

With gratitude to McMaster University Faculty of Health Sciences: Continuing Professional Development for broadcasting this event’s video feed.

Town hall 1: Everybody hurts Read More »