Symposium 1: COVID’s hidden crisis

• COVID-19 and moral injury in Canadian healthcare providers
• Predict, prevent and manage moral injuries in frontline healthcare workers and leaders facing the COVID-19 pandemic
• Associations between psychosocial stressors at work and moral injury in frontline healthcare workers and leaders facing the COVID-19 pandemic in Quebec, Canada: A cross-sectional study

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Hello and welcome.

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My name is Hannah Sung and I am moderating
the symposium today.

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The topic is COVID’s hidden crisis, moral
injury in healthcare providers.

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This event is two hours long with a short
break in the middle.

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I would like to begin by acknowledging the
land on which McMaster University is located,

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which is the traditional territory of the
Haudenosaunee and Anishinaabe nations, and

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within the lands protected by the Dish With
One Spoon Wampum belt.

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That wampum uses the symbolism of a dish to
represent the territory and a spoon to represent

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that people should share resources and only
take what they need.

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Toronto, which is where I am located today,
is home to many diverse First Nations, Inuit,

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and Métis people, and is covered by the Treaty
13 and the Williams Treaties.

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I hope you can take a moment to consider the
treaty territory you are on and what Land

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Back and stewardship of the land mean to you
and your community.

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And in fact, I’d love to hear where you are
this morning.

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Chat your location if you like, just drop
the name of your city or town.

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It’s nice to warm up the chat that way.

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The chat is a space for you today, so please
keep it respectful and on topic.

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This symposium is part of a larger project
called Healthcare Salute: Thank You for Your

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Service, which is funded through PHAC, the
Public Health Agency of Canada.

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And Dr. Margaret McKinnon, who you’ll be meeting
in just a moment, has been working with her

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team to gather evidence on the mental health
impacts of working as healthcare providers

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during the pandemic.

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Data has been gathered using interviews and
surveys with healthcare providers around the

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country, and the researchers will be sharing
their findings today.

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Several Canadian researchers are joining to
provide insight into risk and mitigating factors

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on moral injury.

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And you’ll also hear from healthcare providers
who describe what they’ve experienced at work.

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And it goes without saying before we begin
that we are very grateful to healthcare providers

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for the work they do today and every day.

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So some of what you hear today may bring up
some emotions.

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That’s okay.

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If you need to take a break, please do.

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Maybe step away from the computer, come back,
get a glass of water, take a deep breath.

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There are resources that have been compiled
and that are in the chat for you.

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Please take a moment to copy and paste them
into a new browser or just take a screen cap

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so that you have these numbers and websites
for your use.

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And with that, I would like to introduce Dr.
Margaret McKinnon to the stage.

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Hello Margaret, how are you this morning?

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Good, how are you?

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It’s nice to see you.

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Same here.

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And so today the topic is moral injury and
moral distress and why it is so important

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right now to understand these things.

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Can we start with some definitions?

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What is moral injury?

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What is moral distress?

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Thank you so much, Hannah.

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And before we get started, like you, I’d just
like to take a moment to acknowledge the healthcare

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workers across Canada and public safety personnel
who have sacrificed so much throughout their

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service.

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This has been a sacrifice by healthcare workers,
but also by their families who have also been

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impacted.

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And we very deliberately chose the term Healthcare
Salute: Thank You for Your Service for this

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project.

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And also we have the honour of working very
closely with the Canadian military, and we

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often use the term thank you for your service
and salute: we salute your service.

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And we want to salute that same service of
healthcare workers and public safety personnel

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today and thank them and their families for
their service and their sacrifice.

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In talking about the research today as well,
I also want to acknowledge the people who,

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and the organizations, who generously funded
this research.

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And so the research that we’re presenting
today is from the Trauma and Recovery Research

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Unit at McMaster University, St. Joseph’s
Healthcare, Hamilton, and Homewood Research

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Institute.

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It was funded by, initially by a grant from
— or rather a contract from — the Centre

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of Excellence on PTSD in Ottawa, which is
now the Atlas Institute, by a very generous

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donation from Homewood Health to Homewood
Research Institute, by the Public Health Agency

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of Canada, and by the Canadian Institutes
of Health Research.

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So we just want to take a moment as well to
thank the funders who allowed us to do this

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work very early on and gather the knowledge
and information necessary for the work that

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we’re talking about today.

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So when we think about moral injury and moral
distress, we can think back to the words of

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General Roméo Dallaire when he returned home
from Rwanda and he talked about the moral

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injury and moral distress that he and the
men and women who he served with experienced

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in Rwanda.

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And so there, there — moral injury takes
many forms, but one is the sense that one

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has either engaged in or witnessed events
that violate one’s moral and ethical values.

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So for General Dallaire, he talked about being
in Rwanda and being ordered to stand down

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by the United Nations and not intervene during
the genocide and the slaughter that was occurring.

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And that was for him and for the men and women
with whom he served, a fundamental violation

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of their ethical and moral values.

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In the pandemic, and the interviews that we’ve
been doing — and others across the country

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have also been doing from, other research
groups that will also be here today —we’ve

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heard about, for example, when healthcare
workers have had to deny parents access to

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see a critically ill child because of no-visitor
policies.

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We’ve heard about the proning of older adults
and turning over an older adult who really

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doesn’t want care, but their substitute decision
maker has insisted upon it, and how painful

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and difficult that can be.

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That proning, which takes seven people—
people talk about these things that, that

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had to be done in many instances during the
pandemic, but for people it was really difficult

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because it touched upon or had a sense of
betrayal of their moral or their ethical values.

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Or they witnessed situations that they felt
were violation of their moral or ethical values

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and were powerless to intervene.

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We also heard from General Dallaire when he
returned home about the betrayal that he and

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the men and women he served with felt that
they had experienced, and they talked about

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being ordered to stand down, and the impact
that that had on those who they were there

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to protect.

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So the citizens of Rwanda, and also on the
Canadian Armed Forces, where he said this

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was a betrayal by an organization that had
a duty of care to people, the people of Rwanda,

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and also to those who were serving within
Rwanda.

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And here we’ve heard healthcare workers talk
about in this context, about for example,

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being provided with very light masks at the
beginning of the pandemic.

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I even saw a video where I saw nurses being
instructed to wear Kleenexes, while they transported

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bodies, over their faces.

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Yes.

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And so, many people serving in healthcare
at the time and continuing on, have felt that

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perhaps there was not enough preparedness
for a pandemic in some situations.

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Also that they felt that the organizations
or individuals who they were serving with

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had a duty of care to them, and they felt
that that duty of care was not met — or

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to patients as well, and families throughout
the country.

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And so this really is the concept of moral
injury.

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So the notion that one has engaged in or witnessed
or been powerless to prevent events or incidents

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that violate one’s moral and ethical values,
or that they have felt a betrayal by an individual

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and organization who they feel has a duty
of care to them during the pandemic.

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There’s a lot of complex context there in
terms of understanding moral injury and moral

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distress.

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I hear that on an individual level it’s about
a violation of your own moral code and the

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stress that that entails.

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And I wonder when you use the term moral injury,
can you describe how it is an injury?

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Can you tell us more about that?

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So, moral injury, I would say is something
that exists in itself.

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It is associated with post-traumatic stress
injuries, with depression, and with anxiety.

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But it’s separate.

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It has a different presentation.

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And when a moral injury occurs, what we often
see is an increase in — we can see increases

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for example in suicidality; difficulty functioning
at home, at work, at school; we might see

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an increase in symptoms of depression, anxiety,
post-traumatic stress disorder, difficulty

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sleeping and insomnia, increased substance
use and abuse.

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And so really this is a form of injury.

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We always talk about physical injuries, but
we don’t talk as much about psychological

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injuries.

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And this is a psychological injury that has
occurred to an individual.

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It’s resolved again of their service and their
sacrifice.

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Thank you so much for that.

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Margaret.

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I know that we’re going to be hearing from
you again later on this morning.

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First we are going to hear some findings from
your research team.

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Did you have anything you wanted to add just
before we move on?

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I would just again like to thank the individuals
and organizations who sponsored this research.

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So again, the Public Health Agency of Canada,
the Homewood — Homewood Health Incorporated

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through the generous donation to Homewood
Research Institute — Centre of Excellence

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on PTSD, and of course the Canadian Institutes
of Health Research.

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This work would not be possible without them,
and I think it’s work that really we need

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to do in order to best support healthcare
workers, public safety personnel, and their

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families over this time.

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So thank you Hannah, very much.

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And thank you so much for moderating this
session.

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We’re really grateful.

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I’m just so happy to be here and to be learning
for sure.

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And so speaking of learning, we are going
to go now to a short presentation from a member

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of Margaret’s research team Yuanxin Xue.

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Hi everyone, thanks for having me here today.

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My name is Yuanxin Xue, and I had the pleasure
to work with the Trauma and Recovery lab led

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by Dr. Margaret McKinnon over the past year
and a half.

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I’m really excited to be here to share some
of the results we found in a scoping review.

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We started the summer of 2021 and that we
completed earlier this year.

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So it’s on the potential circumstances associated
with the moral injury and moral distress in

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a healthcare workers and public safety personnel.

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And this is specifically during the pandemic.

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So I just want to warn you, this is a fairly
short presentation, so there may be some details

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on the slides that I won’t be directly speaking
to, but they’ll still be there for your reference.

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So, we knew that healthcare workers and public
safety personnel were encountering many morally

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and ethically challenging situations during
the pandemic.

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And we really wanted to see what was out there
in the literature in terms of the circumstances

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that may cause or may potentially lead to
moral injury and moral distress.

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So this is the research question we used to
guide our review: What are the shared and

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unique circumstances of healthcare workers
and public safety personnel during COVID globally

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that are potentially associated with moral
distress and moral injury?

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So here are some of the abbreviations I’ll
be using throughout the slides, and I just

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want to direct your attention to the last
one there, P.M.I.D.E.

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But this one stands for potentially morally
injurious or distressful event.

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And we used this term to look at moral injury
and moral distress as a collective.

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Our goal wasn’t really to try to delineate
between these two terms, so we thought it

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would be a better idea to look at them together
and to see moral stressors more holistically.

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So here’s a brief overview of our methods.

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We started our search in, or the search of
our articles, in the beginning of 2020 and

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we went until May 2021.

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And we included any article that talked about
healthcare workers or select public safety

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personnel populations in the COVID-19 context,
and they also focused on circumstances that

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might lead to moral injury or moral distress.

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So that’s definitely a bit of a oversimplification,
but you can find the more detailed methods

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online.

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And from that search, we identified approximately
1400 articles and in the very end included

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57.

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So before I get onto this map here, I just
wanted to say that out of the 57 articles,

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all of them were primarily focused on healthcare
workers.

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There was only a very small subsample of public
safety personnel in six of those articles,

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but they were also aggregated with the healthcare
workers as well.

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So it’s really hard to differentiate those
results.

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So for the most part, the results I’ll be
talking about today, they’re primarily relevant

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to healthcare workers, but that’s not to say
that they’re not relevant to public safety

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personnel as well, we just need to do a bit
more research.

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So this here is the world map and we have
different parts shaded in just based on the

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included studies and the populations they
studied.

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So you can see that the majority of articles
are focused on North America and there was

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some in East Asia and South Asia, some in
Europe, and a few others across the globe

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as well.

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And in terms of the results we found, so after
collecting all the relevant data and coding

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them, we’re able to come up with the six overarching
themes that describe the types of circumstances

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associated with potentially morally injuries
or distressful events.

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So the first one here, it had to do with the
risk of contracting or transmitting COVID-19.

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There were 34 articles included.

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And we saw that some articles spoke about
how this is particularly relevant for healthcare

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workers who were more vulnerable to having
severe infection, or those that were living

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with vulnerable populations.

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Now, the second one here, the inability to
work on the frontlines.

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This one really speaks to some of that guilt
that healthcare workers have faced when they

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didn’t have the same level of risk or exposure
compared to some of their colleagues who were

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on the frontlines.

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And this also included people who needed to
quarantine, and then there was that additional

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workload that was placed on their other colleagues.

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The third one here is the provision of suboptimal
care.

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And this one really just refers to healthcare
workers not being able to provide that same

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level of care as they would’ve liked to.

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And this was partially exacerbated by all
of the uncertainty during the pandemic, but

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also by the infection control measures that
created distance between the providers and

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patients, as well as the visitation policies
that made it difficult for family gatherings.

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The fourth thing here, it refers to care prioritization
and resource allocation.

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So this really refers to all those tough decisions
healthcare workers had to make when resources

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were scarce and there was only a limited capacity
to do what they could.

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This was especially tough when it came to
critical care resources.

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The fifth theme here, it refers to healthcare
workers perception of that lack of support

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and unfair treatment by their organization.

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And so some of the ideas that I were in this
category included not having adequate benefits

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or protection for the workers, as well as
the lack of communication and transparency

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about the whole situation.

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And the last one here, it’s the stigma, discrimination,
and abuse the healthcare workers faced.

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Some of the articles included in the section
spoke to how healthcare workers, they were

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viewed as virus carriers by their friends,
colleagues, and even their family.

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Some experienced discrimination by their community
and others also reported acts of violence

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by patients and other families.

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So when we look at all these themes and the
articles that were included in each in terms

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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.