- 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
Hello and welcome.
My name is Hannah Sung and I am moderating
the symposium today.
The topic is COVID’s hidden crisis, moral
injury in healthcare providers.
This event is two hours long with a short
break in the middle.
I would like to begin by acknowledging the
land on which McMaster University is located,
which is the traditional territory of the
Haudenosaunee and Anishinaabe nations, and
within the lands protected by the Dish With
One Spoon Wampum belt.
That wampum uses the symbolism of a dish to
represent the territory and a spoon to represent
that people should share resources and only
take what they need.
Toronto, which is where I am located today,
is home to many diverse First Nations, Inuit,
and Métis people, and is covered by the Treaty
13 and the Williams Treaties.
I hope you can take a moment to consider the
treaty territory you are on and what Land
Back and stewardship of the land mean to you
and your community.
And in fact, I’d love to hear where you are
Chat your location if you like, just drop
the name of your city or town.
It’s nice to warm up the chat that way.
The chat is a space for you today, so please
keep it respectful and on topic.
This symposium is part of a larger project
called Healthcare Salute: Thank You for Your
Service, which is funded through PHAC, the
Public Health Agency of Canada.
And Dr. Margaret McKinnon, who you’ll be meeting
in just a moment, has been working with her
team to gather evidence on the mental health
impacts of working as healthcare providers
during the pandemic.
Data has been gathered using interviews and
surveys with healthcare providers around the
country, and the researchers will be sharing
their findings today.
Several Canadian researchers are joining to
provide insight into risk and mitigating factors
on moral injury.
And you’ll also hear from healthcare providers
who describe what they’ve experienced at work.
And it goes without saying before we begin
that we are very grateful to healthcare providers
for the work they do today and every day.
So some of what you hear today may bring up
If you need to take a break, please do.
Maybe step away from the computer, come back,
get a glass of water, take a deep breath.
There are resources that have been compiled
and that are in the chat for you.
Please take a moment to copy and paste them
into a new browser or just take a screen cap
so that you have these numbers and websites
for your use.
And with that, I would like to introduce Dr.
Margaret McKinnon to the stage.
Hello Margaret, how are you this morning?
Good, how are you?
It’s nice to see you.
And so today the topic is moral injury and
moral distress and why it is so important
right now to understand these things.
Can we start with some definitions?
What is moral injury?
What is moral distress?
Thank you so much, Hannah.
And before we get started, like you, I’d just
like to take a moment to acknowledge the healthcare
workers across Canada and public safety personnel
who have sacrificed so much throughout their
This has been a sacrifice by healthcare workers,
but also by their families who have also been
And we very deliberately chose the term Healthcare
Salute: Thank You for Your Service for this
And also we have the honour of working very
closely with the Canadian military, and we
often use the term thank you for your service
and salute: we salute your service.
And we want to salute that same service of
healthcare workers and public safety personnel
today and thank them and their families for
their service and their sacrifice.
In talking about the research today as well,
I also want to acknowledge the people who,
and the organizations, who generously funded
And so the research that we’re presenting
today is from the Trauma and Recovery Research
Unit at McMaster University, St. Joseph’s
Healthcare, Hamilton, and Homewood Research
It was funded by, initially by a grant from
— or rather a contract from — the Centre
of Excellence on PTSD in Ottawa, which is
now the Atlas Institute, by a very generous
donation from Homewood Health to Homewood
Research Institute, by the Public Health Agency
of Canada, and by the Canadian Institutes
of Health Research.
So we just want to take a moment as well to
thank the funders who allowed us to do this
work very early on and gather the knowledge
and information necessary for the work that
we’re talking about today.
So when we think about moral injury and moral
distress, we can think back to the words of
General Roméo Dallaire when he returned home
from Rwanda and he talked about the moral
injury and moral distress that he and the
men and women who he served with experienced
And so there, there — moral injury takes
many forms, but one is the sense that one
has either engaged in or witnessed events
that violate one’s moral and ethical values.
So for General Dallaire, he talked about being
in Rwanda and being ordered to stand down
by the United Nations and not intervene during
the genocide and the slaughter that was occurring.
And that was for him and for the men and women
with whom he served, a fundamental violation
of their ethical and moral values.
In the pandemic, and the interviews that we’ve
been doing — and others across the country
have also been doing from, other research
groups that will also be here today —we’ve
heard about, for example, when healthcare
workers have had to deny parents access to
see a critically ill child because of no-visitor
We’ve heard about the proning of older adults
and turning over an older adult who really
doesn’t want care, but their substitute decision
maker has insisted upon it, and how painful
and difficult that can be.
That proning, which takes seven people—
people talk about these things that, that
had to be done in many instances during the
pandemic, but for people it was really difficult
because it touched upon or had a sense of
betrayal of their moral or their ethical values.
Or they witnessed situations that they felt
were violation of their moral or ethical values
and were powerless to intervene.
We also heard from General Dallaire when he
returned home about the betrayal that he and
the men and women he served with felt that
they had experienced, and they talked about
being ordered to stand down, and the impact
that that had on those who they were there
So the citizens of Rwanda, and also on the
Canadian Armed Forces, where he said this
was a betrayal by an organization that had
a duty of care to people, the people of Rwanda,
and also to those who were serving within
And here we’ve heard healthcare workers talk
about in this context, about for example,
being provided with very light masks at the
beginning of the pandemic.
I even saw a video where I saw nurses being
instructed to wear Kleenexes, while they transported
bodies, over their faces.
And so, many people serving in healthcare
at the time and continuing on, have felt that
perhaps there was not enough preparedness
for a pandemic in some situations.
Also that they felt that the organizations
or individuals who they were serving with
had a duty of care to them, and they felt
that that duty of care was not met — or
to patients as well, and families throughout
And so this really is the concept of moral
So the notion that one has engaged in or witnessed
or been powerless to prevent events or incidents
that violate one’s moral and ethical values,
or that they have felt a betrayal by an individual
and organization who they feel has a duty
of care to them during the pandemic.
There’s a lot of complex context there in
terms of understanding moral injury and moral
I hear that on an individual level it’s about
a violation of your own moral code and the
stress that that entails.
And I wonder when you use the term moral injury,
can you describe how it is an injury?
Can you tell us more about that?
So, moral injury, I would say is something
that exists in itself.
It is associated with post-traumatic stress
injuries, with depression, and with anxiety.
But it’s separate.
It has a different presentation.
And when a moral injury occurs, what we often
see is an increase in — we can see increases
for example in suicidality; difficulty functioning
at home, at work, at school; we might see
an increase in symptoms of depression, anxiety,
post-traumatic stress disorder, difficulty
sleeping and insomnia, increased substance
use and abuse.
And so really this is a form of injury.
We always talk about physical injuries, but
we don’t talk as much about psychological
And this is a psychological injury that has
occurred to an individual.
It’s resolved again of their service and their
Thank you so much for that.
I know that we’re going to be hearing from
you again later on this morning.
First we are going to hear some findings from
your research team.
Did you have anything you wanted to add just
before we move on?
I would just again like to thank the individuals
and organizations who sponsored this research.
So again, the Public Health Agency of Canada,
the Homewood — Homewood Health Incorporated
through the generous donation to Homewood
Research Institute — Centre of Excellence
on PTSD, and of course the Canadian Institutes
of Health Research.
This work would not be possible without them,
and I think it’s work that really we need
to do in order to best support healthcare
workers, public safety personnel, and their
families over this time.
So thank you Hannah, very much.
And thank you so much for moderating this
We’re really grateful.
I’m just so happy to be here and to be learning
And so speaking of learning, we are going
to go now to a short presentation from a member
of Margaret’s research team Yuanxin Xue.
Hi everyone, thanks for having me here today.
My name is Yuanxin Xue, and I had the pleasure
to work with the Trauma and Recovery lab led
by Dr. Margaret McKinnon over the past year
and a half.
I’m really excited to be here to share some
of the results we found in a scoping review.
We started the summer of 2021 and that we
completed earlier this year.
So it’s on the potential circumstances associated
with the moral injury and moral distress in
a healthcare workers and public safety personnel.
And this is specifically during the pandemic.
So I just want to warn you, this is a fairly
short presentation, so there may be some details
on the slides that I won’t be directly speaking
to, but they’ll still be there for your reference.
So, we knew that healthcare workers and public
safety personnel were encountering many morally
and ethically challenging situations during
And we really wanted to see what was out there
in the literature in terms of the circumstances
that may cause or may potentially lead to
moral injury and moral distress.
So this is the research question we used to
guide our review: What are the shared and
unique circumstances of healthcare workers
and public safety personnel during COVID globally
that are potentially associated with moral
distress and moral injury?
So here are some of the abbreviations I’ll
be using throughout the slides, and I just
want to direct your attention to the last
one there, P.M.I.D.E.
But this one stands for potentially morally
injurious or distressful event.
And we used this term to look at moral injury
and moral distress as a collective.
Our goal wasn’t really to try to delineate
between these two terms, so we thought it
would be a better idea to look at them together
and to see moral stressors more holistically.
So here’s a brief overview of our methods.
We started our search in, or the search of
our articles, in the beginning of 2020 and
we went until May 2021.
And we included any article that talked about
healthcare workers or select public safety
personnel populations in the COVID-19 context,
and they also focused on circumstances that
might lead to moral injury or moral distress.
So that’s definitely a bit of a oversimplification,
but you can find the more detailed methods
And from that search, we identified approximately
1400 articles and in the very end included
So before I get onto this map here, I just
wanted to say that out of the 57 articles,
all of them were primarily focused on healthcare
There was only a very small subsample of public
safety personnel in six of those articles,
but they were also aggregated with the healthcare
workers as well.
So it’s really hard to differentiate those
So for the most part, the results I’ll be
talking about today, they’re primarily relevant
to healthcare workers, but that’s not to say
that they’re not relevant to public safety
personnel as well, we just need to do a bit
So this here is the world map and we have
different parts shaded in just based on the
included studies and the populations they
So you can see that the majority of articles
are focused on North America and there was
some in East Asia and South Asia, some in
Europe, and a few others across the globe
And in terms of the results we found, so after
collecting all the relevant data and coding
them, we’re able to come up with the six overarching
themes that describe the types of circumstances
associated with potentially morally injuries
or distressful events.
So the first one here, it had to do with the
risk of contracting or transmitting COVID-19.
There were 34 articles included.
And we saw that some articles spoke about
how this is particularly relevant for healthcare
workers who were more vulnerable to having
severe infection, or those that were living
with vulnerable populations.
Now, the second one here, the inability to
work on the frontlines.
This one really speaks to some of that guilt
that healthcare workers have faced when they
didn’t have the same level of risk or exposure
compared to some of their colleagues who were
on the frontlines.
And this also included people who needed to
quarantine, and then there was that additional
workload that was placed on their other colleagues.
The third one here is the provision of suboptimal
And this one really just refers to healthcare
workers not being able to provide that same
level of care as they would’ve liked to.
And this was partially exacerbated by all
of the uncertainty during the pandemic, but
also by the infection control measures that
created distance between the providers and
patients, as well as the visitation policies
that made it difficult for family gatherings.
The fourth thing here, it refers to care prioritization
and resource allocation.
So this really refers to all those tough decisions
healthcare workers had to make when resources
were scarce and there was only a limited capacity
to do what they could.
This was especially tough when it came to
critical care resources.
The fifth theme here, it refers to healthcare
workers perception of that lack of support
and unfair treatment by their organization.
And so some of the ideas that I were in this
category included not having adequate benefits
or protection for the workers, as well as
the lack of communication and transparency
about the whole situation.
And the last one here, it’s the stigma, discrimination,
and abuse the healthcare workers faced.
Some of the articles included in the section
spoke to how healthcare workers, they were
viewed as virus carriers by their friends,
colleagues, and even their family.
Some experienced discrimination by their community
and others also reported acts of violence
by patients and other families.
So when we look at all these themes and the
articles that were included in each in terms
of where they’re geographically located, for
the most part, all of these themes, apart
from one, they are fairly globally spread.
And this is especially true for the risk of
contracting or transmitting COVID-19, as well
as the perceived lack of support and unfair
treatment by their organization.
So the only exception was the category of
stigma, discrimination, and abuse, where there
was a lack of articles from North America.
But this is not mean to say that this doesn’t
happen in North America, but it’s more likely
due to potential underreporting of some of
these issues in the context of moral injury
and moral distress.
And we definitely need to do more research
to get a better understanding of the severity
of those experiences and the.
So with that, that concludes the presentation
and I just want to say thank you to Dr. Margaret
McKinnon, as well as everyone who contributed
and really made this review possible.
And thank you guys so much for listening today.
It was a pleasure to speak with you all.
Thank you so much to Yuanxin who will be hearing
from in one moment.
First we’re going to hear from another presentation
from another member of this research team.
It’s from Andrea Brown.
So let’s watch.
Thank you for inviting me to speak today.
My name is Andrea Brown and I’m a research
associate in the Trauma and Recovery Research
Unit at McMaster University.
Since September of 2020, we have been collecting
information about moral injury and healthcare
providers across Canada.
And what we’re finding is that healthcare
providers are in fact experiencing moral injury
during the pandemic.
Moral injury has been called the signature
wound of service, although this was originally
brought forward for military members, we also
believe that it applies to our healthcare
In our very first webinar in the Healthcare
Salute series, Kim Ritchie and Andrea D’Alessandro-Lowe
gave some information about the types of events
that healthcare providers have identified
as morally injurious or morally distressing.
These include witnessing patients dying alone.
At one point, during the pandemic, family
members weren’t allowed to go and and have
end of lifetime with their loved ones.
And during this time, healthcare providers
had to watch their patients dying alone.
And this spanned the age ranges of very old
to very young.
Also providing invasive care, which is perceived
as futile and prolongs the suffering of their
Increasing workload and decreasing staff,
which is an something that’s impacting our
healthcare providers even today.
Bullying, violence and divided opinions as
well as the disconnect between frontline staff
and their organization.
So we know the types of events that are being
identified as morally injurious or morally
distressing by healthcare providers, but we’re
also wondering what are the impacts.
In particular, we’re wondering about post-traumatic
stress, depression, anxiety, stress, dissociation,
substance use, and resilience.
Are these things that are also impacting our
So in order to understand this better, we
have had a survey, or we had a survey that
was open from September of 2020 until September
of 2022, and it was open to healthcare providers
across Canada to complete.
The bulk of our participants were nurses and
respiratory therapists, but we also had many
other healthcare providers complete, including
occupational therapists, physicians, those
in dentistry, long-term care and mental health.
And in total, we had nearly 700 people complete
the survey or partially complete the survey.
Near 80% of our participants identified as
The bulk were from Ontario living and practicing.
We also had nearly 10% from Alberta and British
We did have representation from across the
provinces, although we didn’t have representation
from the territories, and nearly 70% of our
participants identified as having European
The first question we really wanted to know
is how many of our participants said that
they were experiencing these events or these
situations that they would define as morally
So we asked them a question asking if they
had been exposed to three types of events
that goes against their core, their moral
codes or values.
So these are events in which they did something
or didn’t do something that went against their
moral code, they witnessed somebody else doing
something or not doing something that went
against their moral code and then being directly
impacted by something that somebody else did
or didn’t do that went against the moral code
or their values.
So what we found is that 70% of our participants
were exposed to these types of events that
went against their moral code or their values,
and 67% of our participants said that they
experienced these events in 2021.
And 72% of our participants in 2022 said that
they had experienced these events this year,
and that was between January and September.
So we know the types of events that are being
defined as morally injurious, and we know
that two-thirds of our healthcare population
are experiencing these types of events.
So then we wanted to know how is it impacting
So we asked questions in our survey, and what
we found was that those who perceived a greater
moral injury also experienced greater rates
of depression, anxiety, stress, post-traumatic
stress, and dissociation.
These are at a statistically significant level,
but we also found that those who had greater
perceived moral injuries also used more substances
in order to try and cope.
So this includes increasing alcohol use, cannabis
use, and other recreational drugs.
Although this wasn’t statistically significant,
there was a positive correlation between the
And what we also found is that those who had
perceived greater moral injury also had decreased
So this is the feelings that they could cope
with the stresses and that they could bounce
back with the stresses.
So we know that what the morally injurious
events are, we know that two-thirds at least
of our healthcare population are experiencing
these events, and we know that it’s impacting
their mental health, their coping ability,
and their ability to bounce back.
So together with our collaborators, we have
created some recommendations for healthcare
organizations and leaders, and it begins with
listening and understanding healthcare providers’
experiences and the impact these experiences
have had on healthcare providers and their
family, because the impacts go home with them.
Asking healthcare providers questions about
what they need to perform their roles and
improve their mental health, because healthcare
providers know what they need more than anybody.
And then providing access to appropriate supports
for healthcare providers.
So taking what you’ve learned when you’re
listening to their experiences and understanding
what it is that they need, and then providing
them with those supports.
The supervisors and the management in these
organizations are also under a lot of stress.
They have to balance the needs of the healthcare
providers and the organizations to make sure
that the services are being provided for our
So another recommendation we made is to provide
supervisors and management with resources
and training to support healthcare providers’
And finally, we recommend to establish evidence-based
policies to guide ethically difficult decisions.
While on the job, healthcare providers have
to make life-and-death decisions.
And they said it would be helpful if they
had policies to help guide these decisions
and that these policies were based in evidence.
So to summarize my very short presentation
today, we know that healthcare providers are
experiencing moral injury, and we also know
the types of events that they are saying are
We also know that these moral injuries are
impacting their mental health, their ability
to bounce back, and substance use.
So what we are going to do is to continue
to conduct research to identify interventions
and to identify the long-term impacts of these
Thank you very much.
Thank you so much, Andrea.
And I have a feeling that there were probably
many people in this webinar who are nodding
along to the observations and the details
and the recommendations that you just shared
So I would like to invite Yuanxin and Andrea
to join me for a quick debrief of your presentations.
Your presentations were filled with detail,
and I would like to just go very big picture
if I may.
And first I’ll ask you, Yuanxin: you showed
us the map of all the various places from
which you drew your research.
Did you find important similarities between
your findings globally and the data in Canada?
No, no, for sure.
And thank you for that question.
I think that was actually a big part of why
we started the review.
We wanted to see if what we’re seeing in Canada
was really happening across the globe as well.
And although most of the articles were more
the based in North America, I think we did
get a glimpse of what it does look like globally.
And I think like when you look at the themes
we found and the other information that we
gathered on Canadian healthcare workers through
the interviews and the surveys they’re basically
saying the same thing, but just they’re just
organized a little bit differently.
And I think two of the really big similarities,
there’s probably anything that’s related to
patients and not being able to provide the
optimal care that they used to be — whether
it be not having, having patients that had
to die alone because of visitor policies or
other limitations to work because of increased
workloads or changing protocols, or simply
just witnessing like patients who were receiving
care that healthcare workers may have felt
I think that was definitely a big similarity
between what we see here, as well as in the
And I would say another big area was had to
do with the organizations, and that just perceived
a lack of support or sometimes even betrayal.
The healthcare workers felt when there was
inadequate PPE, inadequate staffing, and just
that disconnect that sometimes there was between
the frontline workers and their organization.
Well, I find that so interesting that you
found those key similarities because, as someone
who doesn’t work in healthcare, I would think
that depending on your region, depending on
the type of healthcare system, that there
would be some real specificity about the work
But in fact, there were certain experiences
that healthcare workers had just across the
board during the pandemic.
Mm-hmm, for sure.
I think like when you look at big picture,
I think it’s pretty much, you’re looking at
the same things.
But maybe if you like zoom into Canada or
different parts of the world, the severity
or extent to certain experiences, that that
But I think for the most part we’re seeing
that healthcare workers, they were experiencing
moral injury, they were experiencing moral
distress and there’s definitely a lot that
can be done there.
Thank you Yuanxin.
I would like to move over to —
Can I just add on to that?
Andrea, please do.
So during Yuanxin’s presentation, he said
that the one area that wasn’t as supported
in North America was the stigma, discrimination,
and abuse, but I think that might be because
of when those publications took place.
Cause our research is actually finding that
in the last year, that is a moral injury that
has come up more and more in our conversations
with healthcare providers.
So it could just be that the research ended
and was published towards the end of 2021.
So that means it was submitted before that.
So in the last year it actually has risen.
It’s interesting because in your presentation
you said, Andrea, that you were looking at
research or you, you, your team was conducting
surveys that go all the way up to just a couple
of months ago, until September 2022?
The end of September, right.
So I would love to ask you, Andrea, again,
very big picture, why do you think it’s important
to understand how moral injury specifically
is related to mental health when it comes
to healthcare providers?
I think the big thing, Hannah, is that understanding
the impact of moral injury on healthcare providers
will help us to provide them with the supports
that they need and what types of supports
that they need to have.
Healthcare providers play a vital role in
And it’s one of the things that Canadians
are always so proud of, is our healthcare
Our healthcare providers, who have always
made life-and-death types of decisions, and
have always been in these types of situations,
something about COVID-19 is different, and
it’s intensified everything.
And so we now know that they’re facing moral
injuries, and we know how it’s impacting them.
So we as society, at the government level
and at the organizational, understanding this
can start to implement the behaviours and
the skills and support for our healthcare
providers to help them while they’re helping
And I’m glad to see that there are some questions
that are coming through the chat.
So I will say that there are probably too
many to get to them all, but please keep them
coming and I will get to as many as I can.
So I’m just going to choose one here for you
both, Yuanxin and Andrea.
Karen is asking, when gender-based analysis
was applied to your research, were there any
important variations and findings based on
specific occupation and/or sex and gender
of the healthcare provider?
Would either of you like to speak to that?
At this time, I have not run the analyses
on the gender based analysis.
But I would reiterate that 80% of our population
identified as being female.
So it’ll be a small percentage that identify
as male or non-binary.
And I will ask one more question.
What are the next steps in terms of interventions,
any suggestions and or recommendations?
I know, Andrea, that there were several in
Maybe you can go into some of them in detail.
So, one of the things that’s come out of our
research is that we’ve made some recommendation,
and I know that Sangita has put a link to
these recommendations within the, in the chat.
In addition, with the funding that we’re receiving
from the Public Health Agency of Canada, we
are creating some psychoeducational programs
that will be available online.
It includes some training for trauma-informed
care for, for not — it can be used by healthcare
providers in their work, but it can also be
for people who are supporting healthcare providers
and understanding that everybody has traumas
and when we’re working together, these traumas
are impacting people regardless.
So when you’re dealing with somebody, realize
that they’re, they might not always be in
the same situation that you are because of
what’s happened in the past or what’s ongoing
at work, or also creating with the University
of Alberta some psychoed programs, online
programs on what is moral injury.
And then we’ve also created one on PTSD stress.
And that will help people to understand, let’s
say that you’re a healthcare provider and
you really don’t understand why you’re not
And I’m sure that healthcare providers do
understand this, but it’ll help to go in and
say, PTSD and stress and moral injury, this
is how it affects your body and this is why
you’re feeling this way.
And we will also connect you with some some
other information that you have.
And there are also supports available online
that we will connect you with.
So it sounds like the experiences that healthcare
providers may be having, it’s good to have
the language and the backup and the evidence
to show that healthcare providers need help,
and that these injuries affect the ability
to do the job?
And remembering that healthcare providers
They’re always helpers, and they often put
themselves lowest on their list of who to
take care of themselves.
But it shouldn’t just be on healthcare providers
to take care of themselves.
We as a society need to do what we can to
support our healthcare providers.
The government needs to put in the laws and
the regulations to support our healthcare
providers, and the organizations need to do
So let’s take the focus off the healthcare
providers taking care of their mental health,
and let’s put it on everybody to support our
Well, Andrea and Yuanxin, thank you so much
for your research and your presentations.
I really appreciate it.
Thank you, Hannah.
And while we are speaking about healthcare
providers, why don’t we speak to healthcare
We have a panel of three people who have very
generously given their time and are about
to share their experiences with us.
I’d like to quickly introduce you to them.
Michele Johnson, if you could join, Krissha
Michele and Krissha are nurses.
Jennifer is a family doctor.
And if you’re on Twitter, if you were on Twitter
during the pandemic, you know Jennifer has
provided a lot of information there for laypeople
such as myself to understand COVID data.
So I want to ask all three of you about what
you’re hearing today about moral injury and
moral distress and whether these definitions
in these observations speak to you when you
think about your day-to-day work.
But first, can I ask you just very quickly
in 10 seconds to tell us what is your job
and what is your favourite thing about your
Maybe Michelle, I’ll start with you.
So I’m a nurse of 32 years in a hospital in
And there’s three things I really love about
It’s this kind of collection of this science,
hands-on critical thinking and this empathetic
opportunity to meet with a stranger, a stranger
in distress, who I can reach out with my heart
and reach theirs and have a moment that’s
like — it’s an incredible privilege to be
able to do that.
And the other thing is this kind of incredible
support I get in my whole life, all aspects
of my life, that I get from my colleagues.
Like, working with people who are caregivers
is an incredible privilege, because we care
for each other in the same way we care for
the public and people we’ve never met, we
care deeply for each other — and that’s
a pretty wonderful job.
I love that description.
Thank you so much.
And I’ll also just mention, Michele, that
I think your microphone is rubbing on a little
I don’t know if you want to just — yeah,
check that out.
But you sound great and maybe I’ll go to Krissha
Can you tell us about your job and what you
love about it?
Krissha is not here at the moment.
I’m sorry, I introduced Krissha, but my view
of the Zoom is very complicated, so I could
not see that she’s actually not here at the
She is here!
As you can see from the chat, you have to
have a moment like this in a Zoom.
I’m not sure if we can get Mike to help out
with bringing Krissha into the panel so that
Krissha can speak with us.
But maybe for now, I’ll just go to Jennifer.
Can you tell us a little bit about your job
and your favourite thing about it?
Thanks Hannah, and thanks everyone for joining
I’m a family doctor in Burlington.
I do love my job.
I love my patients.
It is such a privilege to care for people
and their families and develop these long-term
relationships and get to know them over time.
It’s both rewarding and heartbreaking cause
sometimes we do see things happen to people,
but it’s such a privilege to be there to help
fix things that we can fix and to hold people’s
hands like figuratively when they are going
through illnesses and help people with their
health over time.
So I really do love my job and despite some
of the moral distress that we experience,
it is still a very — a great honour to be
a family doctor.
Thank you, Jennifer.
And Krissha is joining us now.
I would love for you to tell us in 10 seconds
about your job and what you love about it.
Sorry about that.
What I love about my job is getting up to
see patients every day, helping those who
need help, who brighten.
They might need something like a flu shot
and then it will change their day.
It’s about touching, it’s about speaking in
to your patients and really connecting with
them in some ways you can to just help.
I don’t know, it’s just always an innate feeling
towards — in my line of work, it’s just,
I’ve always loved helping and I felt like
I was born, I was put in this world for the
purpose of helping somebody.
And it’s just interacting with people every
day and making a difference.
That’s how I believe how I was put in this
world, is to help people day in and day out,
no matter what.
And I know that you are a nurse and that you
work with people who are, I believe newcomers
to Canada, at the moment.
That’s your work, correct?
I currently work with newcomers and refugees
coming into Canada.
I provide mostly primary care, help them go
over, like helping them with resources and
working through a lot of barriers and really
advocating for patients because how come this
patient can’t get their, what they need in
order for them to be healthy, however these
people can, and what I’ve noticed is there’s
a lot of racism involved, and there’s just
a lot of barriers for patients, especially
coming into Canada.
And myself as an immigrant, I know exactly
how I transitioned over here and how challenging
And oftentimes that’s how I’ve been connecting
and able to empathize with patients like that,
because they’re also struggling.
And then I think that’s why I have chosen
this field, is because in some ways I’m doing
more than just cleaning up a wound or whatnot.
I’m actually doing something for them for
And it, it strikes me as you’re speaking that
you work with people who are in a vulnerable
situation because they’re new to the country
and they face many barriers.
But I guess all healthcare workers come in
contact with people who are in a vulnerable
moment because they need your help.
And Krissha, if I may start with you, in terms
of experiences throughout the pandemic and
doing your work, earlier in the pandemic,
you were working in long-term care, and I
would like to know what did it feel like at
first to be managing your nursing staff, especially
when it came to outbreaks of COVID in the
So while I was working in long-term care,
I think that all of us we were all quite scared.
For us, it was kind of an invisible dooming
cloud coming in and you know, and soon as
you know it, you just get it and then it spreads
So for us, it was really important for me
to ensure that staff are well protected and
they always, because you have to think about
it, they have people to come home to.
They have family, loved ones, children, grandparents,
and these are the people who rely on them.
There’s a reason why they come out and do
this job every day.
So for me, I’ve had one experience where I
had to practically raise my voice at the staff
because we were in an outbreak.
And in an outbreak situation, you really need
to be considerate and you need to be very
cautious and you need to be on your high alert
because at that time, we didn’t know what
We didn’t have all these informations and
how widespread it could be and how it travels
through airborne and what kind of protections
do we need.
So for me, I had to stand up for them, because
I had to tell them, “Listen, you know
I need you guys to protect each other.
This is the only way we really can come out
You look out for me.
You look out for her, and you look out for
him, or you look out for your next teammate.
That is what it is all about.”
And I think I was reprimanded for the fact
that I shouldn’t be yelling, I shouldn’t be
raising my voice at staff, but I thought at
that time I was being honest and I really
laid out the reality that it could be any
of us who will get sick, and then God forbid
it spreads to other family members.
Like my dad was a diabetic — or is a diabetic.
I was very scared.
So that’s how some people might not like my
approach, but I felt that I had to make that
very clear, that safety was very important.
I can definitely hear that emotions were running
high because when you say you raised your
voice, you were stretched to that point where
you needed to do that.
Michele, I would like to turn to you for a
moment because you were also a nurse.
And you mentioned that you have been in nursing
for 32 years.
I feel like if you’ve been doing anything
for 32 years, you’ve probably seen it all.
But COVID was unprecedented, as we know.
Were there any firsts that you witnessed at
work during the pandemic?
There certainly were.
And just to start out with, I want to just
say thank you so much to the researchers who’ve
done this work, it’s actually touched my heart
so, so deeply.
I feel a little, it’s, it’s — I’m really
touched to, to have what I’ve experienced
and the emotions that we as nurses carry,
to have it received so wholesomely by the
researchers and reflected back, has actually
really touched my heart.
And I’m a little bit like, Whew!
This is kind of exciting to realize that all
that we have done is being so validated, and
that’s really wonderful.
So thank you for that.
And what I would like to say is what I saw
for the first time was sort of the impact
of this moral injury and moral distress and
the sort of way that COVID tipped things.
When when COVID arrived, we didn’t realize
how deeply us nurses depend on each other.
We are a resilient collective.
We are, we are a network of caregivers who
care for each other and care for our patients.
And it’s a real — I’m doing this with my
hands cause it’s a way to articulate how we
are — we’re greater than the sum of our
parts when we are together.
And when COVID came, they gave us these flimsy
little blue surgical masks and the only work
if we all wear them and we stay six feet apart.
And that imperative to isolate left us alone
and our distresses became individualized.
Prior to this, we had always come together.
I could find a colleague and say, “Hey,”
and suddenly we were individualized.
We weren’t a collective, we weren’t together.
When I experienced what any of us experienced,
the fear, the anxiety, the sorrows, when we
were in a situation of overwhelm, we were
alone with that feeling.
And I had never before seen nurses breaking
We’ve all cried in our shifts.
That’s — but to have to find nurses sobbing
in utility rooms and in quiet corners, it
stood in a stark contrast to SARS, which came
20 years ago.
When it came, we were all rapidly given N95
masks in the hospital.
And the whole city was scared of us, but we
knew we were safe cause we had our N95 masks
and we knew they would keep us safe and we
were able to gather and we were able to support
And the sense of betrayal that I feel because
we’ve been denied proper PPE — because it
was, here’s your blue mask, stay apart — it
has fractured this incredible network that
nurses depend on professionally and personally.
We come to work for 12 hours and we support
each other so that we can also go home and
still be as good of people as we can be.
And I personally feel, I’m quoting Margaret,
I wrote some of her words down, like a guilt
and shame in the difficulties of, and the
moral distress of our failure to our collective
selves as nurses and allied health professionals,
including doctors, in our stuff, and there’s
been no time, energy, or focus for us to come
back and support each other.
And this, this is a big — what’s the word?
Like, this fracture is really detrimental
to novice nurses, to newcomers to the profession.
It’s a really vulnerable time.
And if they don’t have this, I don’t know
how they’ll stay.
And the healthcare system depends on them.
So I really appreciate the urgency that you
researchers are putting into looking at this.
It’s really, really, really wonderful.
Thank you, Michele.
I want to say that I can feel the emotion
and I was doing a lot of deep breathing as
you were speaking, and I invite everyone listening
who’s experiencing your story right now to
take a deep breath — or many, if you need
— and Michele, what I hear from what you’re
saying is echoes of the fear that Krissha
was talking about, the fear in the workplace,
and then on top of that, the isolation, which
is so debilitating for people who work as
a team, and who need to work as a team.
I would like to turn to Jennifer now.
You work as a family doctor, and I mentioned
off the top that you also provided COVID charts
every day on Twitter, which was very useful
for people who were fearful and who wanted
more information or to know how to understand
I know you did that Twitter work above and
beyond your regular job and healthcare professionals
have been going above and beyond on an individual
level, well, since before the pandemic, but
also have been asked to do that during this
What has that been like in your experience
— that constant kind of above and beyond
Well, thanks to Michele and Krissha for articulating
it so well, that feeling, especially early
in the pandemic, when there was no vaccines,
We didn’t even have masks at times.
I remember even in my clinic, we were like
trying to order more masks.
We were running low, like how can we protect
our staff and continue to see patients, but
our supplier — our expect-delivery day,
it kept going back by months.
So it was that kind of fear that we all felt
initially and I think everyone tried to pitch
in in whatever way we can, like going beyond
what our regular clinical duties were.
For myself, I thought, oh, like I can share
Yeah, it’s not part of my job, but I felt
like that was another way we can all work
And I think early pandemic, we all did that.
Like we all thought about what we can contribute
and have a collective effort to protect our
patients, protect our families.
So I think that feeling we all definitely
And even now I think the struggle is that
we’re still constantly adapting to the changing
Like COVID is increasing again, now we have
other respiratory viruses like RSV.
There’s just so much going on.
The children’s hospitals are struggling.
We’re still trying to keep PPE supplies up
and trying to protect our patients.
For example, we’re still doing outdoor visits
in the parking lot for people who have respiratory
symptoms, but the weather’s changing, so we
have to adapt to that.
And it can be difficult because when patients
are sick and struggling, sometimes they’re
also very upset, and that can affect us and
the staff if people are upset at us.
But really we shouldn’t be upset at one another.
We should still continue to try and have that
kind of collective sense of tackling the pandemic
Because really I think that’s what everyone’s
grieving, we’re missing our pre-COVID times
where we didn’t have to have this looming
cloud, like Krissha said, over our heads,
and just live our lives and be normal.
But now that we know, it’s been so long, we
just never know when or if that will happen.
We have to continue to work together and adapt
and support one another through this.
Thank you, Jennifer.
You mentioned many things, but one of the
things you mentioned is that people are upset.
And I saw some data the other day, I don’t
know how they’re measuring it, but there’s
more rudeness — and I think that probably,
especially as people who deal with the public,
you probably don’t need a study or research
to show you that.
I’m just wondering if any one of you would
like to, to tell us about what it’s like to
be the helper, as we’ve talked about, and
all your energy goes into helping on the job
— and yet it is such an exhausting job for
all the reasons that you have outlined, needing
to go above and beyond, needing to really
have part of your mind go to PPE and thinking
about that, or the lack thereof, thinking
about handling patients who are upset.
And there are different types of exhaustion
There’s physical exhaustion, but then there’s
And I’m wondering if anybody would like to
jump in and just talk about how they handle
I can probably provide an example.
I — there’s not really a way to handle this
huge stressor, I think.
How I managed to work through it and because
— like when I was in an outbreak situation,
I was pretty isolated.
I was away from my family members.
I had to live in the hotel.
There was — you’re by yourself.
You essentially get up to go to work.
You prepare yourself and you’re — I think
somebody wrote in the comments that they used
to cry in the car going in.
That used to be me.
That used to be how I managed to deal with
And then, you’re worried about your other
colleagues who were also sick.
But the only thing you have to do is , you
have to get stuff done.
Someone has to take care of these people,
because who else is going to take care of
them, you know?
We have this like moral thing where we don’t
leave anyone behind.
We are in this position of power and these
people are so helpless and you treat them
like family, they’re part of your family.
You don’t leave anybody behind, so what do
you have to do?
You have to get up and then you have to do
You have to put yourself in bootstraps, and
then you have to make a strong face for everyone
else because the next person you’re looking
at, who you might — they’re also just feeling
the same way as you are.
They’re also just breaking down inside, but
they don’t want to show it because they’re
scared that they’re going to be either stigmatized
or be labeled or whatnot.
But they’re also kind of like, I don’t want
to break down at work, I’m not that type of
They have a lot of pride in their jobs and
they’re really dedicated.
So yeah, I remember crying because I couldn’t
care for somebody because I had spent so much
time on another patient.
And it’s true what they have, the research
shows, it’s, you’re never supposed to be in
a position where you have to be God.
You shouldn’t be.
You shouldn’t have to choose this person lives
and this person dies because you’re only one
nurse for 32 patients and everyone’s COVID
positive, and you only have a handful of staff,
and most of the staff are scared for their
own loved ones.
So I remember me and just the other, the PSW
who showed up for her patients, who’ve known
them for years and years and years.
And then we cry in the back and we say, you
We have to do, like, we have to take care
of these people.
Let’s get stuff done.
Let’s get, if we have to, if we miss some
stuff, what can we do?
Let’s just like, let’s just try our best,
because we are the only one who can help them.
And then there’s — they can’t even help
And you have family members calling phones
and whatnot and you can’t even use the phone
because they’re all full of messages.
And as soon as the one phone rings, it’s like,
“Hi, did you hear about my family member?
Did you hear?
I’ve been calling everywhere” and I’m
like, “I’m so sorry.” This is a,
you can’t provide updates.
It’s … what you have to do.
Every day is like a war.
You have to put on your — you have to put
on your gear, you have to put on your mask,
you have to put on your face shield.
You have to be prepared, like wearing PPE
all the time.
You’re going to have your … nose marks,
and then you’re going to get severe headache
because of all the, Hasbro has provided you
with rubber band and a plastic shield and
stuff, and you’re like, am I — is this COVID,
is this just a headache, or is this just the
And yeah, you have to … sometimes what made
me feel better, was that looking back at patients
when they were like, at their best, when they
were like laughing, they were just joking
around or they did some silly thing, or their
family members came and visited and how they
Yeah, , and it’s true what Michele said.
It’s really about camaraderie, right?
And then this pandemic kind of made us feel
more isolated and really fend for our own.
And it’s true.
Like, you go in utility closets.
I went to the chapel, I cried, and then I
I was like, I hope I don’t get it.
And I, I hope no one else, you know — sorry,
I have monopolized the time.
If anyone wants to go, go.
Never say sorry.
Your stories are so important to us.
And Michele, I saw you nodding a lot.
Is there anything you wanted to add?
Yeah, and thanks Krissha.
You’ve really, you captured it.
It’s for sure what we deal with.
It’s this, it’s this— I would like to just
put it into a bit of context, because of my
elder status in the profession.
I remember when it was a really honourable,
not frantic, human, I might even call it a
You know, in 1990 when I graduated, we had
only begun the defunding.
Defunding is said to have begun somewhere
in ’85, ’87.
Our healthcare system has been defunded for
32 years that I’ve been there.
The impact of consistent, progressive defunding
has come at the expense of — and I’m a bit
biased and I’m sorry — but nurses, we are
the bulk, physical workers of our healthcare
We are the backbone of every hospital.
If you need a doctor, you go to a doctor’s
If you’re in a hospital, it’s because you
need a nurse.
And we have defunded.
We as a province have chosen to defund healthcare
for 32 years, and it has brought all of us
to the brink.
The system now depends on each nurse working
full out and to an exhausted state that I
have never seen before.
And it is a malignancy that I think jeopardizes
the future of our healthcare system so fundamentally,
because nurses are fleeing, because they have
reached their limits.
They are, we are, all deeply exhausted.
And what happens with deep exhaustion, is
The moral injuries that do happen in distress
because we’ve made mistakes are real.
We don’t sleep very well at night.
We arrive — when, when someone hears a nurse
works 12 hours, it’s a lie.
I’m at work for 13 hours.
Our government has betrayed us by Bill 124.
And our unions haven’t been able to mobilize
any action to be of benefit to us.
And I just feel like a real threat is looming
at how our hospitals are going to function
and our healthcare and our nursing homes when
nurses begin to fall because it’s too much.
We can’t, we’re done.
We’re, we’re, we’re, we’re, we’re, we’re,
we’re breaking, you know.
It’s just, it’s, it’s a great urgent grief
and fear of mine.
I hear so much Michele in what you’re saying
that matches with the research that we have
been hearing about.
I hear the sense of betrayal organizationally
I’m wondering if there’s anything else that
anyone on this panel has heard about in terms
of the definitions of moral injury and moral
distress and the research findings.
Was there anything else that really struck
you as fitting with your day to day experiences
I guess, one thing I wanted to mention is,
at the end of the day with this defunding
of the healthcare system, impacting all healthcare
workers, and at the end of the day, it’s the
patients that are going to suffer, right?
And sometimes we don’t see it with, it’s not
as immediate, like when you watch someone
get COVID and get really sick which is very
But sometimes there’s these kind of long,
slow-burning kind of fires.
So for example, I have patients that would
get like a breast lump and then they have
to wait for imaging and they have to wait
for biopsy and they have to wait for results.
And then they have to wait for the specialist
to see them to find out what are the needs,
surgery or chemo.
And it’s, it’s so traumatizing to the patient
to have all these weights because the healthcare
system is so overwhelmed.
And these are kind of stories that you may
not hear as much because it’s kind of a more
slow, chronic problem that keeps getting worse.
For example, pap smears, now it takes like
four months for a result.
And that’s, what if we’re missing something?
What if there is something abnormal that needs
to be followed up on?
And we’re just not even getting results in
So it, it’s hard because these things are
not as visible, but patient care is impacted
and when things are delayed, the diagnosis
Treatment may be more invasive and aggressive
because the cancer is worse.
So I think that hopefully maybe, if we can
continue to advocate for our professions and
for proper funding of the healthcare system,
we can avoid a collapse.
But it’s not looking great in terms of the
trajectory right now.
And it’s just very sad to see how a lot of
the weight is placed on our shoulders when
we really need the government to step in and
make things right.
I’d like to jump in if I can now with a question
from somebody who is here listening.
Her name is Tracy and she says she manages
a 31-bed unit.
“I am at 48% staffing.
My staff are at the breaking point.”
So this is what Michele is describing, and
Tracy says, “I am seeing toxic interactions
between our core staff and new I.E.N.”
If someone wants to explain what I.E.N.
means, I’m sorry, I don’t know, but Tracy
is saying she needs help.
“I’ve been a nurse for 30 years.
Is there anything I can do to help all my
This is a very big question, but if there’s
anyone who, Krissha or Michelle or Jennifer,
if you have a piece of advice for Tracy, she
would like some advice.
I wish I had advice.
I wish I knew the answer.
It’s that your staffing levels are not rare
to have to run with 50% of your full-time
lines vacant, and no one to work those, that’s
normative now in healthcare.
What that means, if you don’t know what that
means, it means you work short.
And if you work 10% short, arguably each nurse
does 10% more work.
If you’re 20% short, you’re doing 20% more.
So her unit’s running at 50% short.
That’s not surprising to me.
That’s probably where most of our emerg systems
And at that rate, the nurses who are coming
on, are working 50% more — because there’s
not fewer people.
Our population has grown while our funding
So I think being a manager who cares and can
hear and can do their very best to support
and can recognize how everybody who does show
up tries their best and works their hardest.
I really appreciate when my boss says to me,
Michele, thank you for coming to work.
Thank you for showing up.
Thank you so much for staying late.
Thank you for everything you do.
It is pretty, pretty important to be thanked.
So that’s like the smallest thing I can suggest.
And I think Tracy, you’re not alone.
There’s every manager, every nursing unit
manager is dealing with this identical problem,
and the ability to affect an improvement is
really, really going to be difficult …
What I see is the fracture when she speaks
of senior nurses [who are] aggressive at each
There’s a real fracture of relationships.
And this kind of, what I described as this
kind of thing, we used to stick together and
now — I have done it.
I have snapped at my fellow senior nurses.
I’ve snapped, and I’ve been — we now isolate
just so that we can self-regulate.
And we used to co-regulate and now we self-regulate
and it’s — we’ve lost an ability.
We’ve lost our way to find that relationship
when that’s fundamental to how we get through
And without that, we can hire new nurses,
but they don’t stay because there’s not a
network of support for them.
They are even more isolated and more afraid.
And it’s like a problem that’s like a snowball
going down a hill.
It’s getting bigger and bigger because as
people leave, there’s more work, as there’s
more work, there’s less support, there’s less
support, there’s less processing of the injury.
That’s part of our job.
Moral distress is part of our job.
It’s part of the, it’s part of the water we
Like, there’s just no way you can be a nurse
and not have experienced this.
It’s just COVID tipped the balance in such
a negative way, and I think the people who
are studying nursing and healthcare workers’
traumas prior to COVID, I think the numbers
are probably there saying, yeah, the traumas
have been there all along.
But COVID certainly has just tipped it all,
the balance not in our favour.
So stay strong Tracy.
And I think love in the nurses you have is
already pretty great because, well, it’s kind
of all we can do.
That’s great advice, Michele.
Yes, please finish your sentence.
I didn’t mean to cut you off.
Oh, it’s okay.
Nurses, we create nursing care plans for our
It’s kind of, if you’re a nurse, you know
what I’m talking about, that it’s what we
do to sort of, we create a nursing care plan.
And I have this wish that as nurses we can
create a nursing care plan for nurses that
we can figure out, cause our job’s so unique
and it’s so misunderstood.
We’re not represented in media.
People don’t understand what nurses do.
I feel like only nurses understand just what
we do, cause we’re there.
Anybody can follow me around for 12 hours.
I welcome you.
I’ll try to help you understand what nurses
do, but I really would love to see us be able
to find a way to care for ourselves because
our problems are pretty unique in our environment
and our, our, our challenges are unique.
So that’s it.
I really hope that some of the recommendations
that Andrea had shared earlier can be like
a nurse’s, like a plan that you’re talking
about, a care plan.
I am running just a couple of minutes late
in our agenda, but I do want to close this
panel, which honestly, I could keep listening
to you for so long, I know that you have so
many stories and experiences that are very
But it, it, it, I don’t want to seem trite,
but I do want to end on some sort of a positive
note in terms of, when we started our panel,
we talked about what you love about the job,
and then we talked about the immense hardships
that you face every day.
And Krissha, you mentioned, you just have
to do it.
You just have to deliver the patient care.
You just do it.
You hug your colleague and you just keep going.
So I’m wondering, briefly, if everyone can
mention what is the one thing or what is a
thing that does keep you going, that can recharge
you reliably so you can continue to work.
And it’s in the spirit of the advice for Tracy.
You know, I would love to hear from all of
you, one thing that does that for you.
I see Krissha’s thinking, so I’ll leave her
for a moment.
Yeah, I’m going to be thinking.
It’s like a deep, dark dive.
Jennifer, would you like to start?
Sure, I can start.
I think one thing that keeps me going is that
when patients are at their most vulnerable,
when they’re sick and in distress, they need
someone to be there to be that calm, reliable
And even though sometimes we don’t feel that
way, we’re struggling too, and we’re working
with limited resources, but the patient still
needs someone to be there for them that can
help them navigate the system.
And at the end of the day, that’s our job.
We need to help people.
We want to help people.
That’s why we came into the profession, whether
as a doctor or nurse or any other healthcare
And that’s what we will continue to do.
And that keeps me going because no one else
can be that person for that patient in that
time, and it’s just an honour to be in that
I think when I spoke of what I love about
the profession, it’s still there.
All of what I spoke of is still there.
It’s not gone.
And so I only, it’s fracturing, but it’s not
gone and it’s still there and it’s still what
brings a lot of joy to all of our hearts,
that ability to be a team that comes together
and helps someone who’s in distress.
Who brings our incredible critical thinking
skills, our incredible scientific understanding,
our hands-on technical skills, when we can
do right by our patients, it’s a very glorious
And I think those still happen for sure, and
they’re still pretty rewarding moments.
I echo the same as Michele and Jennifer.
What keeps me going is a lot of coffee and
a lot of self-talk that like, you can do this,
you were put in this earth for a purpose.
And it’s true … what Michelle said.
It is a bit fractured.
cause now I see it in a different way now.
However, the only thing I can do is do right.
Do right by your patients, make your own difference.
And that’s what keeps me going.
I’m just like, I’m here to do my job.
I’m here to take care of this person … during
this shift, and that’s my responsibility.
And I will take care of them to the best of
And yeah, because I, there’s now for me, I
no longer have trust with the system.
I now, I’m not very, I don’t trust the system,
I don’t think it works for any of us or for
the patients and for their own health and
So I have a lot of, I’m quite cautious.
I’m always, it’s terrible now, because I’m,
I’m more like a, kind of like a cynic now
because I don’t trust it.
But it doesn’t mean that, it doesn’t always,
it’s not always negative, it’s always positive.
So what I always think about is my patients
being discharged, walking out of there and
being, like having done something to promote
their own health, and making a really — and
also I find that they’ve also spoken to us
and really understand like, you guys are really
short, you guys are super short-staffed.
And they understand and they give us, and
they’re, they empathize with us and they say,
“I’m so sorry.
I’m not going to try to call, but I just need
this one thing.” And I’m like, “It’s
You know, you need something, you need something.”
But they’re really, and I, and I appreciate
I really do.
And I also appreciate them not voting for
Doug Ford, but that’s usually how we do it
during campaign season.
And yeah, sharing a laugh with them.
I don’t know if you guys notice, I really
like to laugh and that’s one of my thing is
just making people laugh and making my patients
laugh and I, that’s what keeps me going, is
at least like during their time of need, I
can always at least try to make them laugh,
and put a positive spin on a negative situation.
Your patients are lucky to have you.
And I say that to you Krissha and to you Michelle,
and to you Jennifer.
And I want to echo the feelings that are coming
through the chat.
There are many hearts and many thank yous.
I wish I could say thank you in an even bigger
way, but just, I hope you can see in the chat
that people are so appreciative of the space,
of the stories you’ve shared, and that you
brought your whole selves to this conversation,
which I’m sure was not easy though.
So thank you very, very much for today.
And I would like to tell everybody who is
here, please take this opportunity to have
a very quick break.
It’s meant to be five minutes, but maybe we’ll
even shorten it to three minutes.
This is your time to grab a glass of water
if you need.
Also in the chat, I encourage everyone to
drop one word to just say how you’re feeling
at the end of that panel.
It would be really nice to connect or feel
that connection with everybody else who’s
How are you feeling?
How are you doing?
So we’ll be on a quick break and then we’ll
come back with another panel with healthcare
researchers on this topic.
Thank you very much.
And we’re coming back from the break.
Thank you so much to everybody who is keeping
the chat going.
I really enjoyed reading the comments, trying
to stay on top of them, but I’m so happy to
see how people are sharing what that last
panel felt like, to be a part of that conversation,
to be hearing the conversation.
A lot of feeling connected and recognized
and inspired and empowered.
So thank you everybody who is listening and
Now we are going to go to another panel this
time with researchers.
This panel is on risk and mitigating factors
of moral injury and moral distress and Canadian
healthcare providers during the pandemic.
So I’d like to introduce Mahée Gilbert-Ouimet
in Quebec, Michelle McCarron in Saskatchewan,
and Margaret McKinnon is coming back for this
panel as well.
So you three will be bringing your research
to this conversation, and I’ll go to each
one of you one at a time to describe your
research a little, and then we can open it
up for some conversation.
But first of all, I just want to know if anybody
has a quick reaction to what you heard in
the panel before the break.
I see Margaret nodding.
Maybe you would like to start.
Thank you, Hannah.
And you know, I don’t think we can say strongly
enough to our healthcare workers who spoke
today thank you for your courage.
We see reflected in the comments just how
much people are hearing, heard, recognized,
valued, and I think giving people words to
describe experiences are very powerful.
So hearing about moral injury, often people
say it helps me to realize I’m not alone,
that others are experiencing this, and we’re
hearing that in the chat today.
It also is a reflection of the incredible
service that nurses, physicians, occupational
therapists, environmental service workers,
admin assistants, everyone in the system has
I can tell you that during the pandemic when
people were talking about the utility closets,
that rang so true.
I was in a COVID unit for a day and a half,
and I actually sat in the utility closet while
people changed their masks to provide mental
healthcare because of the only time those
healthcare workers had to receive care.
So I just feel that we cannot thank you enough
to all of you in the audience and to our panelists
for sharing your stories and for your courage
and your sacrifices.
So thank you.
And Mahée or Michelle, would you like to
provide any reaction to what we just heard.
Well, like Margaret, I want to thank you for
speaking up, for being there with us today.
I am an epidemiologist.
I work on stress at work among various population,
but the project that I’m going to speak to
you about in the next minute was my first
experience with moral injury.
And what I was not planning to say was that
I cried a lot when I was reading after the
interviews that I performed.
It was really hard and it’s kind of coming
up when I hear you speak.
So it’s a very humbling experience.
I admire you and I want to thank you.
And I, I just want to really echo what Margaret
and Mahée said about thanking the panelists,
the healthcare providers, for sharing their
It’s really so powerful hearing these stories
from you in your own words and how this experience
has impacted you.
And I had the same experience when I did research
in this area, that it brought tears to my
Doing the interviews and then reading through
transcripts after, because just the amount
that people were impacted by their experiences
providing healthcare in those very trying
times, and the sustained impact it was having
on them, the cumulative impact, was really
Yet they kept showing up day after day and
still doing this and trying to provide the
best care possible for patients.
And I heard those same themes echoed amongst
the healthcare panelists today, that strong
commitment to caring for patients really,
really comes through.
So thank you for that.
And I would like to add that for the panelists,
I was saying that there’s almost no way to
verbalize how much gratitude you feel when
you hear the stories communicated.
So please know that these are the kinds of
things we think about later, as Mahée said,
part of your research, we, your stories really
And I’m sorry, I’m just going to do this now
because we’ve been talking for so long the
batteries have died, so I, as long as you
can still hear me.
I want to get right into the research that
all three of you are bringing to the panel.
Michelle, can we start with you?
If you want to briefly tell us about your
research and what types of stressors people
were describing to you in terms of their work
Thank you, Hannah.
And just before I get started, I do want to
acknowledge that I’m speaking to you from
Treaty 4 territory in Regina.
So my team and I did a qualitative study,
interview study, with healthcare providers
in the summer of 2021.
Wanting to learn more about their experiences
of providing healthcare during the pandemic
and the stressors that they were experiencing,
the workplace and the moral distress and experiences
of moral injury that arose from those.
So we conducted this study with 37 frontline
healthcare workers, whom we interviewed across
It was supported by an IDEaS grant from the
Department of National Defence, and we had
the opportunity to speak with people in a
variety of roles.
So nurses, doctors, people in various types
of therapist positions, hospital food service
workers — so really trying to get a broad
spectrum of frontline healthcare providers.
And we also spoke to people from across the
So we had a really good mix of rural, northern,
and urban healthcare providers and in a variety
of healthcare settings.
So in hospital, long-term care, or public
health, for example.
So we had representation from all of these
different parts of the province and people
and working in all sorts of roles.
Yet, there were a lot of types of workplace
stressors that people were bringing up to
us consistently when they were telling their
So some of these were preexisting the pandemic
and were exacerbated by the situations in
So things like increased overtime, the regular
communication barriers that can arise when
you’re working in a large healthcare organization,
and particularly when directives were changing
so rapidly, particularly in the early days
of COVID, the stressors that come with working
in a fast-paced very high-charge, high-stakes
environment, and not always agreeing with
some of the decisions being made by leadership
about the different directives that they had
So there were workplace stressors like that,
but there were also some workplace stressors
people described that were really novel for
them arising from the pandemic.
So things like staff redeployments to ensure
that coverage was in areas of greatest need.
Things that really they felt was impacting
the quality of the patient care that they
So reducing or temporarily shutting down entire
services, delaying surgeries.
So if they weren’t emergent, then they were
typically delayed in a lot of cases.
And people said that these might not be seen
on paper as urgent, but they still really
impact the quality of life of patients.
And having to hear how much they were suffering
because of these delays was really taking
a toll on them.
And then there were things like enforcing
visitor restrictions, and this is one that
came up over and over again.
And particularly, I was hearing lots of stories
from people who were working in long-term
care settings and they kept bringing up the
experiences of working there at Christmas
time in 2020.
So these interviews were conducted in the
summer of 2020.
And it was really heartbreaking for people
to have to keep residents from visiting with
their family members.
So they understood the logic behind the rules
that need to try to prevent the spread of
But people kept telling me that there’s that
physically protecting residents, but then
what about the psychosocial impacts, and the
impacts to their overall quality of life and
to their families?
And sometimes people wondered if the trade
off was worth it because they saw people suffering
in other ways so much.
So sometimes people would find some creative
workarounds for the rules and try to enforce
the spirit of the law, if not the letter of
the law, per se.
So there’s a story one time of someone that
said that they, they didn’t care if they were
going to get in trouble for this, but they
weren’t going to keep this family from seeing
So they had the family stand in the doorway
and the foyer.
So there was still the inner doors there.
They still had the resident physically distanced,
but they were at least able to speak to each
other and see each other.
If people dropped off packages at that time,
they were supposed to hold them for 24 hours
before delivering them.
Just in case — because again, not sure how
much could be transmitted from passing packages
So there was one person who said that, when
families dropped off packages on Christmas
Day, they weren’t going to withhold those
from residents on Christmas.
So they took sanitary wipes, wiped the packages
down thoroughly, and delivered them.
So trying to find those compromises.
There were these stories, these examples of
people who were experiencing these moral dilemmas
about do I do what I feel is really right
for my patients and residents versus do I
follow the directives to the letter?
And people were really struggling with what
that brought up for them and wrestling with
those types of decisions.
So that, that was a really big overarching
So maybe I’ll just stop it there for now so
I can let other people have a chance to speak,
but I’m sure we’ll come back to this at some
Thank you Michelle.
And I would like to go to Mahée because you
also did research on moral injury based on
interviews with healthcare workers in Quebec.
Were you hearing a lot of the same types of
stories, or can you tell us about the stressors
that healthcare workers were describing to
Thank you Hannah.
And thank you Michelle.
Yes, there are definitely overlaps between
what we shared, what we observed in our research,
so a little context for you to understand
what my team and I did.
So we led a research project among 572 frontline
healthcare workers during the third wave of
the pandemic, so also during the summer of
The project was also funded by the Ministry
of Defence of Canada.
Participants, there were two phases of the
So participants first completed a quantitative
questionnaire, mainly focusing on psychosocial
stressors at work and mental health problems,
including moral injury and a subgroup of them
then were invited to be involved in qualitative
interviews to get a deeper understanding of
the events and emotions that led to moral
So in the quantitative component of the study,
the stressor that I really want to speak about
today is the stressor that had the highest
adverse association with moral injury.
It was the lack of ethical culture in the
It’s not surprising in our sample participants
working in a setting lacking ethical culture
had five times more risk of moral injury compared
to workers benefiting from a strong or adequate
ethical culture at work.
So you might wonder what are we calling a
lack of ethical culture?
So we asked a series of questions like, in
general, unethical situations that arise at
work or not discussed transparently with those
We also asked in general, analytical situation
that arise at work are not constructively
presented and openly discussed with the rest
of the workplace.
So we spoke about debriefing, the importance
of the debriefing with the team.
So in qualitative interviews, to give you
an example of a verbatim a participant reported,
“If I think about the profession that
I’m doing, a value that they told us so much
about during our university studies was that
if you are doing something, do it right, do
it neutral, but do not harm.
By obeying the directives, I consider myself
doing harm.” So it kind of resonates
with what we heard before the pause.
So this testimony was aligned with other events
that were reported by participants.
Events involved being unable to provide appropriate
care, even basic one, because of lack of resources.
We were also told about the inability to apply
security measures and directives related to
COVID-19, being unable to ensure your own
security, but also patients’ safety and not
being adequately supervised.
And this was reported a lot when speaking
about movements from units to units and having
to sometimes switch specialty and not being
So these events were linked to a moral injury
through emotions like frustration, anger,
guilt, shame, helplessness, feelings of worthlessness,
isolation, or deconsolidation of the work,
collective feeling of injustice and betrayal,
like Margaret spoke about feeling of incompetence,
sadness, and also sometimes loss of meaning.
So I’m going to finish my short intervention
about the values that were reported as hurt.
They reported that professionalism was hurt,
patient and self safety, compassion, kindness,
So I’m finishing this little testimony by
reiterating the importance of ethical culture,
at least in our research project.
Thank you so much for that Mahée and for
describing what an ethical culture looks like,
which it, it sounds like a lot of communication
and understanding— like recognizing the
humanity of the people who do the jobs that
we need done.
Margaret, I would like to turn to you now.
Earlier when you were speaking with us, we
talked about moral injury, what it meant,
what an injury meant.
I would like to talk about the, or have you
talk about the neuroscience around trauma.
Can you describe what effect moral injury
has on our brains?
Yeah, I certainly can.
And Hannah, if you don’t mind, I’m just going
to follow up a little bit of what we said
already and then turn to that question if
I think what we’ve heard from Mahée and Michelle
is very much what we also heard across the
We conducted 134 qualitative interviews and
heard very similar themes, which I think speaks
to … those experiences that buying Canadian
healthcare workers together.
And we know that one of the most protective
factors against the development of post-traumatic
stress disorder in the face of situations
like this is social support.
So being able to speak to one another, to
hear one another’s stories, to provide empathy
and caring and support.
And so I think part of what our job is in
the Canadian healthcare system right now,
is to recognize the organizational and systemic
factors that are impacted upon healthcare
workers and to provide the supports to bring
the system back together again to bring the
family back together again, essentially.
We’ve done similar interviews in public safety
personnel, which we’ll be holding another
symposium on later in the year to talk about.
But I also want to say that when we looked
at what are the factors that are driving departures
from the healthcare workforce right now, and
we heard a lot about that from Michele, from
Krissha, and also from Jennifer, we found
that moral distress is what’s driving the
decision of one in two healthcare workers
who are currently considering leaving their
clinical positions in Canada.
And so when we look at the number one factor
that’s driving that, it is the moral distress
in the situations like Mahée and Michelle
And so I think when we think about the peril
that our healthcare system is currently in
due to healthcare shortages due to rapid staff
departures and so on, we really do need to
target, to know about these experiences with
the moral distress to address the organizational
and systemic factors that underlie some of
this, and to provide the individual level
supports to healthcare workers and all healthcare
Be that food services workers, occupational
therapists, nurses, physicians, everyone in
the system who’s providing this service.
And the simple value of saying thank you,
I think cannot be underestimated.
I have been in basements of hospitals saying
thank you, and to see the look on people’s
faces when they hear, thank you for your service,
because this is service and your sacrifice.
And to say thank you, those simple words are
And I think the more we say it, the better.
So we want to say it again publicly here today.
When we talk about the neuroscience of trauma,
we certainly know that there’s a saying in
trauma that the body keeps the score.
And so among people who have experienced trauma,
for example, we see higher rates of heart
disease, obesity, diabetes, and other forms
of cardiovascular risk factors.
We also see changes in brain functioning and
And so we can see pat differences in the patterns
of the way that the brain works together in
And we can also see what’s called essentially
a loss of some of the tissue in the brain
with repetitive stress or even a single trauma
in some cases.
And so what we do with all the work that we
do is focused on helping to to help with some
of the impacts of those changes in the body
and in the brain.
With moral injury, in work that we’ve done
led by Ruth Lanius at the University of Western
Ontario, and with some graduate students that
we co-supervised and postdoctoral fellows,
Chantal Lloyd and Braden Tripo, we actually
had military members and public safety personnel
who had PTSD recall events that were associated
with moral injury for them.
So that could be, for example, being in the
combat theatre and seeing a baby going down
the river and being powerless to intervene.
That’s a description, that’s an apt description.
Or being a first responder who is not able
to go into a lake to save the person because
the rules of engagements say that they can’t.
And people talk about these moral injuries
and the consequences for their lives, just
like we hear here with healthcare workers.
And what we found is that when these public
service personnel and military members recalled
these events, we saw areas of the brain involved
in disgust light up.
They were active.
So that feeling in your stomach, like you’ve
been punched in the gut, that [part of] the
brain which is called the insula, and that
region was very, very active when these memories
We also saw that areas of the brain, so one
is the dorsal, it’s called the dorsal anterior
cingulate, [which is] sort of the middle of
the brain, that’s associated with shame and
And that brain region, again, was very, very
And the brain was trying to compensate for
So the frontal part of the brain, which really
helps to regulate our emotions, it was trying
to dampen down those feelings of disgust,
the shame and the guilt, the feeling of moral
The brain was working overtime to try to dampen
that down in a protective way.
And so what I would say these stories tell
us is they tell us the impact of trauma and
situations like moral injury on the brain.
This is an injury like all other injuries,
and there’s so much shame and guilt that surveils
But here we see the changes to the brain that
occur and we can show it in a picture.
This is what’s happening.
So I think that helps to again, explain the
experience and what happens in the brain makes
complete sense in terms of people feel like
they’ve had a punch in the gut.
And this lingers after the incident itself.
These are scans that could be taken four,
five, 10, 15 years later, and we’re still
seeing that punch to the gut in the brain.
What I love about neuroscience and the work
that you do, Margaret, is that when you see
that injury and the evidence of it, I hope
that it does take the onus off of individuals
who are thinking, why can’t I cope?
In fact, you are wired in a way.
We are all wired in ways to react to these
situations and it’s partially why your work
is so important.
In the few minutes we have left, I would like
to ask this whole panel about what you would
like to see workplaces do in order to lessen
the impact of moral distress on healthcare
If we have heard from Michelle that moral
distress is a part of the job for nurses right
now, what can workplaces do to lessen the
And I would also like to ask about what you
are seeing in terms of hope for how workplaces
So we’ll just start, we’re going to cram a
lot into the last five minutes, okay everyone?
So I would just like to start with what you
would like to see workplaces doing.
Maybe Michelle, would you like to begin?
Well, I do want to say that I think it’s encouraging
that workplaces are having this discussion
So we would see, for example, in internal
newsletters that would come out, that they
would be advertising the mental health support
line for staff telling people what sort of
resources were available for mental health
supports and including kind of mental wellness
Now that’s where it sometimes kind of fell
flat for people that I spoke with in the interviews.
And that’s where I think we could maybe do
a better job of increasing supports for people,
is engaging the frontline healthcare workers
and determining what types of mental health
supports are going to be most meaningful for
So I would have people telling me that it’s
all very well and good to provide tips on
healthy sleep hygiene, but if they’re working
so many hours and then have family to take
care of that they don’t have the number of
hours in a day to be able to sleep like that,
then they’re not able to implement those types
So really engaging the frontline healthcare
workers in helping to come up with the solutions
for what is going to support them best in
Mahée, would you like to add to that?
Thank you, Michelle.
Thank you so much.
As a result of our research project, we formulated
recommendations and I’m going to place them
on the chat because I know that we are tight
on schedule, so I’m not sure that everybody
could see them, but maybe you can oppose them.
So, our recommendations are not one size fits
all recipe, but they aim to heal the working
So we are not into coping mechanism.
We really want to focus on the working environment
and on building a climate of kindness and
of psychosocial safety.
They are grouped into different categories,
and I’m going to just give you a few examples
First category is training.
So we really think it’s important to train
the leaders to detect the first signs of the
stress or of moral challenges in their employees
and to actively listen and support.
Second key is communicating.
So opening the gate of open, frequent empathetic
and leader-led team discussions to build awareness
and prepare for the situations that might
or that will come up.
Like Michelle says, having all levels of worker
participating in the intervention efforts
is crucial, and I’m going to end with prioritizing,
prioritizing mental health.
There are not a lot of resources in the healthcare,
but we cannot keep on pushing back.
This is a priority among the other priorities.
So that’s it for me for now.
Mahée, thank you so much.
I think you said that you had dropped the
link in the chat, but I don’t see it.
So maybe if you want to try that again in
the last few minutes or as well, I’m hoping
that Sangita can drop the link to the Healthcare
Salute website and socials and so afterwards,
I hope that everyone here can follow up for
further connection there.
Margaret, can I end with you in, in terms
of where you see hope, for how workplaces
are changing and incorporating these discussions
in the workplace?
And so we asked healthcare records in the
interview, what is it that you need?
What would help you?
And many of these healthcare workers said
we want people to know our stories.
We want people to hear, we don’t want to have
to keep retelling them.
And when we go for mental health supports,
for example, that the person at the end of
the line isn’t crying when they hear our story.
And that often happens for public safety personnel
and military members.
They tell their stories to a mental health
professional and they end up comforting the
mental health professional.
And that’s difficult, right?
So we’ve been really fortunate to have funding
from the Public Health Agency of Canada, a
donation from Homewood Health, Centre of Excellence
on PTSD, and the Canadian Institutes of Health
Research, which is really hopeful, to see
all these agencies supporting this to develop
cultural competency or cultural sensitivity
around the experiences of healthcare workers.
And so, the courage we saw here today of healthcare
workers who told their stories and continuing
work to really get that knowledge out to the
public, to leaders, to policy makers, and
to others, we really have the opportunity
to provide supports that are culturally competent
and what people need and what they’re asking
for, and so that they don’t have to retell
their stories over and over again.
Well, thank you so much Margaret, and thank
you Mahée and Michelle.
And you know, I can see in the chat that there’s
a lot of reaction to the research and the
information that you’ve shared, and I also
just want to thank every participant who has
presented or spoken today, and especially
to the hundreds of people who showed up from
across the country to come and listen and
learn and to participate in the chat as well.
So Mahée, I think you said this is a priority
I couldn’t agree more, and I hope that everybody
here has gotten something out of the symposium
and that you can stay connected as well.
So there was a wellness slide earlier with
some mental health resources.
I hope that that can be shared again here.
And I just want to wish everybody a good day
and thank you so much for taking part.
And thank you to all of you for your service.
We salute you.
Dr. Margaret McKinnon, Homewood Chair in Mental Health and Trauma; Professor, McMaster University
Dr. Margaret McKinnon is Full Professor and Associate Chair, Research in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, where she holds the Homewood Chair in Mental Health and Trauma. She is also the Research Lead for Mental Health and Addictions at St. Joseph’s Healthcare Hamilton and a Senior Scientist at Homewood Research Institute.
Work in Margaret’s unit focuses on identifying the neural and behavioural correlates of PTSD and trauma-related illnesses and on translating this knowledge to the development and testing of novel treatment interventions aimed at reducing the cognitive and affective sequelae of these conditions.
A licensed clinical psychologist and clinical neuropsychologist, Margaret has a special interest in military, veteran, and public safety populations (including healthcare providers), and has worked with these groups clinically and in her research program. She has published or in press nearly 150 scientific works.
Under Margaret’s leadership, the Trauma & Recovery Research Unit is supported by federal and provincial funding from the Public Health Agency of Canada, Canadian Institutes of Health Research, the Canadian Institute for Military and Veterans Health Research, Veterans Affairs Canada, Defence Canada, the PTSD Centre of Excellence, MITACS, and the Workers Safety Insurance Board of Ontario; by a generous donation to Homewood Research Institute from Homewood Health Inc.; and by generous gifts from private foundations including True Patriot Love, the Cowan Foundation, the Military Casualty Support Foundation, the FDC Foundation, and the AllOne Foundation.
Margaret is a frequent commentator in the media on matters related to PTSD, moral injury, and the impact of trauma on special populations.
Dr. Mahée Gilbert-Ouimet, Associate Professor, Université du Québec à Rimouski
Dr. Mahée Gilbert-Ouimet is associate professor in Population Health at the Université du Québec à Rimouski. She also holds the Canada Research Chair in Sex and Gender in Occupational Health. Dr. Gilbert-Ouimet received her PhD in epidemiology from Laval University. She also performed a first postdoctoral fellowship in epidemiology at the Institute for Work & Health and a second postdoctoral fellowship in health economics at the Université du Québec à Montréal.
Dr. Gilbert-Ouimet research mainly focuses on the adverse effects of psychosocial stressors at work on the incidence of chronic health problems, and on how to conduct intervention studies aimed at reducing these stressors. Dr. Gilbert-Ouimet has published 45 peer-reviewed articles and realized over a hundred knowledge transfer activities. In the context of the COVID-19 pandemic, she recently issued preliminary guidelines aiming to prevent and manage moral injuries in Canadian frontline healthcare workers. She also authored a Guide of organizational practices favourable to health that is now distributed by the Quebec Ministry of Health and Social Services to all health establishments of the province of Quebec. Dr. Gilbert-Ouimet is also actively involved in developing methods and recommendations aiming to improve sex and gender considerations in health research.
Dr. Michelle McCarron, Research Scientist, Saskatchewan Health Authority
Dr. Michelle McCarron is a Research Scientist with the Saskatchewan Health Authority (SHA). She is also an Adjunct Professor in the Faculty of Graduate Studies and Research at the University of Regina, where she is a Sessional Lecturer with the Department of Psychology. Dr. McCarron is a member of the Saskatchewan Centre for Patient-Oriented Research (SCPOR) Affiliated Researcher Alliance and the Canadian Institute for Public Safety Research and Treatment (CIPSRT) Academic, Researcher, and Clinician (ARC) Network.
Michelle holds a Ph.D. in Experimental and Applied Psychology from the University of Regina. From 2012-2017, she was the Chair of the Research Ethics Board (REB) for the Regina Qu’Appelle Health Region and now serves as the Vice Chair of the SHA REB. Her primary areas of research interest include frontline healthcare worker and Public Safety Personnel (PSP) mental health, evidence-informed decision-making within healthcare and PSP organizations, and research and professional ethics.
Dr. McCarron was the Principal Applicant on a study funded by the Department of National Defence Innovation for Defence Excellence and Security (IDEaS) program, titled “Operationalizing the Concept of Moral Injury within Canadian Frontline Healthcare Workers” and is the Nominated Principal Applicant on a CIHR-funded Mental Wellness in PSP project developing and pilot testing an online “Research 101” course promoting scientific literacy among PSP leadership to support evidence-informed decision-making in the provision of mental health care for frontline PSP.
Krissha Fortuna, RPN
Krissha Fortuna is a registered practical nurse who works in long-term care in Ontario.
Michelle Johnson, RN
Michelle Johnson is a registered nurse who works in Ontario.
Dr. Jennifer Kwan, Family Doctor
Dr. Jennifer Kwan tweets from @jkwan_md. Throughout the pandemic’s first many waves, she posted important, accessible data about #COVID19Ontario transmission to her Twitter feed. Dr. Kwan is a cofounder of the Masks4Canada volunteer group and the Doctors for Justice in Long-Term Care (Docs4LTCJustice) campaign.
She is a family doctor who practices in Ontario.
Dr. Andrea Brown, Research Associate, Trauma & Recovery Research Unit, McMaster University
Dr. Andrea Brown obtained her PhD in Applied Social Psychology from the University of Guelph. In addition to her work in the Trauma and Recovery Research Unit, Dr. Brown has conducted applied research and program evaluation for not-for-profit organizations, regional government, the Department of National Defence, academe, and industry.
Since 2015, Dr. Brown’s focus has been on mental health and addictions research and evaluation, with a specialty on military sexual trauma (MST) and post-traumatic stress disorder. She is also the Co-Director of the MiNDS Network for MST and the Director of Knowledge Exchange for the Canadian MST Community of Practice.
In addition to this, Dr. Brown is currently completing a Masters in Psychotherapy at McMaster University.
Yuanxin Xue, Research Assistant, McMaster University
Yuanxin Xue is a medical student at the University of Toronto. He completed his Bachelor of Health Sciences and MSc in Global Health at McMaster University. Yuanxin’s current research focuses on various facets of mental health, perioperative medicine, as well as the intersections between these fields. He currently works as a Research Assistant at the Trauma & Recovery Research Unit.
Hannah Sung, Co-founder, Media Girlfriends
Hannah Sung is a co-founder of Media Girlfriends. Her previous work includes producing award-winning podcasts for The Globe and Mail and the Globe Content Studio, including Colour Code, a podcast about race in Canada, and Stress Test, a podcast about personal finance in the pandemic. She executive produced award-winning podcasts at TVO and The Walrus Lab on social issues, politics, and current affairs. In 2020, she was the Asper Fellow at the University of Western Ontario’s Faculty of Information and Media Studies, where she led a post-graduate journalism class in narrative podcasting.
Hannah began her career in music television at MuchMusic, where she was the host of shows including MuchNews and the live red carpet at the MuchMusic Video Awards.
With gratitude to McMaster University Faculty of Health Sciences: Continuing Professional Development for broadcasting this event’s video feed.