The COVID-19 pandemic has resulted in unprecedented and often devastating new circumstances for healthcare providers (HCPs), leading to an increased need for mental health prevention and early interventions efforts to support this critical workforce.
This one-hour event features:
- A research presentation about how healthcare providers are coping with the stresses of COVID-19
- A qualitative analysis of healthcare providers’ experiences of the pandemic
- A panel discussion with mental health researchers who are studying the pandemic’s effects on providers
During this event, we discuss examples of moral distress, moral injury, and other challenges in the work life and home life of healthcare providers during the COVID-19 pandemic. Some moments may be disturbing for you. It’s fine if you wish to stop watching at any point.
If you require wellness support, we encourage you to follow this link.
Hello everyone. Hi there. Thanks for making
it into this room. I know we had a little
bit of technical difficulties, but everyone
who made it, I’m so glad you’re here. My name
is Amy Van Es and I’ll be your host and moderator
for this session.
I’d 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 one
spoon to represent that the people are to
share the resources of the land and only take
what they need.
We seek a new relationship with the original
peoples of this land, one based in honour
and deep respect. May we be guided by love
and right action as we transform our personal
and institutional relationships with our Indigenous
friends and neighbours.
It is in the same spirit that I welcome all
of you to our third of three town halls. Today’s
event is focused on self-care and self-compassion
for healthcare providers to cope with the
occupational stress during the pandemic.
This event is supported by the Public Health
Agency of Canada as part of their work to
address P T S D and trauma in those most affected
In this town hall, we may discuss healthcare
providers who have experienced challenges
in their work and home life during the pandemic.
There could be moments that are disturbing
to you, and it’s totally fine if you wish
to excuse yourself from this event at any
Additionally, if you require wellness support,
there are a number of wonderful organizations
ready to help. You can learn more about each
from the links in the chat.
Over the past two and a half years, we’ve
heard so much about the strain on the healthcare
system and on healthcare providers due to
the pandemic, and we owe a debt of gratitude
to all the physicians, nurses, therapists,
personal support workers, and public safety
personnel who, despite facing incredible challenges
in their daily work lives, still found the
time and courage to talk to us and share their
This research project aims to shine a light
on the impact that the pandemic has had on
the mental health of all those healthcare
providers who have given so much of themselves
to the service of others and continue to do
so. The evidence-based resources and tools
we’re offering to help build mental health
literacy, support and resiliency are our health,
healthcare salute: our way of saying thank
you so much for your service.
One more thing. Before we get into the meat
and potatoes of today’s topic, I wanted to
let you know that there will be time for our
experts to answer your questions towards the
end of the hour. So to submit questions you
can use the q and a function that’s at the
bottom of your screen, and they’ll show up
on my end of things when it comes time for
the panel discussion.
We’ve also just posted a code of conduct in
the chat, so please, let’s all work together
to ensure this remains a safe space for sharing
and learning for everyone.
So to begin our program today, we’re going
to watch a pre-recorded presentation by Mauda
Karram, who will join us live today as well.
In the talk, she’ll be diving into some findings
from her recent research about self-care and
self-compassion for healthcare providers during
Mauda is a clinical research assistant in
the Trauma and Recovery Research Unit at McMaster
University. She completed her undergraduate
degree at McMaster in the psychology, neuroscience
and behavior program with a mental health
specialization and a minor in theatre and
film studies. Currently, she’s the project
coordinator of this ongoing Canada-wide project
on moral injury.
Thank you so much Mauda, for sharing — or
for contributing to the conversation today.
And let’s take a peek at the recording.
Hello everyone. We’d like to thank you all
for being here today. My name is Mauda Karram,
and on behalf of the Trauma and Recovery Research
Unit at McMaster University, I’d like to share
some of our research findings with you on
healthcare providers, self-care and self-compassion
during the COVID-19 pandemic.
During the COVID-19 pandemic healthcare providers
have endured prolonged periods of heightened
stress as well as exposure to potentially
traumatic events. In times of distress, uncertainty,
[and] increased workloads, we want to know
how healthcare providers have cared for themselves
and their mental health during the COVID-19
We conducted a research study out of the Trauma
and Recovery Research Unit at McMaster University,
where we invited healthcare providers from
across Canada to share with us their experiences
during the COVID-19 pandemic. This study had
both an interview portion and a survey portion
where we collected myriad data, some of which
we’d like to share with you today.
Today we’re going to take a deeper look into
how healthcare providers have coped with stress
during the pandemic, and whether healthcare
providers have demonstrated self-compassion
With the interview portion of our study, we
were able to hear firsthand the experiences
of healthcare providers during the COVID-19
pandemic. Healthcare providers were asked
a series of questions related to various mental
health challenges and impacts they’ve encountered.
Today, we hope to magnify the perspectives
of healthcare providers when asked the following
question: “Some people use various types
of coping strategies when they’re experiencing
stressful situations. Have you used any particular
strategies to help you cope?”
Here we have the data from 48 out of the 51
participants who provided demographic information.
As illustrated by the data here, participants
were mainly female respiratory therapists
residing in Ontario. Results from our study
revealed two overarching themes each with
I’ll begin with our first theme here, shifting
approaches to coping.
So overall, from what we’ve heard from healthcare
providers, there seems to have been a constant
shift in how healthcare providers approach
their choices of coping strategies. As we
will talk about in the second theme, these
approaches were often influenced by changing
barriers and differing waves of the pandemic.
Ultimately, healthcare providers navigated
their way through coping with the challenges
they faced on a day-to-day basis, in an attempt
to find out what works best for them and their
own mental health.
in this quote, this healthcare provider had
initially turned to the use of alcohol as
a coping strategy, but decided to seek professional
advice and ultimately turn to meditation and
a useful sleep routine.
On the one hand, healthcare providers describe
this feeling of being able to make an intentional
effort to cope and improve their mental health
in a way that they perceive to be healthy,
positive, and effective in reducing stress,
both short term and long term.
This healthcare provider spoke about strategies
such as yoga, therapy and meditation, where
they describe them as methods for self care,
ultimately creating a positive impact on the
individual’s life where they describe these
behaviours they will carry on past the pandemic.
Towards the other side of these approaches
to decision making, some healthcare providers
sought out coping strategies that were lower
effort and easily accessible, often due to
the lack of bandwidth or capacity to make
an intentional effort. Importantly, healthcare
providers describe these strategies as negative
or unhealthy, yet continued to use them as
they still provided that desired result of
distraction, relaxation, numbing out physical
and emotional stress, and avoiding having
to process their emotions.
Examples from this quote here included alcohol
use and binge eating viewed as a temporary
solution, ultimately creating these feelings
Onto the second overarching theme from the
experiences shared by healthcare providers,
many described a range of barriers that impeded
upon their usual ways of coping to manage
First, we have pandemic-related restrictions
where healthcare providers reported an inability
to access their usual or desired coping strategies
due to government-level policies that were
put in place that apply to everybody. This
included various closures and limits on social
gatherings, as illustrated by these quotes.
Healthcare providers would describe these
strategies as being not allowed or that they
can’t do what they normally would do to support
their mental health.
And then we have these circumstantial barriers
where various circumstances of the individual
influence their ability to engage coping strategies
to reduce stress. These circumstances were
specific to the healthcare provider and their
own individual experiences, and included various
barriers such as seasonal changes, exhaustion,
lack of motivation, and a key aspect of perceived
impacts on family and friend relationships.
Here, there were a few factors at play where
healthcare providers described that they would
refrain from seeking social support from family
and friends as they were fearful of traumatizing
them with their experiences, feeling like
a burden to their loved ones, that their loved
ones wouldn’t truly understand, and that oftentimes
they wouldn’t want to engage in conversations
about political views on vaccines and masks.
So now we’d like to turn our attention to
the topic of self-compassion, what it means
to be self-compassionate, and how we can measure
self-compassion in individuals.
Self-compassion is demonstrated through behaviours
and thoughts one has towards themselves.
It is when one is open and moved by their
own suffering, caring, kind, understanding,
and non-judgemental to themselves and their
inadequacies, and recognize their own experiences
as part of the common human experience.
So by looking at self-compassionate behaviors,
we can understand one’s responses to pain
and failure, one’s predicament, and how one
pays attention to their own suffering.
Here we have some quotes from healthcare providers
in our study where they’ve touched on various
aspects of self-compassion in ways in which
we will discuss shortly. As highlighted In
blue, we see phrases such as “We’re all
going through the same thing”; “It’s
hard to ask for help when you feel that maybe
someone else or there are other people that
are more deserving of the help”; “I
try to have compassion about the situation”;
and words such as “permission” and
There are essentially two ends to each measure
of self-compassion, according to Kristin Neff,
whom is an expert in the field of compassion
Here we have a positive poll where behaviors
are compassionate and a negative poll where
behaviors are unpassionate.
In this first column, we have self-kindness
and self-judgment. Self kindness refers to
the gentle and understanding attitude towards
oneself and expressing unconditional acceptance
towards oneself. Self-judgment on the other
hand, refers to the harsh judgment of oneself
for shortcomings. In the second column, common
humanity speaks to the notion that all humans
fail or make mistakes, and no one person can
lead a perfect life.
On the other hand, isolation is when one feels
isolated by their imperfections, as if they
are the only one who failed or is suffering.
In the final column, mindfulness is being
aware of one’s suffering experience in the
moment and seeing it with clarity, on the
other hand, over-identified as having an exaggerated
storyline of the negative aspects of self.
Today we’d like to share the results from
this self-compassion questionnaire from healthcare
providers across Canada who participated in
So 426 participants completed the self-compassion
scale In the survey portion of our study.
Of note, participants were mainly female nurses
residing in Ontario.
So healthcare providers scored similarly on
scales aimed to measure self-compassion as
scales aimed to measure negative self-compassion,
and this was similar across all professions.
The overall results indicate moderate levels
Further, looking at how self-compassion scores
compared with other measures in our study,
preliminary findings reveal a potential relationship
between self-compassion and resiliency and
self-compassion and emotion regulation. Specifically,
data show a significant positive correlation
between self-compassion and resiliency. So
here where participants scored higher on self-compassion,
they also scored higher on resiliency.
Also, data showed a significant negative correlation
between self-compassion and difficulties in
emotion regulation, where participants who
scored higher on self-compassion scale also
scored lower on the difficulties in emotion
So overall and in summary today, healthcare
providers have struggled to engage in usual
coping strategies due to various COVID-19–related
barriers, and we saw here that healthcare
providers fluctuated between an intentional
effort and a quick-fix decision influenced
by various factors including closures, circumstantial
barriers, and differing weights of the pandemic.
So we see here that there is an urgent need
to develop supports and resources for healthcare
providers to cope with occupational stress
and the unique psychological burden of the
COVID-19 pandemic to improve mental health
outcomes. And we also saw what these moderate
self-compassion scores, that they point to
the necessity to understand how we can support
healthcare providers by not only providing
coping tools, but addressing various factors
impacting mental health and the ability to
seek coping strategies.
Thank you all so much for being here today
and allowing me to share with you some of
our important findings from our research.
These were our references for today,
and we’d like to also thank our collaborators
Thank you so much for sharing your research.
Mauda. You know, it’s clear that there’s a
real need for resources to be developed to
help health healthcare providers who have
just like given, given, and given once more
to cope with their work during the pandemic.
So let’s develop some ideas right here. I’d
like to invite a few more people to the table
to continue this discussion and get into the
nitty gritty of how to integrate self-compassion
into our lives.
So welcome to this digital room, Kim Ritchie,
Hugo Schielke, Margaret McKinnon, and Mauda
Karram. I see you all coming in.
Ah, hello. Hi folks. Okay, so we’ve already
met Mauda, but for the rest of you, I was
hoping you could each take a moment to introduce
yourselves and tell us a bit about your role
as it relates to our topic today. Margaret,
do you mind if we start with you?
Thank you so much Amy. So my name is Margaret
I’m the Homewood chair in mental health and
trauma, and I’m also a professor in the Department
of Psychiatry and Behavioural Neurosciences
at McMaster. My trade, as we say in the military
work we do, is I’m a clinical psychologist
and clinical neuropsychologist. And I have
had the privilege of serving on the front
lines of the pandemic, so spending times,
time rather, in the hospitals providing supports
to staff on COVID units and ICU units.
Thank you, Margaret. And what about you, Hugo?
Hello everyone. My name is Hugo Schielke.
I’m the trauma services development lead for
Homewood Health. Also a clinical psychologist
specialized in helping people with trauma
dissociative disorders. And I guess my relationship
to this topic is that without self-compassion,
you really aren’t able to allow yourself to
give yourself the care you need.
And so that, that’s what we’ll be talking
Thank you, Hugo. And Kim, would you like to
Hi everyone. My name’s Kim Ritchie and I’m
an assistant professor at Trent University,
and I also hold an adjunct position in at
McMaster University in the Department of Psychiatry
and Behavioural Neurosciences.
With this lab, I’m also — my background
is I’m a registered nurse, and primarily in
Thank you Kim, and welcome everyone again.
Do Hugo, I’d love to start with you, and I’d
really love to start by grounding us, all
in this room, in a shared understanding of
the topic we’re going to talk about today.
So my big question, and I think probably a
question for the audience is, is there a difference
between self-compassion and self-care?
That is such a good question. And the short
answer is yes. The longer answer is that,
again, I guess in some ways I already spoke
to this, that it is very, very, very difficult
to give yourself the care you need if you
aren’t being fair and gentle and kind and
compassionate with yourself.
And so each of those words is different ways
of saying compassionate, right? So being fair
is another way of being compassionate, right?
So making sure you’re not judging yourself
overly harshly, which is what we tend to do
in this culture and these cultures. We’ve
learned that to make changes, we need to judge
ourselves harshly when in fact the opposite
is true when you look at the research.
And so lots more I can say about this, but
the short answer to your question is, yes,
so self-care is giving yourself the care you
need, and what allows us to do that is to
relate to ourselves in a compassionate way,
right? To be gentle with ourselves, to be
interested in what’s going on, to validate
what’s valid, and have an easy manner with
ourselves and encouraging ourselves to give
ourselves that care when we need it.
Okay. Wonderful. So self-compassion, the compassion
is like the feeling and the desire to treat
yourself, and the self-care are the actions
that you take. Would that be right?
Okay, great, thank you.
We think of it as like the how and the what,
right? So self-compassion is how you relate
yourself, and then self-care is what you do
to take care of yourself.
Excellent, excellent. Okay. Thank you.
Mauda, I’d love to know — thank you so much
again for sharing your research — I’d love
to know what the most sort of surprising or
insightful outcome of that research was for
Yeah. Thank you, Amy. I think, you know, ultimately
having the privilege of listening to healthcare
providers experiences and being that point
of contact between what’s happening on the
front lines and how we can play a role in
helping, I think that’s all kind of been truly
Most specifically, I guess what resonated
with me was that for healthcare providers
who turned to those quick fix strategies that
I talked about in the presentation that were
perceived to be unhealthy or that those who
struggled to cope to reduce their stress,
it wasn’t necessarily that perhaps healthcare
providers didn’t want to cope or didn’t want
to put in that additional effort to support
their mental health.
Because many healthcare providers expressed
the desire to cope and even mentioned that
if they had perhaps had more benefits or more
bandwidth, that some desired strategies would’ve
been more accessible. And although it may
not seem like this at first glance, speaking
on behalf of the research point of view, it
allows us to see and hear from healthcare
providers what they need to cope, so that
we can find ways to help reduce that burden
of having to use rest time and extra energy
to scramble seeking what’s available. And
you know, you’ll hear some of these strategies
today from us, to combat these barriers and
ease the process of self-care and coping so
that it isn’t this unachievable for healthcare
providers to be able to care for themselves
and their mental health.
Yeah, wonderful. Thank you, thank you for
saying that. That kind of segues perfectly
into my next question, which is, in that presentation
we learned about these quick fixes, right?
The examples that were shared were alcohol,
binge eating — because they provide that
desired stress relief in the small amount
of time that we know healthcare providers
have to focus on themselves.
So Hugo, I’m wondering, these quick fixes
strategies also mentioned sort of end up in
a residual feeling of guilt. So my question
is, how can healthcare providers begin to
work past that guilt?
Such a good and really important question,
right? So if we look at, maybe part of it
is, the way I think about this is that self-understanding
enables self-compassion, which then enables
compassionate action, right?
So it’s actually three steps. Sometimes people
think, I just need to do this thing. But to
get there is actually lots of steps and easiest
broken down into three. And so how do they
get past that guilt, towards that compassion
action? So the first part is a fair self-understanding.
That it makes so much sense that when you’re
overwhelmed, you reach to the things that
you know of helped even a little bit, even
just for a short period of time, because at
least it’s some form of relief.
So it’s about having, again, a fair relationship
with yourself, not shaming yourself for doing
the best you know how so far, right? And then
the next piece is knowing that it is also
really hard to change how you give yourself
the care you need and from a quick fix to
something that is something that helps for
a longer period of time, but might take longer
to help you to get into that routine of doing
And also for, to feel those effects, right?
So it’s knowing that you have to give up something
to work towards something. And that also means
number one, knowing what those other things
are. Two, trusting that they’ll work enough
to want to practice them. Then three, practicing
them, usually when you don’t need them, so
that you’re more able to do it when you really
need to rely on that skill.
And then it’s really during those times when
you’re really struggling, again, being gentle
with yourself. It’s sometimes I think about
this as like giving yourself the care you
need, and there’s an acronym. One part I borrow
from D.B.T., one part developed to help trauma
patients. So the first letter is “G”:
so to give yourself the care you need. So
“G,” being gentle with yourself,
is all the how. Gentle with yourself.
“I” is interested in why you might
be feeling this way and what you might be
missing, right? Or what might change how you
feel if you noticed it. Right?
“V” is validating what’s valid.
So being fair with yourself, but not what’s
not — so you don’t tell yourself I’m a horrible
human being for suffering this way. I’m just
human for suffering like this, right?
“E” stands for easy manner. So being
kind and gentle and fair with yourself, even
if you’re not able to do things the way you
wish to yet.
And then the care. So for giving yourself
the care you need. The “C” stands
for being curious about what could really
help in the situation, all the different things
I know I’m learning, I’ve been working towards,
what could really help in this moment?
“A” stands for, the “A”
of care, stands for acknowledging that change
is hard. Doing things differently is difficult.
“R” stands for reflecting on, of
the different options, which one is most likely
to help me get to where I want to be?
And “E” stands for encouraging yourself
to do that thing that you’ve decided is probably
the best thing, even and especially — so
it’s a triple E— so encouraging yourself
even, especially when it’s hard, because the
reality is we all know that changing habits
And the last bit I’ll say here to make sure
people are fair with themselves is that again,
So it’s learning what you can do ahead of
time. Understanding that what you’re doing,
you don’t want to anymore. Getting to a place
where you’re going to learn something new,
practicing it. And then what tends to happen
is you notice first after you could have,
and here’s where people may shame themselves
for, I knew better then I did it, right? But
actually this is an occasion to give yourself
credit because, oh wait, I now know that I
can do something different. That’s actually
an accomplishment, not a reason for shame.
Does that makes sense?
And the same thing is true. So it’s first
after that you notice, then it’s during, but
you can’t do the new thing yet, then it’s
before, but you can’t do the new thing yet
and then it’s before you’re like, oh my God,
I think this time I would actually be able
to do it, right? And so it’s again, being
really fair with yourself. So how do you get
out of the guilt? It starts by having a fair
understanding of yourself, and a relationship
with yourself that is gentle, interested,
validating, easy mannered, curious, acknowledging,
reflecting, and really encouraging yourself
to even when it’s hard to not give up and
to take that step.
Beautiful. Thank you. You know Margaret, Hugo
mentioned, you know that, I guess what I’ll
say is that it makes sense to me that one
way to adjust this behaviour, like the the
quick fixes that we started this discussion
with about is to make self-compassion more
And I think that’s kind of Hugo, what you
were saying, right? We need to be fair with
ourselves and we need to just like take the
little steps of practice when we’re not in
this moment of crisis of really, really truly
So I’m wondering, Margaret, what are some
equally low-effort strategies that healthcare
providers could integrate into their day,
Thanks, Amy. And I want to start, having been
on the COVID and ICU units and medical floors
and other places in the hospitals during the
pandemic, and what we often heard from people
was, “I can’t take a break. I don’t want
to let my team down. If I take a break then
others have to fill in for me.”
And that’s a really hard place to be in when
we feel that if we take that time and have
that self-compassion for ourselves, that we’re
letting others down. And I think one really
simple thing that we can say to ourselves
is that if we don’t put the oxygen masks on
ourselves, we won’t be able to help others.
And it often sounds like something that we’ve
been told for years and years and years, but
it’s really true. It’s hard to accept sometimes,
but it’s true. And I think part of this is
giving ourselves the permission to be able
to take, to use these strategies.
I’m going to say also that often healthcare
workers have a sense of duty. And duty I think
is something I know myself I struggle with,
that I have such a sense of duty that I’ll
work to the point of exhaustion. Or stay somewhere.
I stayed in — I was at a hospital once for
36 hours and I was in the storage closet most
of that time, right? Not sleeping because
I just felt so strongly that I had a duty
to support others.
And I think that’s often where we find ourselves
in as healthcare workers, is our sense of
duty and our obligation, which is so important
and such a valuable part of our identity,
but also something that I think until we can
put that oxygen mask on ourselves is very
difficult. And so —
Sorry Margaret, I didn’t mean to cut you off.
I was just wondering actually if you could
share more about that experience because I
think that that experience in the closet at
the hospital is really pertinent to this conversation,
right? Like what you were doing was providing
a moment of respite for the healthcare providers.
So I’m wondering if you could explain more
about what that was and how you feel that
affected the healthcare providers.
Yeah, absolutely. And so I was in the storage
closet on an ICU unit and healthcare workers
don’t have a lot of time, right? That’s the
other part of this is, Hugo and Mauda were
talking about, there’s not a lot of time,
and so how do we help people to take that
pause for a moment and just either talk to
someone about the experiences that they’re
having or do something that help can help
to get them in the moment and present.
And so we can think about very simple things.
For example, using our senses, so our sense
of touch or sight or sound or smell. So one
very simple thing that, that I do is I have
worry stones. So these are worry stones. They’re
just simple stones that you could hold in
your hand and rub your fingers on.
And what that you’re doing there is that you’re
paying attention to the sensation of the stones
in your hands, you’re rubbing your fingers
on them, and it’s just a way of simply grounding
yourself in the moment. That’s one very low,
I would say low effort, yet high reward strategy
that healthcare workers might be able to use.
We call this grounding. So that notion of
using your senses to help keep you in the
moment. It’s also that permission when you
come home to say to your family, for example,
“I’ve had a really difficult day, I really
need a break.” Because often we come
in and say, “I want to make sure so-and-so
is okay. I want to call so-and-so. I want
to make sure everything is right for everyone
else.” And that’s especially hard when
you’re a parent, right? When you come home
and everybody comes to the door and they’re
waiting for you. But can we give ourselves
permission again to take that time? Just to
say no distractions, no conversation, I need
this moment for myself.
It’s also really important to think about
the things that have helped us in the past.
I often say mental health is not rocket science.
It’s actually think in the past about what’s
helped you. So for example, I know for me,
I know when I’m overwhelmed, when I get irritable,
that’s a very bad sign for me if I’m irritable.
Cause I’m not generally an irritable person.
And so when that happens, I want to think
about what’s helped in the past. Generally
that’s doing something social, having a bath,
sitting down with my dog and petting her,
whatever that may be. These low effort strategies—
low efforts are often hard, because while
they sound low effort, it’s taking that time
to give yourself permission to take that break.
It’s also allowing yourself to say, I’m not
going to take an extra shift. I am going to
take a day off.
And again, when we have that sense of duty
and obligation, which we all, I think, come
to these helping professions with, but be
that public safety personnel like paramedics
or firefighters, and we come with that sense
of duty. Where come because we want to help
others. But again, we can’t help others unless
we’re able to help ourselves and put that
oxygen mask on ourselves.
Yeah, absolutely. And one of the things that
was mentioned in the talk was, so many people
have a hard time talking to loved ones about
this experience — and actually when I first
came into this topic and I was doing research
on for this very talk, I thought, oh, well
that’s a really good, that’s a really good
support, is talking to your loved ones.
Like, how can you like engage them without
burdening them? But I actually think maybe,
because that’s so complicated from both sides
of the coin, right? So my question for you
Kim, is given that so many people have a hard
time talking to their loved ones about these
experiences that they’ve been through, what
else could you recommend for person-to-person
Yeah. Thanks so much, Amy. That’s a great
question. And I think one of the things we’ve
really learned from the research and we talk
a lot about in the interviews actually, is
that healthcare providers are really, really
good at taking care of others. And as we said
here too, and really delivering that patient-centered
care, but really struggle with turning that
to themselves and taking care of themselves.
And, you know, Margaret also mentioned about
identity, and I think healthcare providers
see themselves as — they’re the ones who
take care of others, and that’s part of the
culture. And it kind of goes against the culture
to turn that inwards and to start looking
So I think at work, taking care of each other
is important too, and supporting each other.
And I think teams already do that. But it
might just be recognizing your colleagues,
and giving them permission to take time for
themselves, in addition to giving yourself
And I think at home, as Margaret said, I think
being aware of your need to take time for
yourself, I think that’s the first step. But
then actually being able to find a way to
take that few minutes that you might need
just to care for yourself is also a strategy
that you could use at home.
I almost wonder, Hugo as well. I mean, you’re
very expert in this, and I wonder if you’d
like to talk a little bit more about grounding
and some of the ways that people can use sites
or their — use their senses to assess with
some of this as well.
Sure, happy to. So first of all, I’d say you
did a lovely job of describing, like finding
those things that speak to you and connecting
with them, right?
Because that’s really at the heart of grounding
. Well, there’s kind of two components really,
I guess. The one we’re talking about there
is really anchoring to the present, really
helping yourself — you can think of like
a ship, right? We feed an anchor into the
present. But it also is a pulling yourself
into, like, if you think about grounding as
like an image, you can be too far away from
the ground, like overwhelmed.
Where you can be so overwhelmed, you kind
of collapse and feel like you’re underground,
right? And so grounding is a set of skills
that helps you get to level ground, if that
makes sense. And so sometimes that’s when
something reminds us of the past and we start
to feel like this is like, or just like the
past, or because the present is so currently
overwhelming that we’re feeling overwhelmed
or just so overwhelmed and flooded that we
shut down and collapse. And grounding is great
for any and all of those things. And yeah,
lots of different ways to do it. At the heart
of it is really, helping yourself focus your
attention on the here and now. And there’s,
and I would say that different strategies,
different grinding strategies work differently
well for different people.
So to not give up if one doesn’t resonate
with you right away, but to know there’s lots
of them. And so here’s just a couple, right,
a couple ideas. The first is, Margaret as
you pointed out so beautifully, like if there’s
an object in particular that you find you
enjoy, the sight, the touch, the feel of,
Grounding is most effective when we’re working
with what I call like grounding helpers that
we find we connect with and help us: just
by spending time with it, we feel better.
Right? So like, for example, you happen to
be wearing a beautiful shawl today, right?
So, and I imagine, it’s probably soft.
And so you can use that as a grounding help,
just to kind of notice and describe to yourself
what does this feel like? Because touch is
often the fastest thing to help us with grounding.
So worry stones, different textures, different
temperatures, taking a sip of water, right,
or a warm beverage. Something with the smell
so you can get as many of your sentences as
possible involved. Making sure your breathing
is a huge part of this. And so for many people,
part of their grounding helper kit, if they
can think about that way, is sense that they
enjoy — or like tea, because that way they
can have the smell as they’re having a nice
warm beverage that’s also soothing.
It can be having objects that have particular
personal resonance for you or connecting with
people, and especially pets. Pets can be incredibly
grounding, right? And just as Margaret, you
were talking about your dog, I couldn’t help
but smile. And that’s the kind of grounding
that’s especially powerful, is the ones that
help you feel like, oh, yeah, right. Like
that. What going to, that’s going to be for,
each person’s going to be a little different,
but those are the ways to reach towards, is
those kinds of pieces.
Yeah. I find it really insightful the way
that you all are talking. I’ve thought a lot
about grounding myself, because everyone experiences
some degree of anxiety. So for example, when
I’m coming to a talk like this, I really like
to engage in grounding practices before I
enter the room, and then I’m fully present.
But one thing I’ve never heard before is that
it’s really helpful in grounding to engage
the senses. Like I really think that’s a really
important kernel of insight for those, because
I think that could —
All five if you can.
Yeah, go ahead.
All five if you can. So the more that you
can be involving and the more you’re connecting
and — one way to connect with it is to describe
it to yourself as if you were writing. As
if like someone else, if they were reading
it. Remember those long-form novels, where
they used to describe way too much detail,
just don’t do that anymore, right? But if
you were writing that so they could imagine
what you’re going through. Cause that’s how
you really anchor in, right, is by the dense
description, if that makes sense.
Right, right. Yeah, I just think that’s so
interesting. Because when I think of the techniques
that I used to ground myself, they’re all,
most of them are touch, right? Like standing
barefoot in the grass.
Or I have a little — similar to Margaret,
I have a little toy here that I play with
to keep my hands busy. So I just find that
the senses insight is so interesting.
Mauda, I’m wondering, what sort of techniques
do you recommend for people, for healthcare
providers to start, begin to begin engaging
Yeah. Well, I can kind of speak a little bit
to what we’ve heard from healthcare providers
to daily things that help them cope and reduce
the stress from work. So for example, establishing
daily routines was a big one, where there’s
adequate time for nutrition, well-balanced
meals, sleep, exercise, social connections.
And these can be just small little daily things.
Meal prepping, for example. So that you don’t
have to worry about going home and cooking
and having that additional stress for the
day. You know, pets: taking the dog on a long
walk in nature. Practicing breathing. Fresh
air, sunlight, being outdoors. Even some healthcare
providers describe leaving specific days set
aside for leisure. Things that are enjoyable
to them, activities that they would have preplanned
so they know that this day’s coming up, there’s
something to look forward to that I’m going
to enjoy on that day and make me feel good
And even integrating those daily strategies
such as mindfulness or gratitude practices:
Wake up first thing in the morning, have these
little practices that you know, Hugo and Margaret
were talking about, that you can carry that
self-compassion with you on throughout the
day. Yeah, those are just a few things that
we’ve heard that really work.
Wonderful. Thank you, Mauda. I’m actually
wondering, I’m going a little off script here,
but I’ve got a question that I think actually
might be helpful. And I’m wondering if one
of you could maybe explain what you mean by
practice breathing, and really practically
explain how someone might engage in that.
I think Hugo probably be best suited to —
I’ll just do a quick nod to Kara in the chat,
noting shaking as a grounding practice, right?
Like shaking off, shaking out the stuff. That’s
actually a really great way to, cause movement
is also a way of like — that in a way, it’s
touch, in terms of like, it’s appropriate
That’s a kind of beautiful way to ground and
let it all go. Thank you for sharing that,
Kara, that’s a beautiful suggestion. Especially
if you’re starting to feel shut down, right?
Like starting with small movement and working
to bigger movements can be really helpful.
So yeah, breathing. I mean, I think [there
are] a couple things. One, cause again, that
self understanding leads to self-compassion
to compassionate action. When we aren’t breathing,
and I can do this — you can hear me do this
— as I get talking, I get excited and so
I am really focused on talking and not breathing.
When we aren’t breathing, a couple things
happen. One, having air helps us feel safe.
So when we don’t have air, our body actually
has a real reason to not feel safe. And we
often, when we’re stressed, we kind of hold
our breath waiting for the moment to pass
or we hyperventilate, right? Like, but neither
one is actually getting our bodies the air
it needs, right?
And so our body then is like, oh, you are
worried about this, but now I’m super worried
about this. And then the mind gets even more
Right. Like danger.
Exactly. Cause it’s real danger. If you’re
not getting the air, that is actual danger.
Right? That’s clear and present danger at
that point. And so having an intentional breathing
practice, and there’s so many different ways
of doing this, so I would really encourage
people to just find what resonates for them.
There’s so many different things to try out.
Most important is to be getting good deep
breaths. Like breathing out longer than in
helps you relax. Breathing in longer than
out gives you energy. So if you’re feeling
overwhelmed and anxious, you would be breathing
out longer. If you’re feeling like I need
to up-regulate myself cause I’m kind of shut
down, you want to breathe in longer.
But there’s lots. You can do boxed breathing,
you can do all kinds of different counting
options. The most important thing is just
to make sure you are breathing, and finding
something that works well for you.
And of course we always have our breath with
us, right? And that’s the other thing I’d
say about breathing, and with grounding too,
you always have the ability to shake things
off or to notice the textures and temperatures
around you, right? Or to notice what the different
sensations are, even on things that you wear
or carry with you on a regular basis.
So these are, what’s wonderful about these
two sets of skills is they’re always available,
And just to even know that you’re doing them,
which is also a really important thing if
you’re a healthcare provider or a human being,
who has a hard time giving yourself permission
to do things in a way that others might see
it, right? You can do grounding and breathing
and no one can know that you’re doing those
Yeah, totally. It can be just this, like even
if you’re on a shift, it can be this sort
of private thing that you just are standing
at the monitor for a moment and taking a second
for yourself. Yeah, wonderful. Hugo, I’m wondering,
I know you work with folks who deal with occupational
stress in your work as a clinical psychologist
at the trauma unit at Homewood, so could you
share a bit about what you’ve observed about
your patients over the course of the pandemic?
So this is a really good question and also
one that makes me sad at two different levels.
So the first one is that I think, as a number
of us have talked about, because of the ways
that people tend to relate to themselves when
they’re drawn to the helping professions,
which is that they’re very focused on giving
and caring for others rather themselves. So
the first observation is that a lot of the
people that we would expect to see coming
in to get help aren’t. And it makes so much
Because people feel that I need to, this is
what I need to be doing, this work — there’s
no time to take care of myself. And so to
the first point there, it makes a lot of sense
to me that people aren’t, who might really
benefit, aren’t able to allow themselves to
give themselves permission to give themselves
the care they need, right? And so my hope
is that they do find a way to give themselves
that permission when they really need it in
terms of reaching out for local support, reaching
out for outpatient support, if that’s available
to you. I know a lot of people have work-related
support available, and if not, to really encourage
your system to support that.
And, or to come in once you feel like you
can do that, right? All of those things. If
coming inpatient is helpful. If not, outpatient.
All those pieces, right? And also meditation,
yoga, whatever speaks to you. But making sure
you’re giving yourself the care that you need
and not ignoring your needs.
In terms of the people that have come in during
the pandemic, especially healthcare workers,
all the themes we’ve just talked about just
resonates so deeply. And what I would say
with great gratitude to everyone on this call,
is for all the work they have done and then
for the reachers, researchers on this call
for the beautiful work they’ve done in helping
understand healthcare workers’ experiences,
because that’s helped us as providers be of
better support, so that we know what people
are going throughout the healthcare pandemic
, and the healthcare challenges for healthcare
workers, so that we can respond in a way that
is, again, more understanding, so therefore
more compassionate, which can hopefully facilitate
more compassionate action.
But yeah, it has been heartbreaking because
this has been so hard for so many people who
just often feel no one does understand, because
mostly they can’t, cause they aren’t there,
right? And one other thing to be aware of
is that, trauma and dissociation are tightly
linked. So if it’s too much to think about,
we don’t. We disconnect from it. We disassociate
And so people who aren’t exposed to this level
of distress, it’s hard for them to think about
it, because our brains don’t want to be connected
to distress, right? It’s because it’s overwhelming.
So our brains start to shut down and that
then makes it harder for people to then speak
to people. Cause they can tell that others
either don’t understand it or aren’t able
to stay engaged when they talk about it.
And so the more —
Yeah. Go ahead.
The more they can allow themselves to get
help from people who are trained to be able
to remain present during those kinds of pieces,
I think the more helpful that can be.
Yeah. And that speaks, that’s really pertinent
to the part where I was mentioning about the
talking to the loved ones, right? Is that
like, it’s not necessarily —
It’s not that they don’t care. They just can’t
They can’t process it. They can’t really understand
it because they haven’t been, like you said,
exposed to that level of stress.
And I just wanted to — Margaret, I wanted
to pass to you, because you had mentioned
earlier a bit about, and I think this relates
to what Hugo was just saying, is that you
mentioned a bit about the relationship between
sense of duty and self-compassion, and I’m
wondering if you could just dig into that.
I don’t have a specific question, but I feel
it’s important because sense of duty I’m sure,
resonates with many in the audience. So I’m
just wondering if you can speak more about,
even when you were on the front lines there
how that relationship is and what we can do
to turn towards self-compassion in that manner.
Thanks, Amy. And as you say, it’s a difficult
one to pull apart, right? So I think, again,
we come into these helping professions because
we want to help. And our identity, as Kim
was saying, really becomes, we’re a helper,
right? That we are here and we’re making these
sacrifices. And I think many of us believe
in service: that we’re here to serve, and
therefore that service is the work that we’re
And in order to serve, we also have to be
healthy ourselves, right? Or as healthy as
we can be. Not, and many of us will — I
mean, I’ve struggled with depression and P.T.S.D.
and I’ve talked very openly about that. I
think it’s really important. But I have to
see that to help others, I also need to have
self-compassion towards myself, and give myself
the space and the time to do things that will
help me to be healthy. I will be really upfront
and say that’s, I find that very difficult.
I will be very upfront with that as a — in
the many roles that I have, it’s hard, right?
But I think part of it is that we also have
a duty to ourselves, right?
So we are the vessels of our own identity,
and we have to care for ourselves too, to
be able to perform our duty. But also we have
a duty of care to ourselves, we owe it to
ourselves to take care of us.
Absolutely. Thank you. Thank you. Margaret,
I just have one, one final question. It is
also for you. And that is that I can’t help
feel like — we’re talking about self-care
and that’s so valuable — but I can’t help
but feel like some of the circumstances that
have led to this very webinar are systemic.
It feels like it needs to be about culture
change within the healthcare industry as well.
So Margaret, I’m curious how organizations,
even though they’re also, everyone is stretched
the limits, including the organizations, but
how can they help healthcare providers right
Great question. Thank you, Amy. And I think
part of it is seeing our common humanity.
So I think healthcare organizations are often
very hierarchically structured.
So there’s the view that we have, those at
the top and those on the front lines, and
there’s a lot of hierarchy in that. And I
think part of what we need to do is be able
to see each other as equals, that we care
for one another, that our first duty is one
of care and not of “this must be done
We’re in a very unique circumstance right
now and I think we need to acknowledge that
and again, see everyone’s humanity. I think
we need to check in with people and see how
they’re doing. So it’s really helpful. When
I was out on the front lines, a lot of managers
would talk about, “I have people come
into my office and I talk to them about how
they’re doing. I get to know them personally.
I speak to them about, what do you need in
order to be able to do your job?”
We need to ask our teams that same question,
so what is it that you need? We can’t respond
to every need, but we can at least hear about
what are some of the needs that you have.
And managers and directors and leaders also
struggle, and we need to provide support and
compassion for them as well.
But I think part of this is a bit of leveling
the playing field and allowing us to see each
other as humans who all have needs and identity.
And how do we support one another in this
because we’re all in this together.
Absolutely. Thank you. And I think that’s
a beautiful note to to end our discussion
So thank you so much to all of the panelists
for participating today.
I just want to say that over the weekend I
had to take a trip to the ER with my youngest
daughter, who’s four. Everything’s fine, don’t
worry. But it was the first time that I’ve
set foot in a hospital since the pandemic,
which I consider myself very fortunate for
that to have been my case.
But when I walked in, everything looked different.
There were dividers in between the waiting
room chairs, and there were nurses in the
full P.P.E. And for me, knowing that this
webinar was coming up, it was really like
stepping into this world that you’ve all been
living in for two-plus years. And I have to
say like everyone, every single nurse, doctor,
healthcare provider that we spoke to, was
so kind to my daughter who was very scared.
And so I just wanted to say, I see you all
in the audience and thank you so much for
showing up every day and doing what you do.
It’s so important. It’s so, so important.
And if there’s one thing that you deserve,
it’s compassion from the public, but also
So that’s it for me today, but before I pass
it over to Margaret to close out, I’d just
like to also thank our sponsor once more.
So thank you to the Public Health Agency of
Canada for supporting this important work.
We appreciate you. And Margaret, I’d love
to pass it to you for some final words.
Amy. And thank you for sharing that experience.
And I think what we have seen over the course
of the pandemic is unfortunately there has
been a real rise in incivility and violence
towards healthcare workers. I think it’s really
important that we acknowledge that and we
know that healthcare workers are facing that.
And I think what you’ve done right now is
exactly what people need to hear. That we
see you. We appreciate you. We know your service
and your sacrifices and we know your stories.
And so I think that’s how I think we’d all
like to end this symposium, is to say thank
you to the healthcare workers and public safety
personnel and other people at the front lines
of this pandemic. Thank you for your service.
Thank you for your sacrifice and let’s all
give ourselves a bit of air to allow ourselves
just to, to breathe and be present, and to
give ourselves that self-compassion that everyone
here needs. So thank you very much.
Thank you all and thank you all for joining
us today and I hope you have a wonderful rest
of your day. Take care.
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. Kim Ritchie, Research Associate, Homewood Research Institute
Dr. Kim Ritchie is an Assistant Professor at Trent University and holds an Adjunct position in the Department of Psychiatry and Behavioural Neuroscience at McMaster University. Since 2020, she has been co-leading a national study examining the mental health impacts of COVID-19 on healthcare providers.
In addition, Kim is a Registered Nurse with over 20 years of experience in direct care and clinical leadership roles, primarily focusing on mental health and geriatric mental health. She completed a PhD in Rehabilitation Science from Queen’s University, and currently conducts research on PTSD, trauma, and moral injury in military/veterans, healthcare providers, and public safety personnel.
Dr. Hugo Schielke, Trauma Services Development Lead, Homewood Health Centre
Dr. Hugo Schielke, PhD, is the Trauma Services Development Lead for Homewood Health Centre and the Centre’s Traumatic Stress Injury & Concurrent Program in Guelph, Ontario. He specializes in the assessment and treatment of trauma-related disorders, and his work is informed by his post-doctoral fellowship at The Trauma Disorders Program at Sheppard Pratt Health System and his involvement with the California Department of State Hospitals’ Trauma-Informed Care Project.
Hugo’s research is focused on the treatment of trauma-related disorders, psychotherapy process, and the relational components of psychotherapy.
Mauda Karram, Clinical Research Assistant, Trauma & Recovery Research Unit, McMaster University
Mauda is a Clinical Research Assistant in the Trauma & Recovery Research Unit at McMaster University. She completed her undergraduate degree at McMaster in the (Science Honours) Psychology, Neuroscience, and Behaviour (Mental Health Specialization) program with a minor in Theatre and Film Studies.
Currently, Mauda is the project coordinator for the Unit’s moral injury project. She aims to continue her research work on coping and self-care in healthcare workers and public safety personnel throughout the COVID-19 pandemic, in hopes to apply the findings in knowledge mobilization efforts for empirically based resources and supports.
Amy Van Es, Founder, Gooder
Amy Van Es spent the first decade of her career as a digital growth strategist, helping media and tech companies rapidly scale their online presence. But she’s since resolved to spend the next decade fixing what she helped break: the internet. She’s obsessed with this mission.
When she’s not interneting with Gooder, Amy enjoys hiking, sewing, and big bowls of pasta. She dislikes push notifications, peas, and writing in the third person.
With gratitude to McMaster University Faculty of Health Sciences: Continuing Professional Development for broadcasting this event’s video feed.