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Saragosa M, Goraya F, Serrano F, Nowrouzi-Kia B, Guilcher S, Abdul Aziz Y, Gohar B. From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists' Experiences and Post-Pandemic Perspectives. Healthcare (Basel) 2024; 12:1050. [PMID: 38786460 PMCID: PMC11120773 DOI: 10.3390/healthcare12101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care.
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Affiliation(s)
- Marianne Saragosa
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
| | - Farwa Goraya
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
| | - Frances Serrano
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
- Department of Psychology, Laurentian University, Sudbury, ON P3E 2C6, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON M5G 1V7, Canada;
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Centre for Research in Occupational Safety & Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
| | - Sara Guilcher
- Department of Physical Therapy, University of Toronto, Toronto, ON M5G 1V7, Canada;
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | - Yasmin Abdul Aziz
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | - Basem Gohar
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (F.G.); (F.S.); (B.G.)
- Centre for Research in Occupational Safety & Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
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D’Alessandro-Lowe AM, Patel H, Easterbrook B, Ritchie K, Brown A, Xue Y, Karram M, Millman H, Sullo E, Pichtikova M, Nicholson A, Heber A, Malain A, O’Connor C, Schielke H, Rodrigues S, Hosseiny F, McCabe RE, Lanius RA, McKinnon MC. The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic. Eur J Psychotraumatol 2024; 15:2299661. [PMID: 38334706 PMCID: PMC10860446 DOI: 10.1080/20008066.2023.2299661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
Background: Healthcare workers (HCWs) across the globe have reported symptoms of Post-Traumatic Stress Disorder (PTSD) during the COVID-19 pandemic. Moral Injury (MI) has been associated with PTSD in military populations, but is not well studied in healthcare contexts. Moral Distress (MD), a related concept, may enhance understandings of MI and its relation to PTSD among HCWs. This study examined the independent and combined impact of MI and MD on PTSD symptoms in Canadian HCWs during the pandemic.Methods: HCWs participated in an online survey between February and December 2021, with questions regarding sociodemographics, mental health and trauma history (e.g. MI, MD, PTSD, dissociation, depression, anxiety, stress, childhood adversity). Structural equation modelling was used to analyze the independent and combined impact of MI and MD on PTSD symptoms (including dissociation) among the sample when controlling for sex, age, depression, anxiety, stress, and childhood adversity.Results: A structural equation model independently regressing both MI and MD onto PTSD accounted for 74.4% of the variance in PTSD symptoms. Here, MI was strongly and significantly associated with PTSD symptoms (β = .412, p < .0001) to a higher degree than MD (β = .187, p < .0001), after controlling for age, sex, depression, anxiety, stress and childhood adversity. A model regressing a combined MD and MI construct onto PTSD predicted approximately 87% of the variance in PTSD symptoms (r2 = .87, p < .0001), with MD/MI strongly and significantly associated with PTSD (β = .813, p < .0001), after controlling for age, sex, depression, anxiety, stress, and childhood adversity.Conclusion: Our results support a relation between MI and PTSD among HCWs and suggest that a combined MD and MI construct is most strongly associated with PTSD symptoms. Further research is needed better understand the mechanisms through which MD/MI are associated with PTSD.
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Affiliation(s)
| | - Herry Patel
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kim Ritchie
- McMaster University, Hamilton, Ontario, Canada
- Trent University, Peterborough, Ontario, Canada
| | | | - Yuanxin Xue
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Mauda Karram
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Emily Sullo
- McMaster University, Hamilton, Ontario, Canada
| | - Mina Pichtikova
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Andrew Nicholson
- McMaster University, Hamilton, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Alex Heber
- McMaster University, Hamilton, Ontario, Canada
- Canadian Institute for Pandemic Health Education and Response, Regina, Saskatchewan, Canada
| | - Ann Malain
- Homewood Health Centre, Guelph, Ontario, Canada
| | | | | | - Sarah Rodrigues
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
| | - Fardous Hosseiny
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
| | - Randi E. McCabe
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Ruth A. Lanius
- University of Western Ontario, London, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Margaret C. McKinnon
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
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D’Alessandro-Lowe AM, Karram M, Ritchie K, Brown A, Millman H, Sullo E, Xue Y, Pichtikova M, Schielke H, Malain A, O’Connor C, Lanius R, McCabe RE, McKinnon MC. Coping, Supports and Moral Injury: Spiritual Well-Being and Organizational Support Are Associated with Reduced Moral Injury in Canadian Healthcare Providers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6812. [PMID: 37835082 PMCID: PMC10572244 DOI: 10.3390/ijerph20196812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace stress. It remains unknown, however, if similar coping methods and supports are associated with MI among this population. We explored associations between MI (including the shame and trust-violation presentations individually) and coping methods and supports. Canadian HCPs completed an online survey about their mental health and experiences during the COVID-19 pandemic, including demographic indices (e.g., sex, age, mental health history) and measures of MI, organizational support, social support, spiritual well-being, self-compassion, alcohol use, cannabis use and childhood adversity. Three hierarchical multiple linear regressions were conducted to assess the associations between coping methods/supports and (i) MI, (ii) shame-related MI and (iii) trust-violation-related MI, when controlling for age, mental health history and childhood adversity. One hundred and seventy-six (N = 176) HCPs were included in the data analysis. Spiritual well-being and organizational support were each significantly associated with reduced total MI (p's < 0.001), shame-related MI (p = 0.03 and p = 0.02, respectively) and trust-violation-related MI (p's < 0.001). Notably, comparison of the standardized beta coefficients suggests that the association between trust-violation-related MI and both spiritual well-being and organizational support was more than twice as great as the associations between these variables and shame-related MI, emphasizing the importance of these supports and the trust-violation outcomes particularly. Mental health history (p = 0.02) and self-compassion (p = 0.01) were additionally related to shame-related MI only. Our findings indicate that heightened levels of spiritual well-being and organizational support were associated with reduced MI among HCPs during the COVID-19 pandemic. Rather than placing sole responsibility for mental health outcomes on HCPs individually, organizations can instead play a significant role in mitigating MI among staff by implementing evidence-informed organizational policies and interventions and by considering how supports for spiritual well-being may be implemented into existing models of care where relevant for employees.
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Affiliation(s)
- Andrea M. D’Alessandro-Lowe
- Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, ON L8S 4L6, Canada;
- Homewood Research Institute, Guelph, ON N13 6K9, Canada
| | - Mauda Karram
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
| | - Kim Ritchie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- Trent/Fleming School of Nursing, Trent University, Peterborough, ON K9L 0G2, Canada
| | - Andrea Brown
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
| | - Heather Millman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
| | - Emily Sullo
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
| | - Yuanxin Xue
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Mina Pichtikova
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON M5S 1V6, Canada
| | | | - Ann Malain
- Homewood Health Centre, Guelph, ON NIE 6K9, Canada
| | | | - Ruth Lanius
- Homewood Research Institute, Guelph, ON N13 6K9, Canada
- Lawson Health Research Institute, University of Western Ontario, London, ON N6C 2R5, Canada
| | - Randi E. McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Margaret C. McKinnon
- Homewood Research Institute, Guelph, ON N13 6K9, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L9C 0E3, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
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