Explore the vast range of titles available.

Background: Staffing shortages across the healthcare sector pose a threat to the continuity of the Canadian healthcare system in the post-COVID-19 pandemic era. We sought to understand factors associated with turnover intention as well as Canadian healthcare providers’ (HCPs) perspectives and experiences with turnover intention as related to both organizational and professional turnover. Method: A convergent questionnaire mixed-methods design was employed. Descriptive statistics and ordinal logistic regressions were used to analyze quantitative data and ascertain factors associated with turnover intention. Thematic analysis was used to analyze qualitative open-field textbox data and understand HCPs’ perspectives and experiences with turnover intention. Results: Quantitative analyses revealed that 78.6% of HCPs surveyed (N = 398) reported at least a 25% turnover likelihood regarding their organization, with 67.5% reporting at least a 25% turnover likelihood regarding their profession. Whereas regression models revealed the significant impact of years worked, burnout, and organizational support on turnover likelihood for organizations, age, sex, burnout, and organizational support contributed to the likelihood of leaving a profession. Patterns of meaning drawn from participants’ qualitative responses were organized according to the following four themes: (1) Content to stay, (2) Drowning and no one cares, (3) Moral stressors, and (4) Wrestling with the costs and benefits. Conclusions: Many HCPs described weighing the costs and benefits of leaving their organization or profession during the COVID-19 pandemic. Although challenging working conditions, moral stressors, and burnout may play a significant role in HCPs’ experiences of turnover intention, there is ample room to intervene with organizational support.

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. 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. 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 (  = .412,  < .0001) to a higher degree than MD (  = .187,  < .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 (  = .87,  < .0001), with MD/MI strongly and significantly associated with PTSD (  = .813,  < .0001), after controlling for age, sex, depression, anxiety, stress, and childhood adversity. 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.

Table of contents Preamble Terms Acute stress disorder (ASD) Adverse childhood experiences (ACEs) Anxiety disorder Burnout Caregiver, informal Caregiver burden Caregiver satisfaction Clinical anxiety Clinical depression Compassion fatigue Complex posttraumatic stress disorder (C-PTSD) Complex trauma Critical incident Cultural competency / Cultural competence Diagnosis / Diagnostic Equity, diversity, and inclusion (EDI) Evidence-based activities Evidence-based medicine (EBM) First responder Gender-based violence Health Informal caregiver Institutional betrayal / Sanctuary trauma Interpersonal violence Intersectionality LGBT purge Mental disorder Mental health Mental health condition / Mental health challenge Mental health injury / Psychological injury Mental illness Military sexual trauma (MST) Moral injury / Moral distress / Moral dilemma Occupational stress injury / Organizational stress injury Operational stress injury (OSI) Panic attack Peer support People with lived experience [of a mental disorder or mental health condition] / Experts by experience [of a mental disorder or mental health condition] Posttraumatic growth (PTG) Posttraumatic psychological stress / Posttraumatic stress / Posttraumatic stress syndrome / Posttraumatic stress symptoms / Psychological stress / Psychological trauma / Psychologically traumatic stress / Traumatic stress Posttraumatic stress (PTS) Posttraumatic stress disorder (PTSD) Posttraumatic stress injury (PTSI) Potentially psychologically traumatic event (PPTE) / Psychologically traumatic event / Potentially psychologically traumatic stressor / Psychologically traumatic stressor (PTS) / Traumatic event / Traumatic stressor Provider Psychological trauma / Psychologically traumatic injury Public safety personnel (PSP) Recovery Resilience / Resiliency Sanctuary trauma Secondary traumatic stress Social support Stigma Stress / Stressor / Stressful event Trauma / Traumatic injury Tri-services Vicarious trauma Vicarious traumatic stress Well-being (wellbeing) Wellness Wellness check Acknowledgements Senior authors team Statement Preamble Background Posttraumatic stress disorder (PTSD) is a potentially disabling condition that is now widely recognized as a public health issue.1 PTSD and other mental disorders are more common among first responders and other public safety personnel (PSP), Canadian Armed Forces members, Veterans, and health care personnel than among the general population in Canada.2 The COVID-19 pandemic increased our reliance on the health care workers and public safety personnel and took an additional toll on their physical, mental, and emotional health.3 In 2018, the Federal Framework on Post-Traumatic Stress Disorder Act (Act C-211) was passed by the Parliament of Canada to address the “clear need for persons who have served as first responders, firefighters, military personnel, corrections officers and members of the RCMP to receive direct and timely access to PTSD support.” Prevalence of PTSD The first nationwide research investigating the proportion of Canadian PSP reporting symptom clusters consistent with various mental disorders found that 23.2% of the total sample screened positive for PTSD.2 By contrast, estimates of the prevalence of PTSD in the general population range from 1.1% to 3.5%.2 Prior to the COVID-19 pandemic, pan-Canadian research, using the Carleton et al.1 online survey and the same psychiatric scales, reported rates of PTSD similar to those found in PSP among the regulated nurses (i.e. registered nurses, licensed practical nurses, registered practical nurses, registered psychiatric nurses, nurse practitioners) who participated in the survey, with almost one-quarter of respondents (23%) screening positive for current symptoms consistent with PTSD.5 6 7 Recent research suggests that since the start of the COVID-19 pandemic, rates of PTSD have increased among both health care providers and PSP.3 Evolution of the glossary of terms Discussions around PTSD and related mental health conditions often lack a common language for people living and working in different contexts. The first version of the glossary was planned and developed to facilitate open discourse among the many academics, researchers, clinicians, policy experts, non-governmental organization members, PSP, serving and veteran Canadian Armed Forces members, and people with lived experience of PTSD who attended the 2019 National Conference on PTSD; to assist in the development of the Federal Framework on Posttraumatic Stress Disorder;1 and to address key priority areas in Supporting Canada’s Public Safety Personnel: An action plan on post-traumatic stress injuries.8 A revised version of the glossary was released the same year, based on feedback on the first version, and version 2.1, with minor editorial revisions, was posted on the CIPSRT website in 2020. [...]disorder” communicates important information to health care providers about a person’s condition, functional limitations, and the optimal lines of treatment.

Table des matières Préambule Termes Abandon institutionnel / Traumatisme du sanctuaire Activités fondées sur des données probantes Aidant naturel / Proche aidant Anxiété clinique Bien-être Blessure de santé mentale / Blessure psychologique Blessure de stress opérationnel (BSO) Blessure de stress post-traumatique (BSPT) Blessure de stress professionnel / Blessure de stress organisationnel Blessure morale / Détresse morale / Dilemme moral Compétence culturelle Crise de panique Croissance post-traumatique (CPT) Dépression majeure Diagnostic Équité, diversité, et inclusion (ÉDI) Épuisement professionnel Événement potentiellement traumatisant sur le plan psychologique (ÉPTP) / Événement traumatisant sur le plan psychologique / Facteur de stress potentiellement traumatique sur le plan psychologique / Facteur de stress traumatique sur le plan psychologique (SPTP) / Événement traumatisant / Facteur de stress traumatique Expérience négative de l’enfance (ENE) Fardeau des aidants naturels Incident critique Intersectionnalité Maladie mentale Médecine fondée sur des données probantes (médecine factuelle) Mieux-être Personnel de la sécurité publique (PSP) Personnes ayant une expérience vécue [de trouble mental ou de problème de santé mentale] / Experts par expérience [de trouble mental ou de problème de santé mentale] Premier répondant Prestataire Problème de santé mentale / Mauvais état de santé mentale Purge LGBT Résilience Rétablissement Santé Santé mentale Satisfaction des aidants naturels Soutien par les pairs Soutien social Stigmatisation Stress / Facteur de stress / Événement stressant Stress post-traumatique (SPT) Stress psychologique post-traumatique / Stress consécutif à un traumatisme / Syndrome de stress post-traumatique / Symptômes de stress post-traumatique / Stress psychologique / Traumatisme psychique / Stress traumatique sur le plan psychologique / Stress traumatique Stress traumatique indirect Stress traumatique secondaire Traumatisme / Blessure traumatique Traumatisme complexe Traumatisme du sanctuaire Traumatisme indirect Traumatisme psychique / Blessure traumatisante sur le plan psychologique Traumatisme sexuel militaire (TSM) Trois services d’intervention d’urgence Trouble d’anxiété Trouble de stress aigu Trouble de stress post-traumatique (TSPT) Trouble de stress post-traumatique complexe (TSPT-C) Trouble mental Usure de compassion Vérification du bien-être Violence fondée sur le genre Violence interpersonnelle Remerciements Équipe des auteurs principaux Avis Préambule Contexte Le trouble de stress post-traumatique (TSPT) constitue une invalidité potentielle maintenant largement reconnue comme un problème de santé publique1. Prévalence du TSPT La première recherche nationale à porter sur la proportion de membres du personnel de sécurité publique canadiens présentant des ensembles de symptômes correspondant à divers troubles mentaux a révélé que 23,2 % des participants faisant partie de l’échantillon total ont obtenu un dépistage positif pour le TSPT2. La première version du glossaire a été planifiée et élaborée afin de favoriser une discussion ouverte entre les nombreux universitaires, chercheurs, cliniciens, spécialistes en politiques, membres d’organisations non gouvernementales, membres du personnel de la sécurité publique, membres actifs et vétérans des Forces armées canadiennes ainsi que personnes ayant souffert d’un TSPT qui ont assisté à la Conférence nationale sur le TSPT de 2019, afin de contribuer à l’élaboration du Cadre fédéral relatif à l’état de stress post-traumatique1 et afin d’aborder les principaux domaines prioritaires énoncés dans le document intitulé Soutenir le personnel de la sécurité publique du Canada : Plan d’action sur les blessures de stress post-traumatique8. Évolution des termes Les cliniciens choisissent soigneusement leurs mots pour décrire et résumer les signes, les symptômes et les diagnostics complexes et pour proposer aux patients et aux clients les traitements les plus susceptibles de les aider.

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.