Canada Funds Projects to Address PTSD in Healthcare Workers

Two McMaster University researchers working on projects that address pandemic-associated posttraumatic stress disorder (PTSD) among healthcare workers have received more than $4.5 million in Canadian federal funding.

The projects include a website with evidence-based resources and a smartphone app that encourages early intervention and peer support. Together, the projects are expected to reach more than 100,000 healthcare workers across Canada.

Moral Distress

“We started surveying the mental health and well-being of Canadian healthcare workers during the Delta variant wave and found that 1 in 4 were endorsing symptoms consistent with PTSD,” Margaret McKinnon, PhD, a professor of psychiatry and behavioral neurosciences at McMaster, told Medscape Medical News. “With the onset of Omicron, we see that 1 in 2 are considering leaving their positions due to moral distress.”

The team’s recent review of healthcare workers and public safety personnel showed that moral distress was triggered by factors such as feeling helpless when caring for critically ill COVID patients, having to perform care that was perceived to be futile, and being at the beside of dying COVID patients instead of their family members, who were prohibited from entering the hospital because of COVID restrictions. Additional stressors included having no time to process events, rushing to change personal protective equipment, and high patient caseloads.

The findings spurred the team to build a website called “Health Care Salute. Thank You for Your Service.” This project was awarded $2.96 million. “Through this platform, we want to thank healthcare workers for their sacrifices during the pandemic and also provide tools to help them to recognize the symptoms of PTSD, depression, and anxiety and validate their experiences,” McKinnon explained.

The website, which is scheduled to be launched in the fall, will include personal stories; psychoeducation modules addressing trauma, PTSD, and moral distress or injury; coping resources; and treatment options.

“Beyond Silence” App

The federal funding also aids development of the McMaster Beyond Silence smartphone app, a project spearheaded by Sandra Moll, PhD, an occupational therapist and associate professor at McMaster’s School of Rehabilitation Science. Moll and her team, which includes McKinnon, developed and were testing version 1.0 of the app “and then the pandemic hit,” Moll told Medscape. “At that point, we made the app available free of charge to organizations that didn’t have any other form of healthcare worker support.”

With an additional $1.56 million, the team is developing version 2.0, which incorporates insights from clinicians who used the earlier version. The new version will include links to resources on the Healthcare Salute website. “We are charged with building a trauma-informed app, and we’re looking at enhancements through that lens,” Moll explained. “This means things like making everything simple to access, providing choice and privacy, and building trust and empowerment. If people are struggling, they need to get information quickly, they need to know what they have to do, and they need validation of their feelings. They need a button that says, ‘Click here for help.’ Those are some of the kinds of features that we’re starting to build in.”

Peer Support a Priority

A key component is the app’s peer support feature. “We don’t have an established culture around peer support for healthcare workers or an established training program, even though the evidence shows it’s beneficial,” said Moll, who will be working with Homewood Health to build a peer-support capacity curriculum. “Organizations that use the app will get this training for their peer-support providers.”

To help validate users’ feelings, the app incorporates a chat bot that asks at the beginning of an interaction, “How are you doing today? What do you need? How can I help you?” When the user is feeling stressed, anxious, scared, or unsafe, the bot conveys the message, “You’re not alone,” Moll said. “I was shocked that being asked about feelings by something on your phone was found to be super helpful.”

The team will be studying the app’s implementation across workplaces in diverse settings, including small practices, large hospitals, long-term care communities, and rural sites, Moll noted. “We’ll be working with organizational champions to answer such questions as, ‘Who takes it up?’ ‘How do they download it?’ ‘Do people use it just once or every day?’ We’re really excited about trying to understand those patterns of use, because we don’t really know.”

A 3-month implementation trial is scheduled to begin on November 1. In the interim, a brief overview of the app and some of the findings to date are available online.

System in Peril

“Overall, an app is just one piece of the puzzle,” said Moll. “Systemic change needs to happen. There needs to be a large-scale rethinking and supports for our healthcare workers.”

McKinnon added, “We’re in a perilous situation now with our healthcare system. Many hospitals are running understaffed, healthcare workers are leaving the profession, and the result can be suboptimal care. If we lose any more of these workers, we will be in deep trouble.”

Follow Marilynn Larkin on Twitter: @MarilynnL.

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