Understanding resilience and stress in health care workers

Health care workers face extraordinary stress at times. Since we are interested in what happens between providers and patients, it only makes sense that we are attentive to issues on both sides of that interaction. Our research in this area wasn’t planned – it emerged naturally when Toronto was particularly hard-hit by the SARS outbreak in 2003 and we found ourselves in the middle of it. We started by studying the impact of that event on the people we work with, and later expanded our research to develop evidence-based approaches to improving health care workers’ resilience and studying the impact of other high stress health care work – especially by collaborating with Janice Halpern on her large study of Toronto paramedics. Who knew it would  feel like we had spent two decades preparing when the COVID-19 pandemic hit?

  • Maunder, R, Hunter, J, Vincent, L, Bennett, J, Peladeau, N, Leszcz, M, Sadavoy, J, Verhaeghe, L, Steinberg, R, Mazzulli, T. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 168 (10), 2003, 1245-1251.
  • Maunder R. The Experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: Lessons learned. Philosophical Transactions of the Royal Society, Series B, Biological Sciences. 359 (1447), 2004, 1117-1126.
  • Maunder, R, Lancee, W, Rourke, S, Hunter, J, Goldbloom, D, Balderson, K, Petryshen, P, Steinberg, R, Wasylenki, D, Koh, D, Fones, CSL. Factors associated with the psychological impact of SARS on nurses and other hospital workers in Toronto. Psychosom Med. 2004; 66: 938-942.
  • Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag Jr. B, Evans S, Fernandes C, Goldbloom DS, Gupta M, Hunter JJ, McGillis Hall L, Nagle LM, Pain C, Peczeniuk SS, Raymond G, Read N, Rourke SB, Steinberg RJ, Stewart T, VanDeVelde-Coke S, Veldhorst GG, Wasylenki DA. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerging Infectious Diseases. 2006; 12: 1924-1932.
  • Lancee WJ, Maunder RG, Goldbloom DS and the Co-authors of the Impact of SARS Study. The prevalence of psychiatric disorders in Toronto hospital workers one to two years after SARS. Psychiatric Services. 59: 91-95, 2008.
  • Maunder RG, Leszcz, M, Savage D, Adam MA, Peladeau RN, Romano D, Rose M, Schulman B. Applying the lessons of SARS to pandemic influenza: An evidence-based approach to mitigating the stress experienced by healthcare workers. Canadian Journal of Public Health. 99: 486-488, 2008.
  • Maunder R, Lancee WJ, Mae R, Vincent L, Peladeau N, Beduz MA, Hunter JJ, Leszcz, M. Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: A randomized trial of the optimal dose of training. BMC Health Services Research. 10:72
  • Aiello A, Khayeri M, Raja S, Peladeau N, Romano D, Leszcz M, Maunder RG, Rose M, Adam MA, Pain C, Moore, A, Savage, D, Schulman, B. Resilience training for hospital workers in anticipation of an influenza pandemic. Journal of Continuing Education in the Health Professions. 31(1):15-20, 2011.
  • Halpern J, Maunder RG, Schwartz B, Gurevich M. Identifying risk of emotional sequelae after critical incidents. Emergency Medicine Journal. 28 (1) 51-56, 2011
  • Halpern J, Maunder RG, Schwartz B, Gurevich M. The Critical Incident Inventory: Derivation and validity of an instrument to identify characteristics of critical incidents experienced by paramedics. BMC Emergency Medicine. 08/2012; 12(1):10.
  • Halpern J, Maunder RG, Schwartz B, Gurevich M. Identifying, describing and expressing emotions after critical incidents in paramedics. Journal of Traumatic Stress. 25(1):111-4, 2012.
  • Halpern J, Maunder RG, Schwartz B, Gurevich M. Attachment insecurity, responses to critical incident distress and current emotional symptoms in ambulance workers. Stress and Health Stress Health. 28(1):51-60, 2012
  • Halpern J, Maunder RG, Schwartz B, Gurevich M. Downtime after critical incidents in emergency medical technicians (EMT)/paramedics. BioMed Research International. 2014 Apr 10.
  • J Hunter RG Maunder. Using Attachment Theory to Understand and Support Healthcare Workers under Stress. Canadian Journal of Physician Leadership 2019;6(1), 30-35.
  • B Rosen, M Preisman, R Maunder, J Hunter. Applying psychotherapeutic principles to bolster resilience in health care workers during COVID-19. American Journal of Psychotherapy. 2020 Dec 1;73(4):144-148. get it here
  • RG Maunder, ND Heeney, A Kiss, JJ Hunter, LP Jeffs, L Ginty, J Johnstone, CA Loftus, LA Wiesenfeld. Psychological impact of the COVID-19 pandemic on hospital workers over time: Relationship to occupational role, living with children and elders, and modifiable factors. General Hospital Psychiatry 71, July–August 2021, 88-94. get it here.
  • Mehta, S., Yarnell, C., Shah, S. et al. The impact of the COVID-19 pandemic on intensive care unit workers: a nationwide survey. Can J Anesth/J Can Anesth (2021). get it here
  • Maunder RG, Heeney ND, Strudwick G, et al. Burnout in hospital-based healthcare workers during COVID-19. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021;2(46). get it here
  • L Jeffs, J Merkley, R Greenberg, L Ginty, N Amaral, R Maunder, L Wiesenfeld, S Brown, P Shing, K Ronald. An Academic Health Sciences Centre’s Strategy to Enhance Nurse Resilience and Psychological Safety amid the COVID-19 Pandemic. Nursing Leadership 2021; 34(2), 35-40.
  • Rosen B, Preisman M, Read H, Chaukos D, Greenberg RA, Jeffs L, Maunder R, Wiesenfeld L. Resilience coaching for healthcare workers: Experiences of receiving collegial support during the COVID-19 pandemic. General Hospital Psychiatry,75, 2022, 83-87 get it here
  • Honarmand K, Yarnell CJ, Young-Ritchie C, Maunder R, Priestap F, Abdalla M, Ball IM, Basmaji J, Bell CM, Jeffs L, Shah S, Chen J, LeBlanc D, Kayitesi J, Eta-Ndu C, Mehta S. Personal, professional, and psychological impact of the COVID-19 pandemic on hospital workers: A cross-sectional survey. PLoS One. 2022 Feb 15;17(2):e0263438. get it here
  • RG Maunder, ND Heeney, A Kiss, JJ Hunter, LP Jeffs, L Ginty, J Johnstone, CA Loftus, LA Wiesenfeld. Trends in burnout and psychological distress in hospital staff over 12 months of the COVID-19 pandemic: a prospective longitudinal survey. J Occup Med Toxicol 17, 11 (2022). get it here
  • B Rosen, M Preisman, H Read, D Chaukos, RA Greenberg, L Jeffs, R Maunder, L Wiesenfeld. Providers’ perspectives on implementing Resilience Coaching for Healthcare Workers during the COVID-19 pandemic. BMC Health Services Research 2022 Jun 14;22(1):780. get it here
  • RG Maunder, ND Heeney, JJ Hunter. Adult attachment insecurity and responses to prolonged severe occupational stress in hospital workers during the COVID-19 pandemic, Health Psychology and Behavioral Medicine, 2022, 10:1, 871-887, get it here
  • Korman MB, Steinberg R, Gagliardi L, Stewart B, Acero CL, Davies J, Maunder R, Walker T, DasGupta T, DiProspero L, Sinyor M, Ellis J. Implementing the STEADY Wellness Program to Support Healthcare Workers throughout the COVID-19 Pandemic. Healthcare. 2022; 10(10):1830. get it here
  • RG Maunder, A Kiss, N Heeney, E Wallwork, J Hunter, J Johnstone, L Wiesenfeld, L Jeffs, A McGeer, K Lee, C Loftus, L Ginty, K Wilkinson, J Merkley. Randomized Trial of Personalized Psychological Feedback from a Longitudinal Online Survey and Simultaneous Evaluation of Randomized Stepped Wedge Availability of In-Person Peer Support for Hospital Staff during the COVID-19 Pandemic. Gen Hosp Psychiatry. 2023 Jun 9;84:31-38. get it here
  • Maunder, R.G., Rosen, B., Heeney, N.D. et al. Relationship between three aspects of resilience—adaptive characteristics, withstanding stress, and bouncing back—in hospital workers exposed to prolonged occupational stress during the COVID-19 pandemic: a longitudinal study. BMC Health Serv Res 23, 703 (2023). get it here
  • RG Maunder, ND Heeney, LP Jeffs, RA Greenberg, LA Wiesenfeld, J Johnstone, JJ Hunter. The Relationship between Moral Distress, Burnout, and Considering Leaving a Hospital Job during the COVID-19 Pandemic: A Longitudinal Survey. BMC Nursing 22, 243 (2023). get it here
  • Korman MB, DiProspero L, DasGupta T,  Sinyor M, Anthony S, Kastner M, Ellis J, Steinberg R, Maunder R. Recommendations for Supporting Healthcare Workers’ Psychological Wellbeing: Lessons Learned During the COVID-19 Pandemic. Healthcare Management Forum. 2024.
  • Gutmanis, I., Sanni, A., McGeer, A., Maunder, R., Robertson, N., CCS Working Group & Coleman, B.L.  Level of patient contact and Impact of Event scores among Canadian healthcare providers during the COVID-19 pandemic. BMC Health Serv Res 24, 947 (2024). get it here.