One of the major contributors to stress during the COVID-19 pandemic is that you continue to work despite the risks the pandemic poses to you, your family, and your community. For public safety personnel (PSP), the consequences of this stress can include compassion fatigue, burnout, and moral injury.

Compassion fatigue

Compassion fatigue occurs after witnessing crises and empathizing with others’ pain. It is seen primarily among police, firefighters, paramedics, caregivers, mental health workers, and other healthcare professionals. It can be caused by a single event or the cumulative effects of prolonged exposure to pain and trauma. PSPs who are getting continuous news updates about COVID-19, witnessing first-hand the effects of the virus, and dealing with operational and community challenges may be at risk of developing compassion fatigue. This can lead to psychological effects, including feelings of helplessness and confusion, as well as physical effects that can make it hard to function.

See our glossary of terms to learn more about compassion fatigue.

Burnout

Burnout is similar to compassion fatigue in that it is caused by being overwhelmed by workplace conditions. However, it is more general in that people in all sectors, not just PSPs and caregivers, can develop burnout if chronic stressors are left unaddressed. Burnout usually appears as a lack of interest in work, exhaustion, and a reduction in work abilities.

See our glossary of terms to learn more about burnout.

Moral injury

Moral injury is a condition that can occur by doing something that goes against your deeply held moral beliefs or by having to make a morally difficult choice (such as who does or does not get a medically necessary intervention). In PSPs, this happens most often when you’re unable to act in the best interests of someone you’re trying to protect or help, or when organizational constraints interfere with your ability to provide the best care or service possible. A health crisis like COVID-19 can put PSPs at risk of moral injury if resource constraints force them to make triaging decisions that may lead to worse outcomes for some people.

Read more about moral injury as it relates to COVID-19.

See our glossary of terms to learn more about moral injury.

See the Guide to Moral Injury developed by the Centre of Excellence on PTSD and Phoenix Australia

Some signs of compassion fatigue, burnout, and moral injury

Recognizing the warning signs of these types of stress is critical because they can negatively impact your personal, social, and occupational performance. Identifying them early may help you improve public safety as well as your job satisfaction and co-worker relationships. The warning signs can include:

  • Physical and/or emotional exhaustion
  • Emotional numbness, lack of emotion
  • Feelings of being overwhelmed
  • Feelings of powerlessness, especially in relation to causes of stress and suffering
  • Changes in sleep patterns, including sleeping too much or difficulty sleeping
  • Physical symptoms, such as headaches, nausea, or stomach aches
  • Substance use, either prescribed or not
  • Increased anger, irritability, or anxiety
  • Avoidance, withdrawal, or self-isolation
  • Decline in performance at work and home
  • Difficulty making decisions
  • Relationship difficulty with co-workers, friends, or family
  • Reduced empathy for others
  • Cynicism
  • Reduced career satisfaction
  • Hypersensitivity

This is not an exhaustive list of all potential signs and symptoms of stress. Be sure to monitor your reactions, thoughts, and feelings, and reach out to your supports if you feel that you need help.

Strategies to reduce the symptoms of compassion fatigue, burnout and moral injury

The following strategies can help you reduce the impact of the unique stresses caused by the pandemic:

  • Recognize the signs and symptoms of stress. If you think you may be dealing with more than just stress — such as anxiety, depression, alcohol use, or other clinical conditions — you can use one of our anonymous online screening tools to help you determine if you should seek additional care.
  • Be compassionate, and try not to judge yourself or your response to pandemic-related situations. Give yourself time to understand your reactions and why you may be feeling stressed.
  • Seek friends and supports to confide in. Be innovative and creative to ensure you respect physical distancing guidelines.
  • Turn off social media and news about the pandemic if it becomes too much. You may find it helpful to schedule specific times to check media/news coverage (e.g., once or twice a day).
  • Make a list of coping strategies that work for you and schedule time to use them. These could include:
    • Mindfulness
    • Physical activities
    • Creativity such as music or art
    • Reading for pleasure
  • Focus on the things you have control over and identify a few positives every day.
  • Eat healthy foods. Resist the temptations of cravings and comfort food.
  • Familiarize yourself with the resources available to you if you have questions or feel overwhelmed due to the stress of the pandemic.

As a PSP, you have an important role in serving your community and family, but you are entitled to put your own needs first sometimes. This is not selfish. It will likely help you be better able to respond to the needs of others. Try to maintain a balance, know your limits, and be okay with saying no when you need to.

The COVID-19 Readiness Resource Project (CRRP) features several virtual town halls that focus on wellbeing, self-care, or moral injury:

  • Managing the Pandemic: Promoting the Well-being of Public Safety Personnel and Their Families with Dr. James Thompson, Sylvie Châteauvert, Christine Godin, Capt. Alain Pellegroms, Meghan Provost, and Sgt. Casey Ward

Managing the Pandemic” Town Hall

  • Self-care During Times of Crisis and Change with Meghan Provost, Nathalie Dufresne-Meek, Katherine Belhumeur, Richard Doyle, and Drs. Alexandra Heber and Rose Ricciardelli, plus a special message from Commissioner Anne Kelly to members of the Correctional Service of Canada

Self-Care During Times of Crisis” Town Hall

  • Moral Dilemmas and Moral Injury: Confronting Wicked Problems, Ticky Questions, and Tough Decisions with Drs. Alexandra Heber and Suzette Brémault-Philips, Robert Stewart, and Nathalie Dufresne-Meek

Moral Dilemma’s and Moral Injury” Town Hall

  • Risk and Resilience to Moral Injury Among Public Safety Personnel and Healthcare Providers with Drs. Margaret McKinnon and Ruth Lanius, Robert Stewart, and Lt. Wade Wallace

Risk and Resilience to Moral Injury” Town Hall

Sources:

  • Canadian Institute for Public Safety Research and Treatment. (2019). Glossary of terms: A shared understanding of the common terms used to describe psychological trauma (version 2.1). Regina, SK: Author. http://hdl.handle.net/10294/9055.
  • Sinclair, S., Raffin-Bouchal, S., Venturator, L., Mijovic-Kondejewski, J., & Smith-MacDonald, L. (2017). Compassion fatigue: A meta-narrative review of the healthcare literature. International Journal of Nursing Studies69, 9–24. doi: 10.1016/j.ijnurstu.2017.01.003.
  • Litz, B.T., Stein, N., Delaney, E., Lebowitz, L., Nash, W.P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
  • Centre for Addiction and Mental Health. (2017). Is there a cost to protecting, caring for and saving others? Beware of compassion fatigue. https://www.camh.ca/en/camh-news-and-stories/is-there-a-cost-to-protecting-caring-for-and-saving-others-beware-of-compassion-fatigue
  • Mathieu, F. (2008). The compassion fatigue workbook. compassionfatigue.ca
  • Coetzee, S.K., & Klopper, H.C. (2010). Compassion fatigue within nursing practice: a concept analysis. Nursing & Health Sciences,12(2), 235–243. Doi: 10.1111/j.1442-2018.2010.00526.x.
  • Jenkins, B., & Warren, N.A. (2012). Concept analysis: Compassion fatigue and effects upon critical care nurses. Critical Care Nursing Quarterly35(4), 388–395.
  • Boyle, D.A. (2011).Countering compassion fatigue: a requisite nursing agenda. Online Journal of Issues in Nursing,16(1).
  • Centre for Disease Control and Prevention. (2020, April 1). Stress and coping. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

English: https://www.moralinjuryguide.ca/

French: https://blessuremorale.ca/