{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:13:06Z","timestamp":1778764386811,"version":"3.51.4"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"\n Background<\/jats:title>\n The global long-term care (LTC) sector is increasingly strained by entrenched structural vulnerabilities, including persistent workforce shortages, constrained resources, high resident-to-staff ratios, and rising clinical complexity, all of which compromise the delivery of safe, high-quality care. In Canada, these challenges are particularly acute, placing substantial psychological, emotional, and ethical strain on LTC workers. Despite this, empirical insight into their lived experiences, particularly within Ontario remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study explores the lived experiences of LTC staff and leaders in Ontario, Canada, examining work-related stressors and coping strategies across the acute and post-acute phases of the COVID-19 pandemic through the lens of Lazarus and Folkman's (2008) Transactional Model of Stress and Coping to inform interventions that support workforce well-being and strengthen care delivery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A qualitative co-design approach was employed using purposive and convenience sampling. Twenty-four LTC staff, including personal support workers, registered nurses, and administrators, participated in eleven focus group discussions. Guided by Experience-Based Co-Design (EBCD) principles, participants were engaged as co-researchers, contributing as collaborative partners in identifying emotionally salient \u201ctouchpoints\u201d and jointly reflecting on workplace stressors and coping strategies. Data were thematically analyzed and subsequently mapped onto the Transactional Model of Stress and Coping, including problem-focused, emotion-focused, and meaning-focused coping strategies.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Five themes were identified, each reflecting an emotionally salient touchpoint and its corresponding coping response: (i)\n Together in<\/jats:italic>\n exhaustion: solidarity through emotion-focused coping; (ii)\n Silent<\/jats:italic>\n in grief: shared healing and meaning-focused coping\n ;<\/jats:italic>\n (iii)\n Living in a prolonged emergency<\/jats:italic>\n : coping within institutional constraints; (iv)\n Care as connection:<\/jats:italic>\n relational resilience through meaning-focused coping; and (v)\n Reclaiming control through redefined boundaries:<\/jats:italic>\n problem-focused coping. Across themes, coping emerged as dynamic, relational, and co-constructed, supported by team cohesion, relational validation, and participatory leadership.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n This study illuminates how LTC workers navigate emotionally salient touchpoints and systemic constraints while sustaining compassionate care through coping processes that are relational, co-constructed, and shaped by supportive interpersonal and organizational contexts. By integrating the Transactional Model with EBCD, it advances methodological and theoretical understanding of coping as a dynamic, context-embedded process rather than an individual response. These insights offer actionable directions for strengthening workforce resilience, enhancing organizational supports, and informing more responsive and relationship-centred models of care within LTC.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/frhs.2026.1789803","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:55:17Z","timestamp":1778651717000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Coping in crisis: a qualitative study of stress and resilience in Ontario's long-term care workforce"],"prefix":"10.3389","volume":"6","author":[{"given":"Sheila A.","family":"Boamah","sequence":"first","affiliation":[{"name":"School of Nursing, Faculty of Health Sciences, McMaster University","place":["Hamilton, ON, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farzana","family":"Akter","sequence":"additional","affiliation":[{"name":"School of Nursing, Faculty of Health Sciences, McMaster University","place":["Hamilton, ON, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mawukoenya Theresa","family":"Sedzro","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Western Ontario","place":["London, ON, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.47326\/ocsat.2021.02.07.1.0","article-title":"COVID-19 and Ontario\u2019s long-term care homes. Science briefs of the Ontario COVID-19","volume":"1","author":"Stall","year":"2020","journal-title":"Sci Adv Table"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2307\/41889901","article-title":"Moral distress and the contemporary plight of health professionals","volume":"6","author":"Austin","year":"2012","journal-title":"HHEA"},{"key":"B3","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1016\/j.jamda.2020.06.010","article-title":"Uncovering the devaluation of nursing home staff during COVID-19: are we fueling the next health care crisis?","volume":"21","author":"McGilton","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"B4","doi-asserted-by":"publisher","first-page":"81","DOI":"10.31389\/jltc.278","article-title":"Interventions for addressing moral distress and moral injury in long-term care staff: a scoping review","author":"MacTavish","year":"2025","journal-title":"J Long Term Care"},{"key":"B5","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13010-025-00171-5","article-title":"Moral distress among healthcare professionals in long-term care settings: a scoping review","volume":"20","author":"Vinckers","year":"2025","journal-title":"Philos Ethics Humani Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"6812","DOI":"10.3390\/ijerph20196812","article-title":"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","volume":"20","author":"D\u2019Alessandro-Lowe","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1136\/qshc.2005.016527","article-title":"Experience-based design: from redesigning the system around the patient to co-designing services with the patient","volume":"15","author":"Bate","year":"2006","journal-title":"Qual Saf Health Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hsdr02040","article-title":"Testing accelerated experience-based co-design: a qualitative study of using a national archive of patient experience narrative interviews to promote rapid co-design in healthcare improvement","volume":"2","author":"Locock","year":"2014","journal-title":"Health Serv Deliv Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1535017","DOI":"10.3389\/fmed.2025.1535017","article-title":"Using experience-based co-design approach to address mental health issues among healthcare workers and leaders in long-term care","volume":"12","author":"Boamah","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e077791","DOI":"10.1136\/bmjopen-2023-077791","article-title":"Empowering Ontario\u2019s long-term care residents to shape engagement in their homes: a codesign project","volume":"14","author":"Lee","year":"2024","journal-title":"BMJ Open"},{"key":"B11","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1016\/j.bbi.2020.05.026","article-title":"Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis","volume":"88","author":"Pappa","year":"2020","journal-title":"Brain Behav Immun"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1001\/jama.2020.5893","article-title":"Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic","volume":"323","author":"Shanafelt","year":"2020","journal-title":"JAMA"},{"key":"B13","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1080\/15710882.2014.888183","article-title":"Probes, toolkits and prototypes: three approaches to making in co-designing","volume":"10","author":"Sanders","year":"2014","journal-title":"Co Design"},{"key":"B14","doi-asserted-by":"publisher","first-page":"520","DOI":"10.3390\/ijerph22040520","article-title":"Navigating workforce challenges in long-term care: a co-design approach to solutions","volume":"22","author":"Boamah","year":"2025","journal-title":"Int J Environ Res Public Health"},{"key":"B15","volume-title":"Stress, Appraisal, and Coping","author":"Lazarus","year":"1984"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1016\/S0277-9536(97)00040-3","article-title":"Positive psychological states and coping with severe stress","volume":"45","author":"Folkman","year":"1997","journal-title":"Soc Sci Med"},{"key":"B17","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/9781118993811.ch21","article-title":"Lazarus and folkman\u2019s psychological stress and coping theory","volume-title":"The Handbook of Stress and Health: A Guide to Research and Practice","author":"Biggs","year":"2017"},{"key":"B18","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2752\/175630615X14212498964312","article-title":"Experience-based co-design and healthcare improvement: realizing participatory design in the public sector","volume":"18","author":"Donetto","year":"2015","journal-title":"Des J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"Braun","year":"2019","journal-title":"Qual Res Sport Exerc Health"},{"key":"B20","first-page":"289","volume-title":"Naturalistic Inquiry","author":"Lincoln","year":"1985"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1080\/10615800701740457","article-title":"The case for positive emotions in the stress process","volume":"21","author":"Folkman","year":"2008","journal-title":"Anxiety Stress Coping"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1017\/S1041610218001606","article-title":"A systematic review and meta-analysis of the prevalence and associations of stress and burnout among staff in long-term care facilities for people with dementia","volume":"31","author":"Costello","year":"2019","journal-title":"Int Psychogeriatr"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1111\/jonm.13336","article-title":"Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: a systematic review of quantitative studies","volume":"29","author":"Labrague","year":"2021","journal-title":"J Nurs Manag"},{"key":"B24","doi-asserted-by":"publisher","first-page":"53","DOI":"10.12927\/hcpol.2022.26854","article-title":"COVID-19 issues in long-term care in Ontario: a document analysis","volume":"17","author":"Oldenburger","year":"2022","journal-title":"Healthcare Policy"},{"key":"B25","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1136\/medethics-2020-106764","article-title":"Towards collective moral resilience: the potential of communities of practice during the COVID-19 pandemic and beyond","volume":"47","author":"Delgado","year":"2021","journal-title":"J Med Ethics"},{"key":"B26","doi-asserted-by":"publisher","first-page":"601574","DOI":"10.3389\/fpsyg.2020.601574","article-title":"Coronavirus disease stress among Italian healthcare workers: the role of coping humor","volume":"11","author":"Canestrari","year":"2021","journal-title":"Front Psychol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"113366","DOI":"10.1016\/j.psychres.2020.113366","article-title":"Psychological effects of the COVID-2019 pandemic: perceived stress and coping strategies among healthcare professionals","volume":"293","author":"Babore","year":"2020","journal-title":"Psychiatry Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e924171","DOI":"10.12659\/MSM.924171","article-title":"Psychological impact and coping strategies of frontline medical staff in hunan between January and march 2020 during the outbreak of coronavirus disease 2019 (COVID-19)","volume":"26","author":"Cai","year":"2020","journal-title":"Med Sci Monit"},{"key":"B29","doi-asserted-by":"publisher","first-page":"3330","DOI":"10.1111\/jonm.13845","article-title":"Association between coping strategies and professional quality of life in nurses and physicians during COVID-19: a cross-sectional study","volume":"30","author":"Calegari","year":"2022","journal-title":"J Nurs Manag"},{"key":"B30","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780190619268.001.0001","volume-title":"Moral Resilience: Transforming Moral Suffering in Healthcare","author":"Rushton","year":"2018"},{"key":"B31","doi-asserted-by":"publisher","first-page":"11786329251344772","DOI":"10.1177\/11786329251344772","article-title":"Hidden in plain sight: a scoping review of professional grief in healthcare and charting a path for change","volume":"18","author":"Phillips","year":"2025","journal-title":"Health Serv Insights"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2158244015573912","article-title":"Death is part of the job\u201d: the LTC staff\u2019s grief and bereavement experience","volume":"5","author":"Marcella","year":"2015","journal-title":"SAGE Open"},{"key":"B33","year":"2019"},{"key":"B34","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1001\/jama.2020.8524","article-title":"Nursing home care in crisis in the wake of COVID-19","volume":"324","author":"Grabowski","year":"2020","journal-title":"JAMA"},{"key":"B35","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1111\/jgs.16752","article-title":"Variation in SARS-CoV-2 prevalence in US skilled nursing facilities","volume":"324","author":"White","year":"2021","journal-title":"JAMA"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1002\/smi.3072","article-title":"Relationships between coping, benefit finding, and well-being during COVID-19","volume":"12","author":"Miao","year":"2021","journal-title":"Front Psychol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1196404","DOI":"10.3389\/fpubh.2023.1196404","article-title":"Support- and meaning-focused coping as key factors for maintaining adult quality of life during the COVID-19 pandemic in Germany","volume":"11","author":"Cohrdes","year":"2023","journal-title":"Front Public Health"},{"key":"B38","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1136\/leader-2020-000260","article-title":"Resilience in action: leading for resilience in response to COVID-19","volume":"4","author":"Barton","year":"2020","journal-title":"BMJ Leader"},{"key":"B39","volume-title":"Mental Health at Work: Policy Brief","year":"2022"},{"key":"B40","volume-title":"The U.S. Surgeon General\u2019s Framework for Workplace Mental Health and Well-being","year":"2022"},{"key":"B41","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1186\/s12913-021-06483-4","article-title":"Realist evaluation of schwartz rounds\u00ae for enhancing the delivery of compassionate healthcare: understanding how they work, for whom, and in what contexts","volume":"21","author":"Maben","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e064144","DOI":"10.1136\/bmjopen-2022-064144","article-title":"Value of schwartz rounds in promoting the emotional well-being of healthcare workers: a qualitative study","volume":"13","author":"Ng","year":"2023","journal-title":"BMJ Open"},{"key":"B43","volume-title":"Who Cares? Attracting and Retaining Care Workers for the Elderly","year":"2020"},{"key":"B44","year":"2022"},{"key":"B45","year":"2022"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1789803\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:54:47Z","timestamp":1778763287000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1789803\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":45,"alternative-id":["10.3389\/frhs.2026.1789803"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1789803","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"article-number":"1789803"}}