{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:52:35Z","timestamp":1777949555282,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:00:00Z","timestamp":1777680000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CIHR Operating Grant","award":["170381"],"award-info":[{"award-number":["170381"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Organizations ought to demonstrate a responsibility for conditions that reduce moral stress and enhance moral resilience for their employees. No literature to date has explored how Emergency Management Personnel (EMP) experience both moral stress and distress [(di)stress], building up to stigma during health crises, given their role in emergency management operations. This study draws from a primary study of EMP, including frontline and first responders and those in leadership, who reported structural stigma during the COVID-19 pandemic. Our research question was, In what ways did structural stigma shape the moral landscape of emergency management practice during COVID-19? This qualitative study draws on the paradigm of critical realism to conduct thematic analysis. Interviews and focus groups were collected in 2024 from a total of 23 participants in the Greater Toronto Area, Canada. Participants represented EMP across emergency and public service sectors. System-level stressors revealed disruptions or \u201ccracks\u201d from an overwhelmed public services system. In sum, systemic \u201ccracks\u201d gave rise to organizational mechanisms designed to compensate for system failures, inadvertently propagating structural stigma. At times these mechanisms generated moral distress and\/or resilience, through simultaneously expanding and limiting EMP\u2019s responsibility and agency. The authors suggest that EMP build their leadership capacity to enhance skills of structural competency.<\/jats:p>","DOI":"10.3390\/ijerph23050604","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:06:21Z","timestamp":1777860381000},"page":"604","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How \u2018Cracks\u2019 in Canada\u2019s Public Services System Manifested as Moral (Di)Stress or Resilience for Emergency Management Personnel During COVID-19: A Critical Realist Study"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5446-5853","authenticated-orcid":false,"given":"Andrew","family":"Schembri","sequence":"first","affiliation":[{"name":"Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9636-3118","authenticated-orcid":false,"given":"Doris Yuet Lan","family":"Leung","sequence":"additional","affiliation":[{"name":"School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2058-4755","authenticated-orcid":false,"given":"Aaida","family":"Mamuji","sequence":"additional","affiliation":[{"name":"Disaster & Emergency Management, Faculty of Liberal Arts & Professional Studies, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mac Osa","family":"Osazuwa-Peters","sequence":"additional","affiliation":[{"name":"Disaster & Emergency Management, Faculty of Liberal Arts & Professional Studies, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-2751","authenticated-orcid":false,"given":"Charlotte T.","family":"Lee","sequence":"additional","affiliation":[{"name":"Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s12961-025-01395-9","article-title":"Impact of the COVID-19 pandemic on the Canadian healthcare workforce: A rapid evidence synthesis of key considerations, lessons learned, and promising practices to address the healthcare workforce crisis","volume":"23","author":"Murphy","year":"2025","journal-title":"Health Res. 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