Supporting mental health and preventing moral injury among long term care+ workers: A mixed methods tool kit development and implementation study

Long term care+ (LTC+) is at the center of tragic outcomes of COVID‑19 and LTC+ workers are facing pronounced risk for occupational stress related injuries including moral injury. Moral injury results from guilt and/or shame that accompanies knowing what is needed yet being unable to do what is needed owing to constraints outside one's control (Dean, 2020). For LTC+ workers, moral injury may occur from experiences such as guilt over being required to "police" end of life visits where family members are only permitted to touch dying loved ones through gloved hands. Moral injury is being newly and necessarily applied to understand occupational stress of health care workers during COVID‑19 because compared to individually focused concepts such as burnout, moral injury locates the source of problems in the structures and processes in which individuals are immersed. Our research question is: how do we support mental health and help prevent moral injury among LTC+ workers? Our objectives are to: 1-gather stakeholder evidence about worker mental health needs and moral injury risks; 2-collect stakeholder assessments of a selection of mental health support/moral injury prevention tools; 3-create and disseminate a mental health support/moral injury prevention toolkit tailored to LTC+ workers in pandemic conditions; and 4-develop theory and evidence-based implementation strategies for scaling and spreading our toolkit.