Moral Injury Among Healthcare Workers on the Frontlines of the COVID-19 Crisis: Developing a Blueprint for Awareness, Prevention, and Mitigation

Project Summary/Abstract We propose a mixed-methods exploratory study to examine moral injury among healthcare workers who have served on the frontlines during the COVID-19 crisis. We aim to assess the prevalence and impact of moral injury related to the COVID-19 crisis, and to identify key risk and protective factors among healthcare workers stationed in high-risk Veterans Affairs (VA) settings. Then, in partnership with VA stakeholders, we will use study findings to design a pragmatic, testable organizational strategy (a "Blueprint") for moral injury awareness, mitigation, and prevention in healthcare settings. The study will be carried out in three phases: In PHASE 1 (Months 1-9), we will survey healthcare workers (n=300) in VA emergency rooms, inpatient units, and nursing homes. Surveys will assess moral injury, stress, burnout, depression, work climate, and COVID-19-related exposures. We also will gather VA administrative data on COVID hospitalizations/deaths, care quality, and patient/staff satisfaction. We will analyze collected data to identify moral injury risk and protective factors. In PHASE 2 (Months 9-15), we will conduct qualitative interviews (n=30) with workers to gain a more nuanced understanding of moral injury impacts, risks, and protective factors, as well as desired interventions. In PHASE 3 (Months 15-24), we will develop a Blueprint for Moral Injury Awareness, Prevention, & Mitigation in Healthcare Organizations. We will refine it through focus groups with VA stakeholders. The study is designed to address NIOSH's goals for the Health Care & Social Assistance [62] NORA (National Occupational Research Agenda) Sector, including the Strategic Goals to: "improve workplace safety to reduce traumatic injuries" [6] and "promote safe and healthy work design and well-being" [7], and the Intermediate Goal to "conduct basic/etiologic research to better understand the burden of non-fatal injuries in healthcare and social assistance and associated risk factors" [6.4.1]. This project addresses these goals by examining the prevalence and impact (burden) of moral injury-a trauma-related mental health injury-among healthcare workers, examining individual and organizational risk/protective factors, and producing a Blueprint to help healthcare organizations reduce moral injuries and promote healthcare workers' wellbeing. This project aligns with the NIOSH Research to Practice (r2p) initiative by: (a) engaging key stakeholders (partnering VA facilities), (b) addressing questions of concern to them, (c) creating a plan to rapidly translate study findings into a product they can pilot, and (d) refining that product through stakeholder engagement. Study outputs will include the Blueprint for Moral Injury Awareness, Prevention, & Mitigation and scholarly publications. Intermediate outcomes will include: (a) improved understanding of the prevalence and impact of moral injury among healthcare workers, (b) identification of risk and protective factors, and (c) dissemination of promising practices for prevention and mitigation. The end outcome-reduced moral injury prevalence and impact among healthcare workers-will be measured in a future R01 implementation-effectiveness trial.