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

COVID-19 危机前线医护人员的道德伤害：制定意识、预防和缓解蓝图

• 批准号: 10287316
• 负责人: Natalie J Purcell
• 金额: $ 19.64万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10287316
• 关键词: Moral; Injury; Among; Healthcare; Workers

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.

项目总结/摘要 我们提出了一个混合方法的探索性研究，以检查医疗工作者的道德伤害， 在COVID-19危机期间在前线服役。我们的目标是评估的流行程度和影响， 与COVID-19危机相关的道德伤害，并确定医疗保健中的关键风险和保护因素 工作人员驻扎在高风险退伍军人事务部（VA）设置。然后，与VA利益相关者合作，我们将 使用研究结果设计一个务实的，可测试的组织战略（“蓝图”）的精神伤害 医疗保健环境中的意识、缓解和预防。这项研究将分三个阶段进行： 在第1阶段（第1-9个月），我们将调查VA急诊室、住院患者 单位和疗养院。调查将评估道德伤害，压力，倦怠，抑郁，工作氛围， COVID-19相关风险。我们还将收集关于COVID住院/死亡的VA行政数据， 护理质量和患者/工作人员满意度。我们将分析收集的数据，以确定道德伤害风险， 保护性因素。在第2阶段（9-15个月），我们将对工人进行定性访谈（n=30）， 获得更细致入微的理解精神伤害的影响，风险和保护因素，以及期望的 干预措施。在第三阶段（15-24个月），我们将制定一个道德伤害意识，预防， 和缓解医疗机构。我们将通过与退伍军人管理局利益相关者的焦点小组对其进行完善。 该研究旨在解决NIOSH的卫生保健和社会援助目标[62]诺拉 （国家职业研究议程）部门，包括“改善工作场所安全”的战略目标 减少创伤性伤害”[6]和“促进安全和健康的工作设计和福祉”[7]， 中期目标是“进行基础/病因学研究，以更好地了解非致命性伤害的负担， 医疗保健和社会援助以及相关风险因素”[6.4.1]。本项目通过以下方式实现这些目标： 研究精神伤害的流行率和影响（负担）-一种与创伤有关的精神健康伤害- 医疗保健工作者，检查个人和组织的风险/保护因素，并制定蓝图 帮助医疗机构减少道德伤害，促进医护人员的福祉。这个项目 通过以下方式与NIOSH研究实践（r2 p）倡议保持一致：（a）与关键利益相关者（与VA合作 设施），（B）解决他们关心的问题，（c）制定一项计划，迅速转化研究结果 转化为他们可以试用的产品，以及（d）通过利益攸关方的参与完善该产品。 研究成果将包括道德伤害意识，预防和减轻的蓝图和学术 出版物。中期成果将包括：（a）更好地了解 卫生保健工作者中的精神伤害，（B）风险和保护因素的识别，以及（c） 预防和缓解的有希望的做法。最终结果-降低了精神伤害的发生率， 将在未来的R 01实施效果试验中进行测量。