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

项目摘要/摘要 我们提出了一项混合方法的探索性研究，以检查医护人员的精神伤害。 在新冠肺炎危机期间曾奋战在第一线。我们的目标是评估艾滋病的流行率和影响 与新冠肺炎危机相关的精神伤害，并确定医疗保健中的关键风险和保护因素 驻扎在退伍军人事务部(VA)高危环境中的工人。然后，我们将与退伍军人管理局的利益相关者合作， 利用研究结果为精神伤害设计一个实用的、可测试的组织战略(蓝图) 医疗保健环境中的意识、缓解和预防。研究将分三个阶段进行： 在第一阶段(1-9个月)，我们将调查退伍军人管理局急诊室的住院医护人员(n=300) 病房和疗养院。调查将评估精神伤害、压力、倦怠、抑郁、工作环境和 与新冠肺炎相关的曝光。我们还将收集退伍军人管理局关于COVID住院/死亡的管理数据， 护理质量和患者/工作人员满意度。我们将分析收集的数据，以确定精神伤害风险和 保护性因素。在第二阶段(9-15个月)，我们将对工人进行定性访谈(n=30)，以 更细致入微地了解精神伤害的影响、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)，我们将制定一份关于精神伤害意识、预防、 &医疗保健组织中的缓解。我们将通过与退伍军人管理局利益相关者的焦点小组来完善它。 这项研究旨在解决NIOSH的医疗保健和社会援助目标[62]Nora (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 减少创伤伤害“[6]和”促进安全和健康的工作设计和福祉“[7]，以及 中间目标是“进行基础/病因学研究，以更好地了解非致命性伤害的负担 保健和社会援助及相关风险因素“[6.4.1]。本项目通过以下方式实现这些目标 检查精神伤害--一种与创伤相关的精神健康伤害--的患病率和影响(负担) 医护人员，检查个人和组织的风险/保护因素，并制定蓝图 帮助医疗机构减少精神伤害，促进医护人员的福祉。这个项目 通过以下方式与NIOSH Research to Practice(R2P)计划保持一致：(A)吸引关键利益攸关方(与退伍军人管理局合作 设施)，(B)解决他们关心的问题，(C)制定一项计划，以迅速翻译研究结果 转化为他们可以试用的产品，以及(D)通过利益相关者的参与来提炼产品。 研究成果将包括精神伤害意识、预防和减轻以及学术蓝图 出版物。中期成果将包括：(A)更好地了解艾滋病的流行情况和影响 医护人员的精神伤害，(B)确定风险和保护因素，(C)传播 预防和缓解的良好做法。最终结果-减少精神伤害发生率和 对医护人员的影响-将在未来的R01实施有效性试验中进行衡量。

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.