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

> **NIH ALLCDC R21** · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · 2021 · $196,396

## Abstract

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 facto...

## Key facts

- **NIH application ID:** 10287316
- **Project number:** 1R21OH012201-01
- **Recipient organization:** NORTHERN CALIFORNIA INSTITUTE/RES/EDU
- **Principal Investigator:** Natalie J Purcell
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2021
- **Award amount:** $196,396
- **Award type:** 1
- **Project period:** 2021-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10287316

## Citation

> US National Institutes of Health, RePORTER application 10287316, Moral Injury Among Healthcare Workers on the Frontlines of the COVID-19 Crisis: Developing a Blueprint for Awareness, Prevention, and Mitigation (1R21OH012201-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10287316. Licensed CC0.

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