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...