Chaplains Distinctly Equipped to Address Moral Injury
Ethicists are called on often to address moral injury during consults, but chaplains also are well suited for this important role. “Chaplains are distinctively equipped to explore the potential spiritual and existential dynamics frequently represented within moral injury,” says Keith G. Meador, MD, ThM, MPH, director for the Center for Bioethical Ethics and Society at Vanderbilt University Medical Center.
Meador noticed chaplains were engaging in the care of veterans with moral injury. To learn how chaplains in the VA Healthcare System conceptualize and address moral industry in their work, Meador and colleagues conducted an anonymous survey of 361 chaplains.1 More than 90% of chaplains indicated they encounter moral injury. “VA chaplains consistently recognize that moral injury and spiritual injury, as discerned by them, overlap but are distinct,” Meador notes.
The vast majority (90%) of respondents also agreed chaplains and mental health professionals should collaborate to provide care for moral injury. “It may offer a distinctive opportunity for collaborations between chaplains and other providers to provide ethically responsible care that honors the particular spiritual history and commitments of veteran patients,” Meador says.
Many chaplains supported a collaborative approach to care for moral injury. This was particularly true for chaplains with advanced training in the use of evidence-based practices (through the Mental Health Integration for Chaplain Services). More than one-third of chaplains indicated they offered a moral injury group, or were planning to. Almost one-quarter of the chaplains indicated they collaborate with mental health to address moral injury, or were planning to.
“Systematically including chaplains as collaborators in the care of moral injury is ethically responsible in order to honor and respect the moral complexities and challenges patients face when suffering with moral injury,” Meador says.
Over the last two years, incidence of moral injury have increased among healthcare workers “because of the intensity of the pandemic and effects on healthcare staffing, burnout, and compassion fatigue,” reports the Rev. Mike Guthrie, director of the spiritual care volunteer services and clinical ethics at Presbyterian/St. Luke’s Medical Center in Denver.
Staffing shortages are causing nurses to question if they have compromised their professional and moral code because of higher-than-normal patient ratios. “They go home with a sense of guilt and frustration over the entire situation,” Guthrie says.
Staff had experienced moral injury over facilities’ visitor restrictions that prevented patients’ families from entering the facility. For providers, this was particularly distressing in end-of-life cases. “The moral injury of standing at the bedside in place of a loved one left many staff in distress,” Guthrie says.
When healthcare professionals experience moral injury, says Guthrie, “people experience spiritual and existential distress in the forms of self-doubt, guilt, frustration, anger, depression, and burnout.”
Collaborating with chaplains is crucial in supporting staff when they believe they have compromised their moral integrity. Guthrie argued this point in a paper on the topic.2
Chaplains are trained to work with individuals experiencing spiritual and existential distress. Chaplains could take the same approach with group debriefings of entire nursing units, such an ICU.
“This begins with educating clinicians on the signs and symptoms of moral injury, helping leaders identify its occurrence in their staff, and referring individuals back to the chaplain,” Guthrie says.
Chaplains must also put their “boots on the ground,” says Guthrie. They should be participating in multidisciplinary rounds on critical units to witness firsthand the situations that are causing moral injury.
Using these approaches, says Guthrie, chaplains can take a lead role in addressing moral injury by “developing strategies, such as group debriefs and individual support.”
- Wortmann JH, Nieuwsma JA, King HA, et al. Collaborative spiritual care for moral injury in the Veterans Affairs Healthcare System (VA): Results from a national survey of VA chaplains. J Health Care Chaplain 2021;Nov 26:1-16.
- Guthrie M. A health care chaplain’s pastoral response to moral distress. J Health Care Chaplain 2014;20:3-15.
When healthcare professionals experience moral injury, they experience spiritual and existential distress in the forms of self-doubt, guilt, frustration, anger, depression, and burnout. Collaborating with chaplains is crucial in supporting staff when they believe they have compromised their moral integrity.
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