# Assessing Moral Injury in Veterans as part of a Chaplain-Delivered Spiritual Assessment: Implications for Social and Community Rehabilitation

> **NIH VA I21** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2021 · —

## Abstract

In recent years, moral injury has been recognized as a source of mental health morbidity in some Veteran
populations and conceptually distinct from existing mental health diagnoses. It represents a constellation of
negative affect, chiefly guilt, shame, anger, and disgust. Moral injury has been associated with a variety of
negative health outcomes, including suicide risk. It has also been theorized to impact select rehabilitation
outcomes. In VA facilities, mental health care providers are the chief source of support for affected Veterans.
Still, moral injury is not routinely assessed or addressed in formal clinical-therapeutic settings. VA chaplains
serve as a source of support for some Veterans affected by moral injury. For example, preliminary findings
suggest that VA chaplaincy service users report a high intensity of potentially morally injurious events. As a
matter of routine practice, chaplains administer pencil-and-paper surveys, called spiritual assessments,
intended to inform chaplaincy services. This project is designed to create a standardized spiritual assessment
tool, comprised of empirically validated instruments, which would simultaneously serve as a vehicle for focused
secondary data collection. The immediate goals of this project are to develop and administer a new
standardized SA tool in VA chaplaincy service with the goal of rapidly identifying individuals with MI and/or
problematic rehabilitation outcomes (e.g., suicide risk) and who are in need of services to address MI. Aim 1 of
this study is to qualitatively examine the feasibility, logistics, and practical implications of developing and
applying a standardized SA tool in VA chaplaincy settings. Aim 2 of this study is to design a standardized SA
tool that (a) meets the stated needs of chaplains and (b) can be used to collect data about moral injury and
rehabilitation outcomes in individual veterans. Focus groups conducted with 8 chaplains and 4 Veterans will be
used to examine (a) how they identify moral injury concerns, (b) incorporating assessment of moral injury with
other aspects of a spiritual assessment, (c) feasibility and logistics of using a standardized spiritual
assessment tool in the chaplains' typical work setting, (d) documentation and procedures to move from
assessment to support for moral injury, and (e) moving from assessment to support for moral injury. We will
use focus groups to assess the feasibility of having VA chaplains use a standardized spiritual assessment tool,
informing the choice of which (a) moral injury instrument(s) is/are most appropriate for inclusion in a
standardized spiritual assessment tool and (b) instruments are most appropriate for examining outcomes
relevant to social functioning, community reintegration, and suicide risk in chaplaincy settings. The
standardized spiritual assessment tool will be developed in collaboration with the VA National Chaplain Center,
which oversees chaplaincy services across all VA facilities. Once approv...

## Key facts

- **NIH application ID:** 10392842
- **Project number:** 5I21RX003029-04
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** Jeanette Irene Harris
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-08-01 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10392842

## Citation

> US National Institutes of Health, RePORTER application 10392842, Assessing Moral Injury in Veterans as part of a Chaplain-Delivered Spiritual Assessment: Implications for Social and Community Rehabilitation (5I21RX003029-04). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10392842. Licensed CC0.

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