Characterizing Moral Distress and Moral Injury among Healthcare Chaplains
Rigo Azanwi,MDiv, is a Roman Catholic Capuchin Franciscan Priest, Saint Joseph Church, York, Pennsylvania and a Master in Bioethics (MBE) Student, Harvard Medical School 

Moral distress and moral Injury (MD/MI) are common among health care professionals. Recent studies, centered primarily on nurses and physicians, have identified a correlation between several mental health concerns and MD/MI and underscored the prevalence and severity of MD/MI among these healthcare clinicians. While healthcare chaplains play a significant role in healthcare teams, by providing pastoral care to patients and staff in times of trauma, serious illness and death, there is a paucity of data measuring MD/MI among chaplains. The aim of this study was to identify the frequency and predictors of MD/MI among chaplains in the US. Understanding MD/MI among chaplains can guide future intervention to mitigate their impact among chaplains and reduce burnout and improve their ability to address spiritual needs in clinical setting. A quantitative and qualitative survey-based study of 360 chaplains across the US was conducted. The Measure for Moral Distress (MMD-HP) Scale and Expression of Moral Injury scale—military version (EMIS-M) scales were used to assess MD/MI. Additionally, chaplains were asked open-ended questions regarding their experiences of MD/MI.  Descriptive statistics were employed to characterize MD/MI among chaplains, and linear regression was used to assess predictors of increasing MD/MI. A qualitative analysis was used to examine themes regarding chaplain MI/MD. The results show most of the surveyed population experienced frequencies of MD/MI. Other predictors of MD/MI were influenced by demographic factors — age, race, religious affiliation, and professional factors —years in practice and practice location. MD/MI exist among chaplains and there is a need to identify mitigating measures to avoid burnout.