Collaborative spiritual care for moral injury in the veterans Affairs Healthcare System (VA): Results from a national survey of VA chaplains.


The psychospiritual nature of moral injury invites consideration regarding how chaplains understand the construct and provide care. To identify how chaplains in the VA Healthcare System conceptualize moral injury, we conducted an anonymous online survey (N = 361; 45% response rate). Chaplains responded to a battery of items and provided free-text definitions of moral injury that generally aligned with key elements in the existing literature, though with different emphases. Over 90% of chaplain respondents indicated that they encounter moral injury in their chaplaincy care, and a similar proportion agreed that chaplains and mental health professionals should collaborate in providing care for moral injury. Over one-third of chaplain respondents reported offering or planning to offer a moral injury group. Separately, nearly one-quarter indicated present or planned collaboration with mental health to provide groups that in some manner address moral injury. Previous training in evidence-based and collaborative care approaches appears to contribute to the likelihood of providing integrated psychosocial-spiritual care. Results and future directions are discussed, including a description of moral injury that may be helpful to understand present areas of emphasis in VA chaplains' care for moral injury.





Published Version (Please cite this version)


Publication Info

Wortmann, Jennifer H, Jason A Nieuwsma, Heather A King, Paola Fernandez, George L Jackson, Melissa A Smigelsky, William Cantrell, Keith G Meador, et al. (2021). Collaborative spiritual care for moral injury in the veterans Affairs Healthcare System (VA): Results from a national survey of VA chaplains. Journal of health care chaplaincy. pp. 1–16. 10.1080/08854726.2021.2004847 Retrieved from

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Jason A Nieuwsma

Associate Professor in Psychiatry and Behavioral Sciences

Dr. Nieuwsma is a clinical psychologist whose interests are broadly related to different aspects of integrative mental health care. He has conducted work in the areas of health psychology, primary care-mental health integration, cross-cultural psychology, implementation science, and extensive work focused on integration of spirituality and health. In addition to being an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke, Dr. Nieuwsma has served for over a decade as Associate Director for Integrative Mental Health (formerly Mental Health and Chaplaincy) in the Veterans Health Administration. He has helped lead multiple projects aimed at more effectively integrating chaplaincy and mental health care services across large healthcare systems, as well as conducting extensive work and training on moral injury, health psychology, and Acceptance and Commitment Therapy (ACT). Dr. Nieuwsma has authored over 50 peer-reviewed journal articles & book chapters; he serves on the editorial board for the APA journal Spirituality in Clinical Practice; he is Associate Editor for the Journal of Health Care Chaplaincy; and he is a co-editor and author on the books ACT for Clergy and Pastoral Counselors and Addressing Moral Injury in Clinical Practice.


Heather Alyse King

Assistant Professor in Population Health Sciences

Areas of expertise: Implementation Science, Health Services Research, and Health Measurement


George Lee Jackson

Adjunct Professor in Population Health Sciences

Areas of expertise: Epidemiology, Health Services Research, and Implementation Science

George L. Jackson, Ph.D., MHA is a healthcare epidemiologist and implementation scientist with a background in health administration.  He joined the faculty of the UT Southwestern Medical Center in February of 2023 as a Professor and Director of the Advancing Implementation & Improvement Science Program in the Peter O'Donnell Jr. School of Public Health.  Dr. Jackson is also a Veterans Affairs (VA) Health Services Research & Development (HSR&D) Research Health Scientist who works with the VA healthcare systems in both Durham, NC and Dallas, TX.  He is the Director of the Implementation and Improvement Science Lab/Core at the Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT).  Additionally, he is a co-leader of a cooperative effort between the Dallas VA and Program on Implementation and Improvement Science designed to enhance the infrastructure for partnered health services and other research across the Dallas VA and UT Southwestern focused on enhancing the health and healthcare of Veterans in North Texas and across the Nation.

The UT Southwestern Advancing Implementation & Improvement Science Program seeks to further enhance collaborations between the UT Southwestern and affiliated health systems and community partners in the pursuit of common missions to enhance the health and healthcare of the people of North Texas.  The goal is to develop a system to identify potentially successful projects using implementation and improvement science – which uses rigorous, data-driven research to expand programs and improve a community’s health.

Dr. Jackson’s own research and evaluation efforts focus on the development, testing, and implementation of team-based approaches to address the treatment and prevention of chronic conditions such as diabetes, hypertension, and cancer.  He has also evaluated efforts to enhance the organization of mental health care.  As an implementation scientist, Dr. Jackson studies strategies focused on the adoption and spread of evidence-informed practices across large health systems.  He is currently the corresponding principal investigator for two VA program grants focused on the process of identifying, replicating, and spreading innovations across large healthcare systems.  These include the Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) partnered evaluation of the Veterans Health Administration (VHA) Diffusion of Excellence program and the Dynamic Diffusion Network (DDN) QUERI Program, both funded by the VA Quality Enhancement Research Initiative (QUERI).

Dr. Jackson received his Doctor of Philosophy (Ph.D.) in epidemiology, Master of Health Administration (MHA), and Bachelor of Science in Public Health (BSPH) in health policy and administration degrees from the School of Public Health at the University of North Carolina at Chapel Hill.  He completed an Agency for Healthcare Research and Quality (AHRQ) pre-doctoral fellowship in health services research at the Cecil G. Sheps Center for Health Services Research and AHRQ post-doctoral fellowship in health services research in the Duke Division of General Internal Medicine and HSR&D Center at the Durham VA.  He came to UT Southwestern from Duke University, where he was a Professor in the Departments of Population Health Sciences, Medicine (Division of General Internal Medicine), and Family Medicine & Community Health.  He also co-taught evidence-based practice in the Duke Physician Assistant (PA) Program.  Dr. Jackson currently maintains appointments as an Adjunct Professor of Population Health Sciences at Duke and Adjunct Professor of Health Policy and Management at the University of North Carolina at Chapel Hill.


Keith G. Meador

Adjunct Professor in the Department of Psychiatry and Behavioral Sciences

Religion and mental health

Theology and medicine

Psychosocial variables in depression in the elderly

Pharmacoepidemiology in nursing homes

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