Date

8-29-2025

Department

School of Education

Degree

Doctor of Philosophy in Education (PhD)

Chair

David Edgell

Keywords

Moral injury, Delphi study, spiritual trauma, pastoral care, interdisciplinary research, psychological ethics

Disciplines

Educational Leadership

Abstract

This study utilized a modified Delphi method to develop a consensus definition of Moral Injury across theological, clinical, and experiential domains. Recognizing the term's interdisciplinary ambiguity, the research engaged chaplains, clinicians, ethicists, and professionals from healthcare, military, and psychological contexts to discern shared language and conceptual frameworks. The Delphi process consisted of three iterative rounds, progressing from open-ended questions to structured Likert-scale responses and definition validation. While consensus (80% agreement) was not achieved, a majority (61.5%) of panelists affirmed a pneuma-oriented definition that positions Moral Injury as a wound to the spirit resulting from a violation of deeply held ethical or religious beliefs, accompanied by guilt, shame, and disruption of spiritual identity. The findings revealed the multidimensional nature of Moral Injury, integrating internal (anima), behavioral (psyche), and spiritual (pneuma) dimensions. Key implications emerged regarding the limitations of existing institutional frameworks (e.g., DSM-5, United States Medical Licensing Examination [USMLE], legal codes) in capturing the full scope of Moral Injury, particularly in settings where diagnostic standards for spiritual or moral harm are lacking. Participants advocated for theological and pastoral engagement, interdisciplinary education, and the inclusion of lived experiences in future research. The study concludes by proposing applications for clinical care, chaplaincy, policy, and theological formation, while acknowledging methodological limitations, including panel composition bias and interpretive subjectivity. The study contributes to the growing literature seeking integrative, context-sensitive, and spiritually robust approaches to understanding and addressing Moral Injury.

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