| Course | NUR-3320 Nursing Science Foundations Theory, Ethics, and Practice |
|---|---|
| Module | Module 4 |
| Paper type | Reflective ethics paper: moral distress |
| Length | About 1,002 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 3320 Module 4
Knowing What Is Right and Not Being Able to Do It: Moral Distress on a Medical Floor
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-3320: Nursing Science Foundations: Theory, Ethics, and Practice
Mentor Name
Month Day, Year
Knowing What Is Right and Not Being Able to Do It: Moral Distress on a Medical Floor
Introduction
In my fourth week of clinical practice I cared for a man who was dying and receiving treatments that seemed only to prolong his suffering. I felt something I had not felt before: a sense that we were doing wrong and that I could do nothing about it. The staff nurse I worked with felt it too, more strongly. This paper names that experience and examines what research says about it.
The Situation
Mr. Kowalski is invented for this paper. He was 84 and had advanced heart failure, kidney failure and dementia. He was no longer able to communicate. Each day he received dialysis, frequent blood draws and repositioning that clearly caused him pain. His physicians had recommended comfort-focused care, but his daughter, his decision maker, insisted that everything be done, saying her father had always been a fighter. The staff nurse, called Ms. Rivera here, cared for him every day. She told me she went home feeling like she was hurting him.
Defining Moral Distress
Jameton (1984) introduced the term moral distress for a nurse's experience of having reached a moral judgment about what should be done while the setting prevents acting on it. He distinguished it from moral uncertainty, not knowing which principles apply, and moral dilemmas, where two or more principles conflict. In moral distress, the nurse has made a moral judgment but cannot act on it.
A Theory of Moral Distress
Corley (2002) proposed a theory of nurse moral distress and a research agenda. She described its sources as including situations in which nurses believe care is futile or harmful, inadequate staffing, lack of collegial relationships and institutional policies that conflict with patients' interests. Its effects included anger, frustration, guilt and powerlessness, physical symptoms and, over time, withdrawal from patients, burnout and leaving positions or the profession. She noted that unresolved distress can leave a moral residue that builds with each new episode. She also identified the potential for moral courage, acting on one's moral judgment despite risk.
Measuring It
Hamric et al. (2012) developed and tested a revised Moral Distress Scale with 21 items describing situations that commonly cause distress, such as following a family's wishes to continue life support when it is not in the patient's best interest or working with levels of staffing considered unsafe. Respondents rate both how often each situation occurs and how disturbing it is. Their testing with nurses and physicians in intensive care and other units found that moral distress scores were higher among those who had left or were considering leaving a position because of it, and that the most distressing items involved prolonging life when it was not in the patient's interest.
| Concept | Source | What it describes in this case |
|---|---|---|
| Moral distress | Jameton (1984) | Knowing comfort care was right but being unable to provide it |
| Moral residue | Corley (2002) | Ms. Rivera's growing distress over many similar cases |
| Measurement | Hamric et al. (2012) | Continuing aggressive treatment against the patient's interest is a top-rated item |
My Experience Through These Lenses
My feeling matched Jameton's definition: I believed comfort care was the right course, and the constraint was the decision of the patient's surrogate, supported by institutional policy. Ms. Rivera's distress fit Corley's description of moral residue, built over years of similar cases. She described feeling angry with the daughter and then guilty for the anger, and said she had considered transferring to an outpatient setting. The situation matched the highest-rated item on Hamric and colleagues' scale.
What Was Not Distress
Reflecting further, I recognized that part of what I felt was moral uncertainty. I did not fully understand the daughter's perspective, her father's earlier wishes or the medical uncertainty. Distinguishing the two matters: uncertainty calls for learning and conversation, while distress calls for advocacy and support.
Ms. Rivera's Moral Courage
Ms. Rivera eventually acted. During team rounds she said, in a calm voice, that she believed Mr. Kowalski was suffering and asked whether a palliative care consultation could be requested. It was a small act, but Corley would describe it as moral courage: speaking up despite discomfort and the risk of conflict with a family and physicians. Watching her taught me that moral courage is often quiet and specific, a question asked at the right moment rather than a confrontation.
Individual Responses
Corley's work suggests that moral courage and advocacy can reduce distress. For a student, this means raising concerns with the instructor and staff nurse, asking questions in team discussions and learning about palliative care. For Ms. Rivera, it might mean requesting an ethics consultation or a palliative care consultation, which the unit can do without the daughter's agreement in many hospitals, to help the family understand the situation. Debriefing with peers and reflective writing help process the experience.
Organizational Responses
Moral distress is not only a personal problem. Hospitals can reduce it through early palliative care involvement, clear policies on potentially inappropriate treatment, accessible ethics consultation, interdisciplinary family meetings and regular debriefings for staff after difficult cases. Units can track moral distress using a validated scale and respond to patterns.
What Happened
After an ethics consultation and a family meeting led by the palliative care team, Mr. Kowalski's daughter agreed to stop dialysis and focus on his comfort. He died peacefully three days later with his family present. Ms. Rivera told me she felt relief but also sadness that it had taken so long.
Limits
My experience is short and shaped by being a student. The case and nurses are invented. Organizational responses vary by hospital.
Conclusion
Jameton's definition named what I felt, Corley's theory explained its causes and its cumulative toll on experienced nurses and Hamric and colleagues showed that prolonging life against a patient's interest is among the most distressing situations nurses face. Moral distress calls for both personal courage and organizational support, and learning to tell it apart from uncertainty is the first step for a new nurse.
References
Corley, M. C. (2002). Nurse moral distress: A proposed theory and research agenda. Nursing Ethics, 9(6), 636-650. https://doi.org/10.1191/0969733002ne557oa
Hamric, A. B., Borchers, C. T., & Epstein, E. G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research, 3(2), 1-9. https://doi.org/10.1080/21507716.2011.652337
Jameton, A. (1984). Nursing practice: The ethical issues. Prentice-Hall.
NUR 3320 Module 4 instructions, in plain terms
Moral and professional reasoning run through TESU's catalog description of NUR-3320, and as TESU keeps the syllabus for enrolled students, module four reflects on moral distress. Define moral distress from its original source and separate it from moral uncertainty and from a true dilemma. Apply a theory of its causes and effects, mention a validated measure and examine your own experience honestly, then propose responses at both the personal and organizational level. Some sections ask students to interview a nurse about a distressing case. Ask whether patient details should be changed beyond what privacy rules require. Describe at least one example of moral courage, from yourself or a nurse you observed, since it shows how distress can lead to action. Note any difference between your distress and a staff nurse's.
How the NUR 3320 Module 4 example is put together
A fictional accelerated BSN student cares for an 84-year-old man with heart failure, kidney failure and dementia whose daughter insists on aggressive treatment. Jameton's definition, Corley's theory of moral residue and moral courage and Hamric and colleagues' revised scale are explained and linked to the case in a table. The student separates her own distress from uncertainty, a staff nurse's long experience is examined and personal and organizational responses are proposed. An ethics and palliative care consultation and its outcome, limits and a conclusion follow. A section on a staff nurse's quiet act of moral courage at rounds is included before the responses. Margin notes point out the line between distress and uncertainty.
NUR 3320 Module 4 rubric: what earns full marks
Readers expect a definition from Jameton, a clear line between distress and uncertainty and a theory applied to the specific case rather than described in general. Referring to a validated scale shows that moral distress can be measured and tracked. Attention to the cumulative toll on experienced nurses, through moral residue, and to moral courage adds depth. Proposals that include organizational changes, such as palliative care involvement and debriefings, show systems thinking. Keeping a student's own actions to raising concerns and learning shows professional judgment. Showing moral courage as a specific, modest act gives students a model they can follow. Comparing a student's brief distress with a veteran's accumulated residue adds insight.
NUR 3320 Module 4 help: mistakes that cost marks
Many papers on this topic describe stress or sadness but never identify what blocked the nurse from acting rightly; name the constraint. Others suggest only personal coping, such as rest or talking with friends. Define the concept from its source, separate distress from uncertainty, apply a theory to your case, mention a scale and propose responses for the unit and hospital as well as for yourself. Change identifying details. Our free first draft, built on your own experience, comes back once you share the prompt. Look for a small, specific way to raise a concern, such as asking for a palliative care consultation at rounds. Notice how distress builds over years, not only within one case.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 3320 Module 4 questions, answered
Where can I find a free NUR 3320 Module 4 sample paper?
The moral distress paper by an invented nursing student caring for a dying patient appears in full on this page.
What is moral distress?
The pain of having judged what is right while the setting blocks acting on it, as Jameton first described.
What is moral residue?
Corley described the lingering distress that remains after morally distressing situations and builds over time.
How is moral distress measured?
Hamric and colleagues' 21-item scale asks respondents to score each situation for frequency and for how much it disturbs them.
How can hospitals reduce moral distress?
Through early palliative care, ethics consultation, clear policies, family meetings and staff debriefings.