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A Case Study of Moral Distress

Hamric, Ann B. PhD, RN, FAAN

Journal of Hospice & Palliative Nursing: December 2014 - Volume 16 - Issue 8 - p 457–463
doi: 10.1097/NJH.0000000000000104
Ethics Series

Moral distress occurs when an individual’s moral integrity is seriously compromised, either because one feels unable to act in accordance with core values and obligations, or attempted actions fail to achieve the desired outcome. Recurrent situations of moral distress can lead to the “crescendo effect,” with buildup of moral distress and moral residue in care providers. This article analyzes a case that led to moral distress in a health care team. Themes of moral distress are identified, and strategies are offered to help clinicians manage such cases. Institutional resources such as ethics committees and palliative care teams can be helpful in dealing with moral distress if they are knowledgeable about the phenomenon.

Ann B. Hamric, PhD, RN, FAAN, is associate dean, Academic Programs, and professor, School of Nursing, Virginia Commonwealth University, Richmond.

Address correspondence to Ann B. Hamric, PhD, RN, FAAN, School of Nursing, Virginia Commonwealth University, 1100 E Leigh St, Room 4009b, PO Box 980567, Richmond, VA 23298 (

The author has no conflicts of interest to disclose.

© 2014 by The Hospice and Palliative Nurses Association.