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bioethics, moral distress, NICU, palliative care



  1. Hamric, Ann B. PhD, RN, FAAN


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.