COLLAPSE According to Butts (2016)

"Moral distress occurs when nurses experience varying degrees of compromising moral integrity" (p. 82). A clinical situation where a registered nurse may encounter moral distress is when a patient's code status is do not resuscitate (DNR) and they encounter a situation where the patients condition is declining but the physician is hesitant to treat the patient. DNR does not mean do not treat. I recently encountered a situation where a patient's condition was rapidly declining due to sepsis. He was on a Medical Surgical floor and it was apparent that he needed to be transferred to a higher level of care. He developed a fever, became tachycardic, and his lactic acid was increasing. I reported to the physician about his condition and requested he be transferred and the doctor said, "but he is DNR". Morally, I felt extremely distressed because I knew he needed a higher level of care and that he would continue to decline. At the time I wasn't aware of the "Four A's to Rise above Moral Distress", but did ask the appropriate questions to confirm that moral distress was present.