| Course | NU706 Ethics, Policy, and Advocacy in Population Health |
|---|---|
| Unit | Unit 6 |
| Paper type | Moral distress analysis |
| Length | About 1,120 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NU706 Unit 6
Discharged at 1700 With Insulin He Could Not Buy: A Unit 6 Analysis of Moral Distress on a Medical-Surgical Unit
[Student Name]
Purdue University Global
NU706: Ethics, Policy, and Advocacy in Population Health
Unit 6 Moral Distress Analysis
[Instructor Name]
[Date]
The patient, nurses, unit and survey figures are composite and illustrative; the instrument and studies cited are real.
The Case
Mr. Ruiz was admitted with a glucose above 500 and new type 2 diabetes. By Friday he was eating, his glucose was in range on basal insulin and the hospitalist wrote a discharge order at 1300. His nurse, Kendra, taught him the pen and watched a correct return demonstration. At 1530 the outpatient pharmacy called: his pen would cost $312 for the month at cash price, and he said he had about $60 until his next check. The case manager had left at 1500. The manufacturer's assistance program required a signed application, proof of income and a prescriber form, none of which could be completed before Monday. The hospitalist, reached by page, said the patient was medically ready and the bed was needed for an admission waiting in the emergency department.
Kendra discharged him with a written plan, a prescription and the clinic's phone number. Her note reads, "Patient states he will try to get insulin next week." On Monday, the follow-up call reached a voicemail. Nine days after discharge he was back, this time through triage, with a glucose of 486.
Why This Is Moral Distress
Jameton (1984) first distinguished moral distress from moral dilemma: in a dilemma, a person does not know which action is right; in distress, the person knows and cannot act on it because of constraints. Later work has widened the definition. A narrative synthesis of the literature concluded that most accounts share two elements, a moral event and the psychological distress that follows, and that the constraint may be internal as well as external (Morley et al., 2019).
Kendra knew what the right action was: Mr. Ruiz should not leave without a way to get insulin. The constraints were external and specific. The discharge order and the bed shortage set the time, the pharmacy price set the barrier, the assistance program's paperwork and office hours made the obvious remedy unavailable before the weekend and no policy authorized a bridge supply. Each constraint had a reason. Together they made it impossible for her to do what she knew was right, which is the structure the definitions describe.
She was not unsure what to do; she was unable to do it, and that is the difference that matters.
How Often It Happens Here
The case was not unique. After it, the unit council invited nurses on 5 West and 6 West to complete the Measure of Moral Distress for Healthcare Professionals, a 27-item instrument that asks respondents to rate every listed situation twice, once for frequency and once for the intensity of the distress it causes (Epstein et al., 2019). Forty-four of 61 nurses responded. The item about following orders for care the nurse believes is inadequate because of cost or insurance was one of the three highest-scoring items on both units, with 31 respondents rating it at least moderately frequent.
In the instrument's development study, nurses scored higher than physicians, and clinicians considering leaving their positions scored markedly higher than those who were not (Epstein et al., 2019). On our units, 12 of the 44 respondents reported thinking about quitting their job within the last twelve months, and their mean score was well above the mean for those who had not. A unit survey cannot show that distress caused the intent to leave, but the pattern matches the published one and gives the unit a reason to act.
Effects on Nurses and Patients
Kendra described the evening afterward as "the shift I keep replaying." Moral residue, the distress that lingers after the event, is often cited as a reason that repeated episodes harm clinicians even when each one seems minor. Two other nurses on the council said they had begun leaving teaching for cash-paying patients to the end of the shift, "so I don't have to find out what it costs." That response protects the nurse and harms the patient, and it shows how unaddressed distress can reshape practice quietly.
For patients, the effect is direct. A patient who leaves with a prescription he cannot fill is, in practice, discharged without treatment, and the teaching he received becomes a skill he has no means to use. Mr. Ruiz's return visit cost the hospital more than a month of insulin would have, before counting the risk of ketoacidosis or a fall at work on a roof. The distress the nurses describe is therefore not a private feeling to be managed; it is an accurate signal that something in the discharge process is failing patients.
Responses at Three Levels
Responses should change the constraint where possible, not only help nurses tolerate it.
At the individual level, nurses need a way to act when they recognize the situation. The unit will add a step to the discharge checklist: if a patient on new insulin cannot afford the prescribed product, the nurse must notify the charge nurse before discharge, and the charge nurse may delay discharge for up to two hours to find a solution. That small authority turns silent distress into a defined action.
At the unit level, the council will hold a short debrief after any discharge in which a nurse believed a patient left without safe access to medicine, and record the case. Debriefs are not a cure for distress, but recording cases builds the evidence the next level needs.
At the system level, three changes would remove most of the constraint: a price check for cash-paying patients earlier in the stay, as the Unit 4 revision proposes; a case manager or pharmacy technician available on Friday evenings; and a small fund for a 30-day bridge supply when a patient has no other route. The council will present the survey results and the recorded cases to nursing leadership with that request. A referral to the ethics committee is also appropriate, since the case raises a question of policy, not only of one nurse's conduct.
Conclusion
Kendra's Friday evening fits the definition of moral distress exactly: she knew what was right and was prevented from doing it by constraints she did not create. The survey shows that the same constraint troubles most nurses on two units and is linked, at least in pattern, to intent to leave. Responses that give nurses a defined action, record cases and remove the price barrier at discharge address the cause rather than only its effects on staff.
References
Epstein, E. G., Whitehead, P. B., Prompahakul, C., Thacker, L. R., & Hamric, A. B. (2019). Enhancing understanding of moral distress: The Measure of Moral Distress for Health Care Professionals. AJOB Empirical Bioethics, 10(2), 113-124. https://doi.org/10.1080/23294515.2019.1586008
Jameton, A. (1984). Nursing practice: The ethical issues. Prentice-Hall.
Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2019). What is "moral distress"? A narrative synthesis of the literature. Nursing Ethics, 26(3), 646-662. https://doi.org/10.1177/0969733017724354
NU706 Unit 6 instructions, in plain terms
Unit 6 brings the course's ethics work back to nurses themselves, asking students to analyze an instance of moral distress and what an organization should do about it. Prompts commonly want a case described in enough detail to see the constraint, an explanation of why it is distress rather than uncertainty, some evidence of how often it occurs, its effects on staff and patients and responses at more than one level. Instructors favor cases from the student's own setting, with names and details changed. A validated instrument, even applied informally, strengthens the claim about frequency. A definitional source belongs among the references, beside the evidence on frequency. The paper should end with responses that alter the constraint, since resilience training alone treats the nurse as the problem and is usually marked down as incomplete.
Inside the NU706 Unit 6 example
The case section gives the timeline from the 1300 discharge order to the 1530 price call and the 1700 departure, then the nine-day return. A definitions section uses Jameton and Morley to show the structure of distress and matches each constraint in the case to it, under a highlighted line on being unable rather than unsure. Survey results from 44 of 61 nurses follow, using the instrument Epstein and colleagues developed, with its link to intent to leave stated cautiously. The effects section reports that some nurses had begun pushing teaching for cash-paying patients to the end of the shift, with a margin note tying distress to patient harm. Three levels of response close the paper: a defined action for the bedside nurse, recorded debriefs for the unit and three system changes, plus an ethics committee referral.
Where the points sit in the NU706 Unit 6 rubric
Graders in NU706 look first at whether the case fits the concept, so a paper that calls ordinary disagreement moral distress loses credit early. Accurate use of a definition earns points, especially when each element of the case is mapped to it. Evidence of frequency, whether from published data or a unit survey, carries weight, and so does honest reporting of its limits. The effects section is judged on whether it reaches patients as well as staff. Responses are the largest criterion in most rubrics: they should be specific, assigned to a level and aimed at the cause. Use of a validated instrument, scholarly sources and correct APA 7 format account for the rest. Many instructors also give credit for recognizing when a case belongs before an ethics committee rather than a staff meeting.
NU706 Unit 6 help from the desk
The most common shortfall in a moral distress paper is a moving story with no analysis of the constraint behind it. Next is a definition quoted at length and then left behind, with no element of the case matched to it. Some writers claim a survey proves distress causes turnover, when a single unit survey can only show a pattern. Responses that rely on self-care, yoga or resilience classes miss the point of the concept and tend to score poorly. Papers also lose marks for leaving out the patient's outcome. Start by writing the one action the nurse knew was right and the specific barrier that stopped it, then ask who could remove that barrier. A custom analysis can work from the situation that troubled your own unit, kept composite, with responses matched to your organization.
Get an NU706 Unit 6 example written to your instructions
Send the situation, the people involved and the analysis instructions with the rubric. A custom analysis names the constraint, its effects and steps at the individual and system levels. It is free the first time and arrives within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU706 Unit 6 questions, answered
What is moral distress?
The experience of knowing the ethically right action but being constrained from taking it, often by institutional or resource limits. It differs from uncertainty about what is right.
How is moral distress measured?
Instruments such as the Measure of Moral Distress for Healthcare Professionals assess frequency and intensity across common situations.
What reduces moral distress?
Changing the constraint where possible, ethics consultation, debriefing and giving staff a way to act, such as a defined process for the situations that cause distress.
Where can I find a free NU706 Unit 6 sample paper?
Yes, the full NU706 Unit 6 moral distress analysis appears above, built on a Friday discharge of an uninsured patient on insulin he could not buy, with unit survey results and responses at three levels.
How does the NU706 Unit 6 sample show the case is moral distress?
It uses Jameton's distinction: the nurse knew the right action, that the patient should not leave without insulin, but specific external constraints, the discharge time, the price and closed offices, prevented her from taking it.