Mrs. R., an 87- year- old patient, has a past history that includes coronary artery disease, a previous stroke,

and advanced Alzheimer’s disease. Ten days ago, Mrs. R. was hospitalized for aspiration pneumonia and has been ventilator dependent since being admitted to the intensive care unit in a small rural hospital. Family members visit daily and have repeatedly voiced their concern to the nursing staff about the continued ventilator support that Mrs. R. is receiving, most notably the fact that Mrs. R. would never have wanted such care. They also note that Mrs. R. has not recognized them in past months and that they plan to visit less in future days, but can be contacted should any change in Mrs. R.’ s condition occur. Her primary physician has practiced in this community for multiple years; he is well known for his reluctance to discontinue any type of life support for any patient. When questioned, Dr. G.’ s consistent response is, if this were his frail 92- year- old mother, he would prescribe the very same treatment for her. Dr. G. has now requested that the nurses talk to the family about moving Mrs. R. to a major medical center, where she can receive more advanced care, including vigorous rehabilitation and physical therapy, so that she may eventually return to a long- term nursing care facility.

How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress? Apply the MORAL model to resolve the dilemma.