Describe a clinical situation in which a registered nurse may encounter moral distress. Answer the AACNs Four A’s found on page 84 in your Butts and Rich textbook to further explain the situation and the possible mitigation strategies.

Four years earlier the AACN ethics work group developed a call-to-action plan titled The Four As to Rise Above Moral Distress (2004). Nurses use the Four As plan as a guide to identify and analyze moral distress:

  Ask appropriate questions to become aware that moral distress is present.

  Affirm your distress and commitment to take care of yourself and address moral distress.

  Assess sources of your moral distress to prepare for an action plan.

  Act to implement strategies for changes to preserve your integrity and authenticity.


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