One of the more interesting aspects of moral distress is a component first described by nurse researchers Dr. Ann Hamric and Dr. Beth Epstein in a 2009 article published in the Journal of Clinical Ethics. There they characterize MD as having a crescendo effect, where mild to moderate encounters with MD that are not fully resolved can lead to a rising level of overall MD over time. The researchers termed this "moral residue" and characterized the effect in a figure depicted below:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612701/
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