DNP 661 Module 2 Discussion Board 1: Moral Distress in Advanced Practice Example

Reviewed by Ingrid Vasterling, MSN, RN Arizona State University Updated October 2026

This DNP 661 Module 2 sample is Discussion Board 1 in Ethics and Advanced Nursing Practice, the one graded discussion in this ASU Doctor of Nursing Practice course. ASU DNP 661 schedules the board during the first month, while the readings treat nursing as a moral calling, so the sample applies that idea to a pressure every new nurse practitioner meets: a clinic schedule that books a patient every fifteen minutes. Drawing on her own Safford clinic, the composite student describes a nurse practitioner she works with, separates moral distress from ordinary stress, and explains how unresolved distress builds over time. She asks classmates where the line falls between efficiency and neglect, and two replies extend the thread to rural familiarity and to charting at night.

CourseDNP 661 Ethics and Advanced Nursing Practice
ModuleModule 2
Paper typeDiscussion board post and replies
LengthAbout 468 words
FormatDiscussion post with APA 7 citations
SchoolArizona State University
ProgramDoctor of Nursing Practice
UpdatedOctober 2026

Free sample paper for DNP 661 Module 2

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Discussion Board 1: Nursing as a Moral Discipline

Fifteen Minutes per Patient: Moral Distress When the Schedule Decides

Initial Post

At my clinic, the nurse practitioner I work beside is booked every fifteen minutes from 8 to 5. Last week a woman in her sixties came in for a medication refill and, near the end of the visit, mentioned that her husband had started hitting her. The nurse practitioner had three patients waiting. She gave the woman a hotline card and the name of a shelter, refilled the medication and moved on. Afterward she told me she felt sick about it.

That feeling is not ordinary stress. Moral distress is the pain of seeing what ought to be done and being blocked from doing it by forces outside one's control, here a schedule built for billing rather than for disclosure of abuse (Epstein & Hamric, 2009). The same authors describe moral residue, the feeling that stays after each such episode, and a crescendo in which residue builds with every repeated situation until clinicians become numb or leave. I think the schedule is producing exactly that crescendo in our clinic.

Grace and Uveges (2023) describe nursing as a moral practice whose purpose is the good of the patient. If that is true, a schedule is not a neutral administrative fact. It is a moral structure, because it decides how much attention a patient can receive. Advanced practice nurses therefore have two duties: to do the best we can inside the schedule and to work to change schedules that routinely make good care impossible.

In this case, a better response was available inside the constraint. The nurse practitioner could have asked the next patient to wait ten minutes, completed a brief safety assessment and arranged a warm handoff to our social worker. She now plans to add a standing "safety disclosure" exception to the template that allows a visit to run over without penalty.

Question for the group: where have you seen the line between efficiency and neglect, and who drew it?

What this page is doingThe post names a specific event, defines moral distress and moral residue from the source, then argues that a schedule is a moral structure, which is the course's opening idea applied rather than restated.
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Reply to a Classmate (Family Nurse Practitioner, Rural Clinic)

You wrote that in your town you treat your children's teachers and your neighbors, and that staying professional is hardest when patients expect special access. I see the same in Safford. Roberts et al. (1999) describe how overlapping relationships in small communities make confidentiality and boundaries harder, not because clinicians care less but because everyone knows everyone. Do you have a script for declining a request in the grocery store?

Reply to a Classmate (Psychiatric Nurse Practitioner)

Your point that you finish notes at night because visits run long describes a quieter version of the same distress. The patient gets the time, but you pay for it. I wonder whether moral distress research should count unpaid charting as one of the constraints that slowly wear nurses down.

What this page is doingEach reply links the classmate's experience to a named concept and ends with a question, so the thread advances instead of trading compliments.
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References

Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. The Journal of Clinical Ethics, 20(4), 330-342. https://doi.org/10.1086/JCE200920406

Grace, P. J., & Uveges, M. K. (Eds.). (2023). Nursing ethics and professional responsibility in advanced practice (4th ed.). Jones & Bartlett Learning.

Roberts, L. W., Battaglia, J., Smithpeter, M., & Epstein, R. S. (1999). An office on Main Street: Health care dilemmas in small communities. The Hastings Center Report, 29(4), 28-37. https://doi.org/10.2307/3528064

What the DNP 661 Module 2 instructions ask for

The posted syllabus lists one discussion board in DNP 661, worth 10% of the grade and scheduled in Weeks 1 to 4, when the course introduces nursing as a moral discipline and gives an overview of ethics in nursing. The exact prompt, the posting deadlines and the rubric are in Canvas, so check them before you write. Expect the board to ask you to apply the opening readings to your own practice, using a situation you have seen rather than a hypothetical case, and to respond to classmates in a way that adds something new. Because it is the only board in the course, it carries more weight than a weekly post would. Plan a first post of several paragraphs resting on two or more scholarly sources and replies that each bring in a concept or a question.

Inside the DNP 661 Module 2 example

The initial post begins with a short, concrete scene from the writer's clinic, a disclosure of abuse at the end of a fifteen-minute visit. It then defines moral distress and moral residue from the original article and argues that the scheduling template itself is a moral structure, tying that claim to the course text's view of nursing as a moral practice. A fourth paragraph shows a better response that was possible within the constraint and a change the clinician now plans. A closing question invites classmates to name who drew the line in their own clinics. Each reply responds to a specific classmate's point, adds a source or concept, and ends with a question. The total length stays within what a busy instructor will read closely.

DNP 661 Module 2 rubric: what earns full marks

Graduate discussion rubrics at ASU tend to score five things: how well the first post applies the readings, which sources support it, what the replies add, whether posting met the deadlines and how clearly it is written. The initial post earns most when it applies the week's concepts to a specific situation and takes a position rather than summarizing the readings. Evidence should come from the assigned text and at least one peer-reviewed article, cited in APA format. Replies count when they extend the conversation with a new idea, source or question, and lose credit when they only agree. Posting early in the week gives classmates time to respond, which some rubrics reward directly. Clear, concise writing matters more than length.

DNP 661 Module 2 help: mistakes that cost marks

Many first posts summarize the readings and never reach the writer's own practice. Start from something you have seen and use the readings to explain it. Another frequent problem is calling every hard day moral distress; use the definition and show the constraint that blocked the right action. Keep patient details changed and brief. Replies that say "great post" earn little, so bring in a concept, a source or a question. Describe the scene from your own clinic, with names changed, and the desk can shape a first post from it. Check the posting deadlines in Canvas, because late initial posts limit the replies you can receive. Proofread before posting, since edits after submission may be visible to faculty.

Write yours, or have the desk draft it

This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.

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More DNP 661 and Doctor of Nursing Practice sample papers

DNP 661 Module 2 questions, answered

Where can I find a free DNP 661 Module 2 sample paper?

The discussion post above is a complete DNP 661 Discussion Board 1 sample, with an initial post on moral distress under a fifteen-minute schedule and two replies to classmates.

How many discussion boards are in DNP 661?

The posted syllabus lists one discussion board, worth 10% of the course grade, in the opening weeks on nursing as a moral discipline.

What is the difference between moral distress and stress?

Stress is a general strain from pressure; moral distress is narrower, the anguish of knowing the right step and being blocked from taking it.

What is moral residue?

It is the lingering feeling left after each episode of moral distress, which can build over repeated situations in what Epstein and Hamric call the crescendo effect.

Can I use a situation from my own clinic in the discussion?

Yes, and it usually makes the post stronger, but alter names, ages and settings until nobody in the story could be identified.