Nurses caring for people with advanced illness face decisions in which patient preferences, expected benefit, treatment burden, family expectations, professional duties, and organizational realities may conflict. Ethical difficulty alone, however, does not establish moral distress. This article develops an ethical decision and moral-resilience account that separates the morally salient event, the nurse’s appraisal, practical capacity to speak or act, criterion-based moral distress, persistence as moral residue, and conditions supporting recovery. Professional power and voice, ethical climate, resource constraints, recurrent exposure, reflective practice, and interprofessional ethics support are treated as interacting conditions rather than interchangeable causes. The central contribution is a conditional framework in which moral distress is most plausible when a morally consequential concern remains unresolved or cannot be ethically accommodated, while later outcomes depend on recurrence and multilevel support. Moral resilience is interpreted as professional ethical capacity, not a substitute for organizational responsibility.
