A qualitative meta-analysis of three ethnographic studies conducted by the original investigators of those studies yielded new understandings of the dynamics of health care relationships in context. Through this analysis, the authors show that moral judgments and decision making in health care are highly relational and contextual. The use of power to compel health care providers and patients to comply with organizational practices is shown as fundamental to organizational functioning, and nurses participate in activities that often perpetuate conditions that contribute to their own moral distress. Furthermore, resistant actions often operate to sustain the practice patterns and ideologies being resisted. The authors call for an understanding of moral distress as relational and for collective strategies to counter practices that thwart ethical practice.
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