Original Manuscript Situating moral distress within relational ethics Sadie Deschenes and Diane Kunyk University of Alberta, Canada Abstract Nurses may, and often do, experience moral distress in their careers. This is related to the complicated work environment and the complex nature of ethical situations in everyday nursing practice. The outcomes of moral distress may include psychological and physical symptoms, reduced job satisfaction and even inadequate or inappropriate nursing care. Moral distress can also impact retention of nurses. Although research has grown considerably over the past few decades, there is still a great deal about this topic that we do not know including how to deal well with moral distress. A critical key step is to develop a deeper understanding of relational practice as it pertains to moral distress. In this article, exploration of the experience of moral distress among nurses is guided by the key elements of relational ethics. This ethical approach was chosen because it recognizes that ethical practice is situated in relationships and it acknowledges the importance of the broader environment on influencing ethical action. The findings from this theoretical exploration will provide a theoretical foundation upon which to advance our knowledge about moral distress. Keywords Ethics, moral distress, nursing, relational ethics Introduction Nurses are moral agents with the responsibility to conduct themselves ethically and provide ethical care. Codes of ethics for nurses are developed to provide guidance for ethical situations and to inform nurses of the moral responsibilities to which they are bound. 1,2 However, due to the complex work environment and nature of ethical situations in everyday practice, codes of ethics alone cannot ensure ethical practice. 1 Nurses are not always able to provide patients with the care they need due to these complexities, and therefore the professional goals of nurses cannot be achieved. When this occurs, nurses may experience moral distress. 3 This phenomenon can include a wide range of feelings such as anxiety, despair, worth- lessness, resentment and anguish. Reports of moral distress are increasing as is our understanding of its numerous effects on nurses, patient care, the healthcare system and the nursing profession. 3,4 Although the research on moral distress has grown considerably over the past few decades, there is still a great deal about this topic that we do not know particularly, effective interventions to address moral distress. A critical key step is to develop a deeper understanding of relational practice as it pertains to moral distress. Corresponding author: Sadie Deschenes, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada. Email: sdeschen@ualberta.ca Nursing Ethics 1–11 ª The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions 10.1177/0969733019884621 journals.sagepub.com/home/nej