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Table 2 Illustration of the analytical steps

From: Moral distress - a threat to dementia care? A qualitative study of nursing staff members’ experiences in long-term care facilities

Quotes

Initial codes

Preliminary themes

Final themes

“Next of kin want intravenous treatment for every infection, but they do not see how demanding it is for the resident, as they are not present all the time” (P4)

“It is quite demanding to perform (intravenous treatment)– it goes so much against what I should do for the resident, but then you do it for their next of kin” (P17)

Next of kin and nursing staff have different opinions about treatment levels

Disagreements with next of kin about treatment are highly demanding experiences for nursing staff

Nursing staff feel forced to give painful treatment

Nursing staff feel forced by next of kin to provide futile treatment

Feeling compelled to provide futile end-of-life care

“You are left quite helpless. When your offer is refused when they just reject you. Then, how are you going to help? “(P9)

“It is an ethical dilemma when you see how they (the residents) are not comfortable.” P19

Nursing staff feel helpless when “care” is rejected, and they are not able to help the resident with pain relief

Provision of pain relief is morally difficult when residents are unable to understand why such measures are implemented

Nursing staff are rejected from helping the residents with pain relief

Providing pain relief against the resident’s will is morally difficult

Being prevented from providing necessary pain relief at the end of life

“I feel bad, but I truly do not have a choice. Because there are so many requiring my assistance” P12

“You have to postpone palliative care until the definite end; it is only at the very end of their life they get that hand to hold” P16

Nursing staff feel bad because they have to little time to each resident

Nursing staff experience lack of recourses make them do hard prisonizations

Nursing staff feel torn between spending time with each resident and the pressure of spending time with all the residents

Time constrains require hard prioritizations

Being exposed to time constraints and challenging prioritizations