Table 2 Results from the data analysis displaying the organization of the overarching theme, themes, categories, and subcategories

Struggling to make the right choice

1. Ethics as a sense of right or wrong

Experiencing various ethical challenges^a

 Challenges between self and organization^b

 Challenges within self^b

 Challenges between self and culture^b

Wanting to do the right thing^a

Recognizing unethical motivations^a

2. Adversely bearing the burden of choice

Experiencing emotional suffering^a

 Powerlessness and instability

 Anger and frustration

 Being isolated and abandoned

 Sadness

Negative impacts on care delivery^a

Not wanting to continue work^a

Needing coping mechanisms^a

 Needing to be tough

3. Held hostage by institutional constraints

Being silenced by the organization^a

Organization feigning ignorance^a

Bureaucracy as an alibi^a

Struggling against orders^a

4. The difficulty of preparing for ethical challenges

Lacking formal ethical guidelines^a

Questioning how to train for challenges^a

Looking for guidance from the team^a

Experience making it easier^a

Positive organizational support^a