Table 2 Result of content analysis from FGD with disaster healthcare responders about moral challenges

1. Politics

Not being able to act and being hindered by external circumstances

Type of difficult situation: duration, frequency, and intensity

2. Difficult priorities

3. Cultural aspects in the work context

4. Lack of resources and enormous needs

5. Being hindered by the organization

6. Not being able to act

7. Not being able to give care and comfort

8. Own security hindering giving care

1. Not standing up for values

Actions perceived as insufficient

2. Making different priorities

3. Frustration in not having enough capacities to act sufficiently

4. Inequalities between you and the population/local colleagues

5. Balancing collaboration with other partners and authorities

6. Having to build trust before acting

7. Frustration due to lack of coordination

8. Frustration due to lack of leadership

1. Creating false hope

Imposing harm instead of helping

2. Causing harm instead of helping

3. Different motivations and attitudes among colleagues causing bad reputation

4. Being part of a bad decision/act

5. Colleagues’ wrongdoing

6. Being accused of a decision taken

7. Contributing to/causing inequalities

1. Constructive solutions

Resolving the situation

Managing difficult situations

2. Focus on solutions rather than problems to adapt to the context

3. Create collaborations and ask for help to resolve

4. Using experience

5. Do something instead of nothing

6. Sense of teambuilding

7. Fighting and using courage to resolve

8. Discontinue the mission

1. Realizing unforeseen consequences

Consequences of unresolved situations: moral distress

2. A sense of powerlessness and ruminating

3. Feeling isolated and surreal

4. Feeling scarred

5. Not worth it, leaving earlier

6. Leaving earlier, to save yourself

7. Depending on the time in the field

8. More tough to come home than to be there

9. Finding a new everyday life

10. Feeling alienated

11. Feeling lonely

12. It eventually hits you

13. Losing something

14. Having a pause before going back to work

1. Contribute to improvements and better support

Positive consequences of managing difficult situations

2. Creative solutions

3. Learning from mistakes

4. Self-confidence and learning things about myself

5. More aware of inequalities

6. Growth and being more grateful

1. Relying on informal support while there

Informal support

Tools and support

2. Creative support-seeking while there

3. Lack of access to normal social support while there

4. Lack of social support when home

5. Creating your own support when home

6. Not being lonely with the feeling

1. Lack of accessible formal support from the organization while there

Formal support

2. Formal support when home (debriefings, psychological support etc.)

3. Lack of appropriate support when home

1. Preparations, courses, and trainings

Preparatory support

2. Briefings and information before

3. Lack of adequate information before

1. Other tools used to relieve stress while there

Other tools

2. Going back to work, or take a pause

3. Own methods used to resolve/adopt when coming home

1. Achieve good for others

Altruistic motivation

Engagement as a protective factor

2. Making a difference

1. Creating learning and experience

Professional and personal motivation

2. You do what you can

1. Working within a structure

Framed by the professional role

2. You must follow guidelines

1. We have problems in our own health care system

Challenges are part of the work

2. Have agreed on the conditions

1. Risk-taking in dangerous environments, security risk

Work environment

Work environment stressors as a risk factor

2. Not being able to go back to normal work directly, financial, and personal health risk

3. Traumatic events

1. Malfunctioning team

Stress and exhaustion

2. Facing continuous suffering

3. Having a role of responsibility in stressful environments