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The narratives concern complicated situations where the RNs felt uncertain about what is best for the
patient. Patients may send contradictory signals, objecting to the treatment one minute while telling the physician that everything is fine the next day, giving contradictory messages about a wish to withdraw from the
treatment and showing mistrust of the RNs’ competence. Some patients may suffer from cognitive impair-
ment or psychiatric symptoms which make them even more vulnerable. The RNs try to convey their feelings
to the physicians in order to change the regime to one more favourable to the patient but, due to their uncer-
tainty, their message becomes unclear. The RNs experience a lack of serious attention from the physicians
making them feel powerless and unable to change the situation. Having to act against what they believe is
good for the patient, knowing it will cause the patient even more suffering, leads the RNs to have a troubled
conscience and feelings of guilt. To cope with their guilty feelings, the RNs gather in small groups, confirming one another but excluding dissident colleagues and blaming the physicians for not being willing to discuss what might be best for the patient.