TABLE 3.

Coding list of experiences potentially challenging/supporting dignity

Initial categories and themes analytical framework	Refined themes	Final themes
Individual level
Illness‐related concerns: ‐ Existential/Spiritual distress (loss of identity, loss of meaning etc.) ‐ Psychological distress (medical uncertainty, death anxiety etc.) ‐ Physical distress (pain, short of breath etc.)	‐Loneliness of the patient (‐) ‐Patients losing meaning in life and giving up (‐) ‐Missing physical contact by patients and relatives(‐) ‐Meaningful moments for relatives and patients (+) ‐Relatives anxious about patients dying alone ‐Relatives’ fear of coming too late (‐) ‐Relatives’ uncertainty and having to make decisions related to patient's treatment (‐) ‐Fear of patients and themselves becoming infected (‐) ‐Relatives advocating comfort for the patient (‐) ‐Patients with dementia not understanding the situation (‐) ‐Unrecognised symptoms of COVID‐19 by GP (‐) ‐Relatives’ concerns about patient not wanting to eat (‐) ‐Rapid physical deterioration of the patient (‐) ‐Relatives not understanding end of life is near (‐) ‐Burdensome symptoms of patient (shortness of breath, agitation and pain) (‐) ‐Patients not receiving physical care or treatment (‐) ‐Good palliative treatment for comfort (+)	Dealing with an unknown illness ‐ Relatives overwhelmed by the rapid process of the disease ‐ GPs unfamiliar with COVID‐19 ‐ Nurses not taking the risk of infection seriously ‐ Relatives’ concerns about medical treatment ‐ Relatives’ fear of vulnerable family members becoming infected Being isolated ‐ Relatives unable to visit patient in nursing homes ‐ Missing physical contact ‐ Patients being alone and isolated ‐ Parents separated from each other ‐ Not understanding ‘window visits’ by patients with dementia ‐ Relatives failing to stay in contact at distance: video calls did not work out ‐ Patients losing meaning and courage to go on ‐ Patients not wanting to eat anymore ‐ Accumulation of factors leading to death Restricted farewells ‐ Saying farewell at the ambulance ‐ Relatives’ fear of themselves becoming infected ‐ Abrupt farewells ‐ Patients dying alone ‐ Fear of being absent or too late ‐ Family frictions; having to choose who is going ‐ Relatives having to wear gloves, masks and suits Lack of attentiveness and communication ‐ Relatives missing attention and attentiveness from HCP ‐ Relatives wishing more contact with GP or Physician ‐ Relatives and patients losing role in the decision‐making process ‐ Relatives having to make decisions about to stop the oxygen ‐ Relatives making an effort to speak the GP ‐ Relatives’ limited contact with GP/HCP through telephone or video calls ‐ Nontactical communication from HCP to relatives Meaningful end‐of‐life moments ‐ Extended visiting opportunities ‐ Relatives’ gratefulness for certain moments ‐ Relatives’ broader perspective of death ‐ Further suffering of patient has been spared ‐ Patients’ wishes were fulfilled ‐ Relatives’ and patients’ spiritual/religious belief ‐ Relatives’ overall acceptance Compassionate professional support ‐ Compassionate nursing care for patients and relatives ‐ Nurses stood up for relatives’ emotions and needs ‐ Open and clear communication
Dignity‐conserving repertoire:Personal characteristics and perspectives ‐ Personal protective practices	‐Patient's wish/promise fulfilled (+) ‐Relatives acceptance of the COVID‐situation (+) ‐Relatives grateful for certain moments or that the suffering of the patient has been spared (+) ‐Relatives’ or patients’ spiritual or religious believes (+) ‐Relatives picking up daily life (+) ‐Relatives sharing their story (+) ‐Relatives’ meaningful moments (+)
Relational level
Social Dignity ‐ Social support (feeling connected and supported by essential others) ‐ Interactions with family and friends ‐ Virtual calls	‐Not being able to physically see each other (‐) ‐Relatives not being able to embrace the patient (‐) ‐Staying in contact via window contact (+ ‐) ‐Saying farewell at the ambulance (‐) ‐Contact possibilities at the end of patient's life (+‐) ‐Not saying goodbye at end of life (‐) ‐Saying goodbye at end of life via phone (‐) ‐Relatives saying goodbye in protective equipment (‐) ‐Fear within the family of becoming infected (‐) ‐Support within the family (‐) ‐ Relatives staying in contact with the patient by telephone or video calls (+‐) ‐ Virtual calls not facilitated by nursing staff (‐)
Professional support (Being taken seriously, being respected, feeling burdened): ‐ Interaction with health care professionals (HCP), such as nurses ‐ Interaction with GP, medical specialist, physician.	‐ Less contact or communication with HCP (‐) ‐ Relatives effort needed to get contact with HCP (‐) ‐ Communication via mail, app, phone (‐) ‐ No communication between disciplines (‐) ‐ Clear communication with HCP(+) ‐ Relatives felt compassion from HCP (+) ‐ Relatives felt no compassion (‐) ‐ No respectful interaction with HCP (‐) ‐ HCP being lax and not acting appropriately in care situation (‐) ‐ HCP standing up for relatives’ needs and emotions (+) ‐ Not receiving attention and care for the patient that was needed (‐) ‐ Loving care for the patient (+) ‐ Less contact with GP (‐) ‐ Difficult for relatives to speak/reach GP (‐) ‐ Regular contact with GP (+) ‐ Nontactical communication from GP toward relatives and patients (‐) ‐ Less compassion (‐) ‐ Patients and relatives not taken seriously by GP (‐)
Societal/organisational level
COVID−19 Policy: ‐ Visiting rules and possibilities ‐ Isolation rules and Personal Protective Equipment	‐No visits anymore after the lockdown (‐) ‐Relatives being present by the patient all day (+) ‐Visiting possibilities were extended in terminal phase (+) ‐Relatives not being able to be present during decease (‐) ‐Visitor policies differed between organisations/departments and changed over time (‐) ‐Limited number of visitors; relatives had to make choices and not everyone could say goodbye (‐) ‐Relatives’ appreciation of nursing staff's handling of visitor policy (+) ‐Limited or no protective equipment for relatives and nursing staff (‐) ‐Unprotected care was provided by nurses (‐) ‐Relatives saying farewell in protective equipment (‐) ‐Not being able to touch/embrace each other (‐) ‐Relative not recognisable in PPE by patient (‐)