Table 8.

Themes constructed through reflexive thematic analysis of free-text responses to the question “Is there anything you wish to add about ethics rounds?” in a survey of veterinary team members following participation in virtual ethics rounds (n = 89).

Theme	Subtheme	Example(s)
Benefits of ethics rounds	Ethics rounds helps clarify thinking	“While I probably thought like this, it was helpful to formally break down a ethically challenging situation with respect to stakeholders—their impact on the situation, the impact of the situation on them.” “I found that learning about the different frameworks for thinking about ethical challenges useful for ordering my thoughts and talking about tis with clients/colleagues. Like all the bits and pieces were there before but now I can articulate them better.”
	Ethics rounds allows participants to see ethical challenges from the point of view of others	“In particular I can see a real benefit of it to allow people to discuss ethically challenging situations with work colleagues...irrespective of rank. I think an opportunity to air concerns in an open and frank manner is invaluable for each others state of mind. Even if no specific “answer” is arrived at, it is soothing to know that other colleagues have similar concerns and we can learn from each other's strategies to cope.” “This really helped me understand different viewpoints and how to address them.”
	Ethics rounds provided a safe, supportive forum	“Free and open sharing of ethical issues encountered was facilitated by an excellent facilitator, and colleagues were supportive of one-another.” “They provide a safe space for unpacking and engaging ethically challenging situations.”
	Ethics rounds can help veterinary team members identify and deal with moral distress	“It is such an important area to be aware of. I think many vets and nurses experience moral injury without knowing that is what it is as this is a topic most of us have never heard of. For me personally it has been an absolute revelation that a concept like moral injury exists and it has helped me explain my reactions in so many situations across my career but also privately. I think this has huge potential for helping many vets and associated staff.” “There was a sense that our load had been lightened.”
	It was validating to discuss ethically challenging situations	“Surprisingly helpful in validating team member's stress and concern about the ethical decisions they have to make.”
	Ethics rounds increased confidence to speak up in the face of ethically challenging situations	“Discussing topics with peers was extremely rewarding and made me more confident to speak up in the workplace.”
Ethics rounds can have potentially negative impacts on participants		“While I found the overall experience to be positive, reliving some distressing situations which I had encountered caused me some upset. Distressing situations which I encountered in practice changed the course of my career at different points, and so the impact of those challenging situations was significant.”
There are constraints preventing veterinary team members from speaking up in the face of ethically challenging situations		“Whilst it is pleasant to consider all colleagues working harmoniously, there are differences in opinions which should be respected, but any bullying behavior impacts significantly on one's confidence in self-expression. “Gaslighting” continues to be an industry problem.” “There is a strong level of unspoken intimidation in most clinics where I have worked. The more forceful (usually male) voices dominate and are disparaging toward other, less strong, more timid voices, often subduing these into silence, leaving them longing for the security of darkness and anonymity. There is a far greater issue at stake than just the question of ethics here. As with all things, it appears to be about power.” “I think in future perhaps just team members and no managers should participate. I felt that the team were scared to truly voice some opinions with the managers there.”
Ethics rounds could be improved		“More discussion of what could be done in each of the ethically difficult situations.” “…it was more like a webinar than a rounds session, we talked about ethical situations in general terms but without any specifics which made it hard to come to any conclusions on how we might be able to do things differently in future.” “I think if ethics rounds were more frequent and timely (in relation to a particular event), on-going stress and distress might be less of an issue.”
Limitations of the Euro-MCD as it pertained to the experience of participants		“The challenge in this survey is that there are other considerations not included here, which have an impact upon the decision-making.” “Regarding the comment above about support... I am not sure we know enough about support as a community to support each other with ethically challenging situations. We can mentor, and share opinions... but I'm not sure thats the same as support.”