Applying both articles to ethical analysis and service improvement in care of older adults

The two articles, Fagerberg and Bollig, show that ethical care of older adults depends on both close relationships in daily care and supportive organizational structures. Together, they help us analyze ethical situations not only as single dilemmas, but also as signs of how a service is working.

1. What ethical issues in older adult care look like

Fagerberg describes care as shaped by ethics, organization, and relationships. Carers try to respect older people as individuals, adjust to their pace, listen carefully, and respond to personal needs. Ethical care is shown in ordinary moments: taking time, noticing vulnerability, supporting dignity, and understanding what matters most to the person.

At the same time, Fagerberg shows that carers often face tension between what they believe is right and what the organization allows. Time pressure, routines, and conflict with co-workers or managers can make it hard to provide the care they think older people need.

Bollig adds that ethical challenges are common in nursing homes and are often experienced as a burden by staff. The article shows that ethics is not only about dramatic end-of-life decisions. Many frequent ethical issues are everyday matters that can remain “under the surface,” such as respect, communication, choice, privacy, and how staff respond in routine situations.

2. How to analyze an ethical situation using both articles

Using both articles together, an ethical analysis should ask questions about the person, the relationships, and the organization.

Questions about the older person

• What does the older person seem to need, want, or value?
• Has the person been treated as an individual with their own pace, history, and preferences?
• Has the person had a real chance to participate in decisions?

These questions are strongly supported by Fagerberg, which emphasizes attentiveness, responsibility, competence, and responsiveness in care.

Questions about relationships

• How are staff relating to the older person?
• Are relatives supporting the person’s interests, and are their views being handled respectfully?
• Are co-workers supporting ethical care, or making it harder?

Fagerberg highlights that relationships with older people, relatives, co-workers, managers, and leaders all influence whether ethical care is possible.

Questions about the organization

• Are time limits, staffing, or routines preventing good care?
• Is there a place to discuss the ethical difficulty?
• Do staff have support from managers and colleagues?

Bollig is especially useful here because it shows that staff want more systematic ethics work, including time for discussion, meeting places, ethics education, and access to people with ethics knowledge.

3. Example of applying both articles

Imagine an older resident refuses a shower, but staff are under pressure to complete morning routines quickly.

From Fagerberg, the ethical analysis would focus on respecting the older person’s pace and individuality. Staff should try to understand why the person refuses: fear, discomfort, tiredness, embarrassment, or a wish to decide later. Ethical care involves being attentive and flexible rather than forcing a routine.

From Bollig, we can also see this as an everyday ethical issue that may be hidden under the “ethics iceberg.” It may seem small compared with end-of-life decisions, but it concerns autonomy, dignity, and respectful care. If staff repeatedly face this kind of situation, the service should not leave it to informal coping alone. It should be discussed in regular ethics meetings so the team can agree on better approaches.

4. Main service improvements suggested by the two articles

Regular ethics discussions

Bollig strongly supports regular ethics discussions. Staff in the study reported a need for more systematic ethics work, and the article suggests that time to address ethical challenges can protect staff psychologically. Regular discussions can help teams reflect before problems become crises.

Attention to everyday ethical issues

A key lesson from Bollig is that services should not focus only on major dilemmas like resuscitation or hospitalization. Everyday ethical issues happen more often and need more attention. This fits well with Fagerberg, where ethical care is shown in ordinary interactions such as listening, accompanying, adjusting, and preserving dignity.

Support from managers and co-workers

Fagerberg shows that carers need managers and leaders who listen and help them understand difficult situations. Co-worker support also matters. When carers are left alone, or criticized for trying to meet an older person’s needs, ethical stress increases. Therefore, service improvement should include a culture where staff can raise concerns safely and receive confirmation and guidance.

Ethics education for all staff

Bollig reports that ethics education for the whole staff was one of the most wanted improvements. Ethics education can help staff name problems, analyze them, and respond more consistently. It can also make everyday issues more visible instead of leaving them unnoticed.

Meeting places and access to ethics support

According to Bollig, staff wanted time for discussion, meeting places, and the possibility of asking someone with special ethics knowledge. This means services should create clear structures for reflection, not rely only on chance conversations.

More person-oriented participation of older people

Both articles point toward the importance of seeing the older person as an active subject, not just a recipient of care. Fagerberg emphasizes respect for the person’s needs and wishes. Bollig shows that resident participation in ethics meetings was very limited and suggests a need for more creative verbal and non-verbal ways to support person-oriented participation.

Careful involvement of relatives

Bollig shows that relatives often represented residents’ views in ethics meetings. Relatives can be valuable partners, but they should not automatically replace the older person’s own voice. Ethical improvement means involving relatives while still asking how the resident’s own wishes can be understood and respected. Fagerberg also reminds us that demands from relatives can create pressure for carers, so services need ways to handle these relationships well.

5. Practical steps for improvement in older adult care services

• Schedule regular ethics discussions for staff.
• Include everyday ethical issues, not only dramatic medical decisions.
• Give staff protected time to reflect on difficult situations.
• Provide ethics education for all professional groups.
• Ensure managers actively listen to and support staff.
• Strengthen respectful teamwork among co-workers.
• Create meeting places and access to ethics resource persons.
• Develop more person-oriented ways for older people to participate in decisions and discussions.
• Involve relatives carefully, while keeping the older person’s wishes central.
• Use recurring ethical problems as signals for service redesign, not just individual blame.

6. Overall conclusion

Taken together, Fagerberg and Bollig show that ethical care of older adults is built in everyday practice and supported by the organization around it. Ethical analysis should therefore ask not only, “What is the right decision?” but also, “What relationships, routines, and supports are needed for good care?” Service improvement should include regular ethics discussions, greater attention to everyday ethical issues, stronger support from managers and co-workers, ethics education, and more person-oriented participation of older people and relatives. In this way, ethics becomes part of the daily culture of care rather than something discussed only in exceptional cases.