Comparing Fagerberg (2012) and Bollig (2015): integrating caring meaning and nursing home ethics

Lesson objective

This lesson compares how the two studies connect relationships, organizational conditions, and ethics in care for older adults. It also integrates the account of caring meaning in Fagerberg with the account of ethical challenges and ethics support in Bollig.

1. What each article mainly studies

Fagerberg explores the meaning of caring for older people from carers’ lived experience. The article presents care of the old as deeply shaped by ethics, organization, and relationships. Caring becomes meaningful when carers can be attentive, responsive, and flexible toward the older person as an individual.

Bollig examines ethical challenges in nursing homes and staff experiences with systematic ethics meetings. The article focuses less on the inner meaning of caring and more on how ethical problems arise in practice and how organizations can create structures for discussing them.

2. Relationships in the two articles

Fagerberg: relationships as the core of meaningful care

In Fagerberg, the relationship between carer and older person is central. Meaningful care depends on meeting the older person with presence, respect, and sensitivity. Carers describe the importance of taking time, adjusting to the older person’s pace, and learning the person’s needs, wishes, history, and vulnerability. This relational knowledge allows care to become ethically good care rather than just task completion.

The article shows that carers experience satisfaction and closeness when they truly know the older person. At the same time, this closeness can be demanding. Relationships with relatives also matter, because relatives can place expectations on staff and affect care situations. Relationships with co-workers and managers are equally important, since support or lack of support changes how carers can act.

Bollig: relationships as part of ethical decision-making

In Bollig, relationships appear mainly in the context of ethical challenges and ethics meetings. Staff, relatives, and sometimes physicians or other professionals are involved in discussing difficult cases. Relatives often represent residents’ views in prospective ethics meetings. The article therefore highlights relationships as necessary for decision-making, especially around end-of-life care, hospitalization, treatment burden, and refusal of interventions.

However, Bollig also identifies a limitation: no resident participated in the prospective resident ethics meetings reported. This raises concerns about participation and person-oriented care. The article suggests that resident involvement may be restricted and that more creative support for communication is needed.

Comparison

• Fagerberg emphasizes the lived, ongoing relationship between carer and older person as the source of caring meaning.
• Bollig emphasizes relationships as part of ethical deliberation among staff and relatives.
• Both show that care is never only technical; it is shaped by human connections.
• But Fagerberg focuses more on the direct caring encounter, while Bollig focuses more on the discussion structures around difficult situations.

3. Organizational conditions in the two articles

Fagerberg: organization can support or injure ethical care

Fagerberg presents organizational demands as a major influence on carers’ ethical lives. Carers face emotional stress when professional judgment conflicts with organizational expectations. Time pressure, routines, and workplace norms can make it hard to respond to the older person’s actual needs. This creates moral strain: carers know what good care would require, but organizational conditions may prevent it.

The article also shows that organizational support matters. When managers and co-workers listen, confirm carers, and help them reflect on difficult situations, carers are better able to continue their work. Thus, organization is not just a background factor; it directly shapes whether caring meaning can be preserved.

Bollig: organization needs formal ethics support

Bollig treats organization as the place where ethics support should be built. The study reports that staff often face ethical challenges and that many experience them as burdensome. Most participants wanted more systematic ethics work. They particularly asked for ethics education, time for discussion, meeting places, and access to someone with ethics knowledge.

The article argues that regular ethics discussions can play a protective role for staff psychological health. It also introduces the idea of an “ethics iceberg”: visible formal dilemmas, especially end-of-life issues, get attention, while frequent everyday ethical issues remain hidden “under the surface.” This means organizational ethics should not only respond to dramatic cases but also create space for ordinary daily concerns.

Comparison

• Fagerberg shows how organizational conditions affect carers’ ability to give good care in the moment.
• Bollig shows how organizations can develop structures to recognize and discuss ethical problems.
• In both articles, lack of time and inadequate support weaken care.
• Together, they show that ethics in older adult care depends not only on individual goodwill but also on organizational design.

4. Ethics in the two articles

Fagerberg: ethics is embedded in caring practice

In Fagerberg, ethics is not mainly presented as formal decision-making. Instead, ethics is part of how carers meet the older person. The article connects carers’ practice to Tronto’s four elements of care ethics: attentiveness, responsibility, competence, and responsiveness. Ethical care means noticing the older person’s needs, taking responsibility, using professional knowledge well, and being responsive to how the person receives the care.

This makes ethics practical, relational, and everyday. The ethical challenge is often whether carers can remain faithful to the older person’s individuality under pressure.

Bollig: ethics is both everyday and structured

Bollig presents ethics as something staff encounter daily, but also something that can be strengthened through systematic ethics work. Ethical issues include end-of-life decisions, hospitalization, resuscitation, artificial nutrition, treatment burden, and refusals of treatment. Yet the “ethics iceberg” model stresses that everyday issues are just as important, even when they are less visible.

The article therefore broadens ethics from single dramatic dilemmas to the culture of care in nursing homes. Ethics meetings, education, and discussion spaces are ways to support this culture.

Comparison

• Fagerberg frames ethics as part of caring relations and moral experience.
• Bollig frames ethics as both recurring practical challenge and an organizational responsibility.
• Both reject a narrow view of ethics as only rare extraordinary dilemmas.
• Both show that everyday care is ethically charged.

5. Integrating the two articles

The strongest integration is this: Fagerberg explains what meaningful ethical caring looks like from within practice, while Bollig explains what organizational supports are needed so staff can recognize, discuss, and sustain such care.

From Fagerberg, meaningful care requires:

• presence with the older person,
• respect for individuality and pace,
• responsiveness to needs and wishes,
• supportive relationships with co-workers and managers.

From Bollig, sustaining ethical care requires:

• ethics education,
• time for discussion,
• regular meeting places,
• access to ethics knowledge,
• attention to both major dilemmas and hidden everyday issues.

Put together, the articles suggest that caring meaning cannot be protected by personal commitment alone. If organizations want carers to provide the kind of attentive and responsive care described in Fagerberg, they need the ethics support structures emphasized in Bollig. Likewise, ethics meetings in Bollig should not only solve difficult cases; they should also help staff preserve the relational, person-centered meaning of care described in Fagerberg.

6. Key similarities and differences

Similarities

• Both articles connect ethics with everyday care of older adults.
• Both show that staff experience burden when care ideals conflict with reality.
• Both identify the need for supportive colleagues and organizational attention.
• Both imply that quality care depends on more than technical skill.

Differences

• Fagerberg is more phenomenological and focuses on carers’ experience of meaning.
• Bollig is more practice- and system-oriented and focuses on ethical challenges and ethics meetings.
• Fagerberg centers the caring relationship itself.
• Bollig centers the organizational handling of ethical issues.
• Bollig gives more explicit attention to formal ethics support mechanisms.

7. Practical takeaway for older adult care

A combined reading of Fagerberg and Bollig suggests that good older adult care requires both relational ethics and organizational ethics support.

• Staff need time and freedom to know the person, adapt care, and respond humanely.
• They also need structured opportunities to reflect on burdens, conflicts, and dilemmas.
• Managers should recognize that everyday care decisions are ethical decisions.
• Ethics support should include not only end-of-life cases but also ordinary daily tensions that affect dignity, participation, and responsiveness.

8. Conclusion

Fagerberg shows that caring for older people becomes meaningful when carers can enter respectful, responsive relationships and act according to their ethical understanding. Bollig shows that nursing home staff regularly face ethical challenges and need systematic ethics support to manage them. Read together, the articles argue that ethics in older adult care is created at the meeting point of person-centered relationships and organizational conditions. Meaningful care depends on both.