Ethical Challenges in Care of Older Adults: Study Guide Across Fagerberg & Engström (2012) and Bollig et al. (2015)

Overview

This study guide brings together two complementary perspectives on ethical care for older adults. Fagerberg & Engström (2012) explores the meaning of caring for older people from the lived experience of students and professionals, while Bollig et al. (2015) examines the ethical challenges faced by nursing home staff and the role of systematic ethics discussions. Together, the articles show that good elder care depends both on carers’ ethical-moral commitment and on organisational conditions that support ethical practice.

Sources: [Fagerberg & Engström (2012)](material:99); [Bollig et al. (2015)](material:100).

Article 1: Fagerberg & Engström (2012) — The meaning of caring for older people

The study aimed to illuminate the meaning of caring for older people as experienced by health care students and professionals. It used a qualitative lifeworld perspective and a phenomenological hermeneutic approach based on interviews with students, registered nurses, and enrolled nurses.

Core understanding of caring

The article presents caring as more than task performance. Caring is experienced as a deeper feeling of helping someone who needs help. Carers describe an ethical foundation for their work, joy in meeting individual needs, and a strong sense of preserving the older person’s value as a human being.

Key themes

• Ethical moral self: caring is rooted in the carer’s moral commitment and desire to do good.
• Meeting individual needs: attentiveness to each older person’s wishes, vulnerability, and situation is central.
• Pliability toward the older person: carers adapt their approach to the individual rather than forcing uniform routines.
• Community and confirmation: relationships with older people give meaning to care, and carers experience joy when the older person responds positively.

Ethical strain and organisational barriers

The article also highlights what happens when carers cannot provide the care they believe older people need. Difficulties arise when co-workers, managers, leaders, or the organisation do not share or support an ethical foundation for caring. Carers may then experience strain from not being able to act according to their moral commitments.

Organisational implications

Fagerberg & Engström argue that elder care organisations must value the ethical and moral implications of care work and promote ethical leadership. Cost-cutting, reduced staff numbers, and structures that ignore the needs of older people can undermine caring. The study suggests that good care requires supportive teamwork, understanding managers, appropriate competence, and organisational development focused on the needs of older adults.

Source: [Fagerberg & Engström (2012)](material:99).

Article 2: Bollig et al. (2015) — Ethical challenges in nursing homes

This study investigated nursing home staff opinions and experiences with ethical challenges and examined which ethical dilemmas are discussed in nursing homes. It used a two-tiered approach: a questionnaire to staff in a Norwegian nursing home and a registration of systematic ethics discussions from an Austrian model of practice.

How common are ethical problems?

Ethical challenges were very common. Most staff experienced ethical problems in daily work, and many described them as a burden. This suggests that ethics is not a rare or exceptional issue in nursing homes, but part of everyday practice.

Main ethical challenges identified

• Lack of resources was the most frequently reported challenge.
• End-of-life issues were the second most common challenge.
• Coercion was another major concern.
• Other challenges included communication, lack of professional competence, and autonomy.

Systematic ethics work

Staff most often discussed ethical issues informally with colleagues, but many wanted more structured support. The study found strong support for ethics education and time for ethics discussion. Regular ethics meetings can help staff address dilemmas, reduce burden, and work toward acceptable decisions for those involved.

Residents and relatives in ethics discussions

Bollig et al. argue that residents and relatives should be invited to participate in discussions about ethical challenges whenever possible. This supports autonomy and helps ensure that decisions reflect the perspectives of those most affected.

Source: [Bollig et al. (2015)](material:100).

Comparing the two articles

Shared concerns

• Both articles show that elder care is deeply ethical, not only technical.
• Both recognise that organisational conditions can either support or obstruct good care.
• Both imply that carers need support to act in ways consistent with respect, dignity, and individual needs.

Different emphasis

• Fagerberg & Engström (2012) focuses on the inner meaning of caring and carers’ lived moral experience.
• Bollig et al. (2015) focuses on the practical ethical problems staff face in nursing homes and the need for systematic ethics support.

Key takeaways for study and practice

1. Good care for older adults depends on recognising each person’s individuality, dignity, and vulnerability.
2. Caring is experienced by staff as morally meaningful, but this meaning can be undermined by poor organisational support.
3. Ethical challenges in nursing homes are common and often related to resources, end-of-life care, and coercion.
4. Ethics education, regular ethics discussions, and participation by residents and relatives can strengthen ethical practice.
5. Application to practice requires connecting personal moral commitment with supportive organisational structures.

How to revise these articles

• Learn the aim and method of each study.
• Memorise the main themes from Fagerberg & Engström (2012).
• Memorise the top ethical challenges from Bollig et al. (2015).
• Practise comparing lived meaning of caring with organisational and ethical problems in practice.
• Prepare to discuss how leadership, staffing, and ethics meetings affect quality of elder care.

Sources: [Fagerberg & Engström (2012)](material:99); [Bollig et al. (2015)](material:100).