Ethical issues in long-term care settings: Care workers’ lived experiences

Abstract

Background Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work. Research aim Our aim was to describe the care workers’ lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, occupational well-being and nursing education. Research design Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding. Participants and research context We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021. Ethical considerations This was a sensitive study, which was connected to the participants’ individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed. Findings Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS. Conclusions Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society.

Development and prima facie validation of the Dementia-Specific Ethical Self-Efficacy scale for professional caregivers

“…However, there are at least two compelling reasons for considering ethical self-efficacy directly. First, caregivers routinely have to make ethical decisions (Arjama et al, 2023;Preshaw et al, 2016;Strech et al, 2013). Navigating such ethical issues can be challenging, and several studies have shown that professional caregivers of people with dementia find this process stressful (Chen & Highfill, 2023;Costello et al, 2019), notably when compared to non-dementia caregivers (Ory et al, 1999;Sheehan et al, 2021).…”

“…Impaired capacity means that people with dementia increasingly require assistance to make medical decisions and eventually, the majority of people with dementia require strong support in terms of long-term care (sm-Rahman et al, 2022). The increased need for support in long-term care involves several specific ethical issues, such as the conflict between respecting the self-determination of people with dementia and ensuring that their well-being is protected, as well as considering whether to tell the truth to people with dementia even if this harms them (Arjama et al, 2023; Preshaw et al, 2016; Schou-Juul & Lauridsen, 2024; Strech et al, 2013). Such ethical issues are extremely prevalent in dementia care and caregivers are tasked with making ethical judgments on a day-to-day basis (Lewenson & Truglio-Londrigan, 2007; Ulrich et al, 2010; Varcoe et al, 2012).…”