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Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training

Authors Jonasson LL, Sandman L, Bremer A

Received 24 December 2018

Accepted for publication 19 April 2019

Published 28 May 2019 Volume 2019:11 Pages 63—74

DOI https://doi.org/10.2147/JHL.S199167

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Russell Taichman


Lise-Lotte Jonasson,1 Lars Sandman,1,2 Anders Bremer1,3

1Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden; 2Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden; 3Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden

Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care.
Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data.
Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons.
Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented.

Keywords: manager, ethical responsibility, municipal, older person, thematic analysis

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