Ethically challenging situations in eldercare: A cross-sectional study.

Background: Ethically challenging situations are one of the many stressors that strain eldercare employees.

Aim: The study aimed to examine (1) the mean levels of ethically challenging situations among eldercare employees in different Finnish eldercare service types and (2) the associations between organizational constraints and poor work-unit collaboration with ethically challenging situations.

Research design: Cross-sectional survey in 2020 including 4,347 Finnish eldercare employees (response rate 67%). These employees provide care and support to older adults, such as assist with daily activities and manage medical needs. Employees were classified into four categories based on the eldercare service type: home care (n = 1,683), service housing (n = 1,649), outpatient and ward care (n = 650), and guidance and activity services (n = 365). The data was analyzed with variance analysis, t-tests, and linear regression analysis.

Ethical considerations: The study was approved by the ethical board of the Finnish Institute of Occupational Health. Respondents' provided informed consent for participation.

Findings: Analyses showed that the level of ethically challenging situations was highest in service housing, among nurses, and among practical nurses. Organizational constraints-job strain and organizational injustice-had the strongest positive association with ethically challenging situations. Poor work-unit collaboration, instead, had a minor positive association with ethically challenging situations.

Conclusions: Organizational constraints, especially job strain and organizational injustice, are important to identify to alleviate ethically challenging situations among eldercare workers.