Moral Stress and Moral Agency in Swedish Eldercare

A Study Protocol on a Participatory Action Research Project

Abstract

Background: Ageing population, high levels of sick leave among eldercare personnel and financial constraints on municipal budgets impact eldercare. Daily care work is complex and ethical dilemmas are constantly present for eldercare personnel. This project aims to a) identify situations that give rise to moral stress, b) study the relationship between moral stress and moral agency c) explore how moral agency can be fostered in eldercare. The argument underpinning this research project is that ethical dilemmas in the work cause moral stress among staff in eldercare. While much research on moral stress highlights the connection between moral stress and negative effects on health and wellbeing, our focus is on the possible connection between moral stress and moral agency. Moral agency encompasses cognitive capacity, feelings, skills, and actions.

Methods/Design: This project has a systemic approach to eldercare and interprets eldercare as an advanced system where a range of different skills is required. Participatory action research (PAR) will be used as an overall methodology. Focus-groups and research circles will be conducted with care workers, first line manages and needs assessors. 

Discussion: An ongoing discussion on relevant knowledge production in research, stresses the importance of participation. This is expressed by concepts such as deliberative democracy, user participation, empowerment, collaboration, follow-up research and citizen dialogue. In our research project we refer to robust knowledge as relevant knowledge that is valid in the eyes of care workers, care municipal needs assessors and first line managers. As the research is performed in collaboration with these three vocational groups, local politicians, and trade unions in three municipalities as well as two educational settings, different sorts of knowledge will be present. This unique stand will show how moral agency, as a response to moral stress, can be the ground for social changes and improve quality of care.