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How can we ensure that people with dementia receive dignified and ethical care? Should staff insist that a resident takes their medication or showers, even if they refuse? And what should be done if a resident who was previously a vegetarian suddenly only wants to eat meat?

Care staff at nursing homes face ethical dilemmas daily, balancing respect for residents' autonomy with the need for care and safety. Studies show that many employees in the care sector have long sought better tools to manage these complex situations.

To address this, researchers at the National Institute of Public Health, in collaboration with the Danish Alzheimer’s Association and Rudersdal Municipality, have developed an initiative that provides tools to tackle difficult ethical situations. The initiative, called CARE, has been tested in four nursing homes in Rudersdal Municipality—with promising results.

The initiative has been evaluated in a study recently published in the journal International Journal of Nursing Studies Advances.

Creating clarity in difficult situations

CARE consists of two training days where staff participate in literature-based discussions and group exercises to learn how to identify, analyze, and manage ethical dilemmas. They also share and discuss their own experiences from daily practice.

"There are no simple answers to ethical issues, and care staff often have to weigh concerns related to residents' safety, dignity, and health. However, the study shows that after participating in CARE, staff feel better prepared to understand and assess what is at stake and what considerations need to be taken. The vast majority report that they have gained concrete tools to make ethical decisions—contributing to better care for residents," says research manager Sigurd Lauridsen.

The study also highlights that many care staff experience a culture where discussing sensitive ethical dilemmas can be challenging.

They describe a "zero-error culture", where admitting doubt or mistakes can feel risky, even though ethical dilemmas are inherently complex and rarely have a single correct answer.

"Several staff members report that it can be difficult to engage in open reflections where they put themselves on the line and admit that they do not always have the answers. This lack of openness can make it harder to integrate necessary ethical discussions into daily practice," says Sigurd Lauridsen.

Strengthening professionalism and team cohesion

In addition to providing tools to handle ethical dilemmas, the program has also strengthened teamwork in nursing homes.

"Incorporating literature and group-based reflections into the initiative has been highly beneficial. It makes ethical dilemmas more tangible and provides care staff with a shared understanding that they often find themselves in difficult situations. Many have had eye-opening experiences, reporting increased job satisfaction and stronger bonds both within their own departments and across nursing homes," says Sigurd Lauridsen.

At the same time, staff point out that maintaining new initiatives can be challenging due to high employee turnover in the sector. They fear that anchoring new knowledge could be difficult when new colleagues constantly join the workforce without having received the same ethical training.

Need for systematic training

The positive results from Rudersdal have encouraged researchers to look toward the future. Sigurd Lauridsen hopes that the program can be tested on a larger scale and implemented in more nursing homes across Denmark:

"Our research shows a genuine need for systematic ethical training in the care sector. A broader implementation of CARE could be a step toward strengthening both the professionalism of care staff and the quality of life for people with dementia."

The initiative has been developed, implemented, and evaluated with support from the Velux Foundation’s HUMpraxis program.

Contact: Research manager Sigurd Lauridsen, Phone: +45 6550 7810, Email: sila@sdu.dk, National Institute of Public Health, 糖果派对.