Care work against all odds

Impossible situations and moral work in Danish elderly care

Abstract

Professional elderly care in Denmark is characterised by numerous and often conflicting considerations. On the one hand, employees need to provide person-centred care, while on the other, they are required to ensure fairness and transparency, often achieved through meticulous time management and documentation. Based on qualitative interviews with nurses, skilled care workers, and physiotherapists in four nursing homes and six homecare teams, this article examines specific challenging situations in care work. It explores the practices and experiences of professionals from a moral perspective, drawing on the work of, among others, Zacka (2017) and Banks (2013, 2018). We demonstrate how “im possible situations,” without clear or optimal solutions, can lead to feelings of dissonance, inner conflict, or moral stress, ultimately contributing to physical and mental exhaustion. Nevertheless, staff often succeed in managing these situations through continuous efforts of prioritization and compromise. Often, this moral work is invisible in daily practice, but as professionals are repeatedly exposed to impossible situations, some risk developing various complexity-reducing dispositions as an adaptive response. Over-involvement, rigid system-thinking, and indifference are three such dispositions, each problematic in its own way, with negative consequences for the citizens, staff, and the psychological work environment.