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Handling Ethical Uncertainties in Daily Support: Frontline Staff Practices in Group Homes for Adults with Intellectual Disabilities
Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).ORCID iD: 0009-0000-1561-5567
(English)Manuscript (preprint) (Other academic)
National Category
Social Work
Identifiers
URN: urn:nbn:se:mau:diva-80526OAI: oai:DiVA.org:mau-80526DiVA, id: diva2:2013276
Available from: 2025-11-28 Created: 2025-11-12 Last updated: 2025-12-23Bibliographically approved
In thesis
1. I det nära: etiska dilemman i det vardagliga arbetet vid LSS-gruppboenden
Open this publication in new window or tab >>I det nära: etiska dilemman i det vardagliga arbetet vid LSS-gruppboenden
2025 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Self-determination is a central goal in all Swedish social legislation. Under the Act Concerning Support and Service for Persons with Certain Functional Impairments (SFS 1993:387), commonly referred to as LSS, the right to make decisions about one’s own life is fundamental (SFS 1993:3 7, 5–6 §§). This study examines how frontline staff in LSS group homes handle everyday ethical dilemmas that arise when supporting adults with intellectual disabilities in daily life.

The study consists of two peer-reviewed articles and a capstone essay. It explores how frontline staff working in group homes understand and handle everyday ethical dilemmas that arise in relation to residents’ self-determination. Tensions arise between staff’s desire to protect and promote the well-being of residents and the need to respect their integrity and autonomy. The overall aim is to gain deeper insight into how frontline staff recognize, navigate and handle ethical dilemmas in daily practice.

To address the dual focus on staff experiences and practices, the study draws on two theoretical perspectives, one in each article. The first article uses Arne Johan Vetlesen’s concept of Closeness an ethics (Jodalen and Vetlesen, 1997) to examine how staff interpret ethical dilemmas in their relationships with residents. To deepen the understanding of how ethical dilemmas emerge and are managed in everyday practice, this reasoning is complemented by an everyday ethics perspective as formulated by Fioretos et al. (2013).The second article applies Patrik Aspers’ concept of Epistemic Uncertainty (2024) to analyze how staff make sense of and act in ethically complex situations.

The empirical material consists of six sequential focus group interviews with frontline staff from two group homes in a large Swedish municipality. Each group participated in three interviews, spaced 1–4 weeks apart to allow reflection between sessions. As a complemental method, four full-day participant observations were conducted at the same group homes.

The first article shows that managing everyday ethical dilemmas is a significant part of frontline staff’s work in LSS group homes. Daily practice often involves one-on-one situations that require immediate micro-decisions with ethical implications. The complexity becomes particularly evident in stressful situations or when actions risk negatively affecting the individual resident, other residents, staff, or visitors.

The second article identifies two overarching themes that describe how staff make sense of their actions and handle ethically uncertain situations: (i) Acting First, Reflecting Later, and (ii) Supporting Autonomy or Subtle Manipulation? These themes illustrate the tension between intuitive, in-the-moment decision- making and the reflective processes that follow, as well as the fine line between empowering residents and influencing their choices in ethically ambiguous contexts.

There is a fine line between motivating, which means supporting and guiding a person’s self-determination and manipulating, which involves the use of control and constraints. The individualized approach that underpins Swedish social policy requires staff to co-create personalized solutions with residents. However, the complexity of professionals´ task - supporting individual self-determination while ensuring collective well-being - is often under-recognized, or left out, in policy and regulation. As a result, staff risk being left without sufficient guidance and must develop practical solutions on their own. This shifts moral responsibility downward in the organizational hierarchy without adequate support.

The study highlights the need for decision-makers and service providers to acknowledge the ethical complexity of frontline work and to establish a shared language, knowledge base, and structures that support professional discretion in ethically challenging situations.

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2025. p. 87
Series
FoU-rapport Hälsa och samhälle, ISSN 1650-2337, E-ISSN 3119-2718 ; 2025:1
Keywords
Self-determination, Group homes for adults with ID, Frontline staff, Everyday ethical dilemmas, Closeness, Epistemic uncertainty
National Category
Social Work
Identifiers
urn:nbn:se:mau:diva-80509 (URN)10.24834/isbn.9789178776900 (DOI)9789178776894 (ISBN)9789178776900 (ISBN)
Presentation
2025-12-12, Niagara NI:COE11, Nordenskiöldsgatan 1, Malmö, 10:15 (Swedish)
Opponent
Supervisors
Note

Paper II in thesis published as manuscript and not included in the fulltext online.

Available from: 2025-11-13 Created: 2025-11-12 Last updated: 2026-03-19Bibliographically approved

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