title: Malnutrition in elder care: qualitative analysis of ethical perceptions of politicians and civil servants.
abstract: BACKGROUND
  Few studies have paid attention to ethical responsibility related to malnutrition in elder care. The aim was to illuminate whether politicians and civil servants reason about malnutrition in elder care in relation to ethical responsibility, and further about possible causes and how to address them.
  
  
  METHODS
  Eighteen elected politicians and appointed civil servants at the municipality and county council level from two counties in Sweden were interviewed. They worked at a planning, control and executive level, with responsibility for both the elder care budget and quality of care. Qualitative method was used for the data analysis.
  
  
  RESULTS
  Two themes emerged from their reasoning about malnutrition related to ethical responsibility. The theme assumed role involves the subthemes quality of care and costs, competent staff and govern at a distance. Old and ill patients were mentioned as being at risk for malnutrition. Caregivers were expected to be knowledgeable and stated primary responsible for providing adequate nutritional care. Extended physician responsibility was requested owing to patients' illnesses. Little was reported on the local management's role or on their own follow-up routines. The theme moral perception includes the subthemes discomfort, trust and distrust. Feelings of discomfort concerned caregivers having to work in a hurried, task-oriented manner. Trust meant that they believed for the most part that caregivers had the competence to deal appropriately with nutritional care, but they felt distrust when nutritional problems reappeared on their agenda. No differences could be seen between the politicians and civil servants.
  
  
  CONCLUSIONS
  New knowledge about malnutrition in elder care related to ethical responsibility was illuminated by persons holding top positions. Malnutrition was stressed as an important dimension of the elder care quality. Governing at a distance meant having trust in the staff, on the one hand, and discomfort and distrust when confronted with reports of malnutrition, on the other. Distrust was directed at caregivers, because despite the fact that education had been provided, problems reappeared. Discomfort was felt when confronted with examples of poor nutritional care and indicates that the participants experienced failure in their ethical responsibility because the quality of nutritional care was at risk.
authors.affiliation: Department of Neurobiology, Caring Sciences and Society, Karolinska Institute, Stockholm, Sweden. anna-greta.mamhidir@hig.se
authors.forename: Anna-Greta
authors.initials: AG
authors.lastname: Mamhidir
authors.forename: Mona
authors.initials: M
authors.lastname: Kihlgren
authors.forename: Venke
authors.initials: V
authors.lastname: Soerlie
mesh_terms: D000288:Administrative Personnel / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000941:ethics*; D005260:Female; D006299:Health Services for the Aged / Q000941:ethics*; D006699:Home Care Services / Q000941:ethics; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000517:prevention & control*; D028681:Moral Obligations; D009718:Nurse Administrators / Q000941:ethics; D011057:Politics; D036301:Qualitative Research; D012938:Social Perception; D012941:Social Responsibility; D013219:State Government; D011795:Surveys and Questionnaires; D013548:Sweden; D035502:Trust