Background: This study explored the dynamics of ethical encounters between frail older residents and assistant nurses during assisted bodily care at the end of life within nursing homes. While personalized palliative care is recognized as crucial for this demographic, little is known about the ethical dimensions of daily care practices in this setting. 

Design: Focused ethnography. 

Methods: Data consisted of 170 hours of fieldwork in an urban Swedish nursing home. This involved participant observation and interviews. Thematic analysis was used, with input from five public community stakeholders during a focus group. 

Results: Our findings uncover barriers to achieving ethical encounters in assisted bodily care within the nursing home, primarily linked to communication, relationships, and care quality. These obstacles stem from resource limitations, ineffective communication, and misaligned work values. However, ethical encounters can be facilitated through the promotion of moral sensitivity, genuine resident engagement, and collaborative practices, essential for person-centered care. Personnel, particularly assistant nurses, must recognize their responsibility in addressing resident vulnerability. 

Conclusion: We advocate for continuous moral reflection on communication, compassion, decision-making, and behavior, with a strong focus on the care relationship. To improve care quality, organizations should allocate resources for relationship-building and provide assistant nurses with adequate post-shift recovery time. Additionally, we recommend further research, including the implementation of ethically grounded palliative care, to continuously enhance care practices in nursing homes.

Ethical issues and approvals: The study followed ethical standards stated by the Declaration of Helsinki, approved by The Regional Ethics Board of Stockholm (Dnr 2017/8-31/1).