Staff Reactions Toward Lesbian,Gay, or Bisexual (LGB) People Living in Residential Aged Care Facilities (RACFs) Who Actively Disclose Their Sexual Orientation

Fifty-three staff members currently working in residential aged care facilities located in Barcelona, Spain, were asked about the way they would react if a resident told them that he or she felt sexually attracted and had maintained sexual relationships with another resident of the same gender. Acceptance of non-heterosexual sexual orientation was a frequent answer, and around one in four professionals stated that they would try helping the resident in question, by offering a private space or giving some emotional support. However, some reactions were not consistent with a respectful approach toward sexual diversity, as, for instance, informing the resident’s family or advising the resident to keep his or her sexual orientation hidden. We highlight the importance of developing formal policies and offering formal training to staff in order to address the specific needs of older LGB people living in RACFs.     

Staff Member Reactions to Same-Gender,Resident-to-Resident Sexual Behavior Within Long-Term Care Facilities

The current study assesses ageism and heterosexism relating to older adult sexual activity within long-term care facilities. To assess caregiver reactions, 153 residential care facility staff members read one of three vignettes. Each vignette described a scenario in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. Although no main effects were discovered for vignette type, exploratory analyses revealed that the facility where participants were employed was significantly related to their ratings of approval. Furthermore, an interaction effect between vignette and facility types was also discovered for caregivers’ approval of sexual activity among residents. Additionally, a strong overall approval rating of older adult sexuality was reported by staff members. The results of this study warrant that further research is necessary regarding older adults’ perception of caregiver bias, as well as further investigation of caregivers’ perceptions of older adults’ sexual activity.     

The Potential Impact of Discrimination Fears of Older Gays,Lesbians, Bisexuals and Transgender Individuals Living in Small- to Moderate-Sized Cities on Long-Term Health Care

ABSTRACT

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

The potential impact of discrimination fears of older gays, lesbians, bisexuals and transgender individuals living in small- to moderate-sized cities on long-term health care

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

Why is Housing Always Satisfactory? A Study into the Impact of Preference and Experience on Housing Appreciation

This study focuses on residents’ perceptions of residential quality concerning 23 different dwelling aspects. Respondents were asked to indicate their appreciation of these dwelling aspects on a scale ranging from 0 (“extremely unattractive”) to 100 (“extremely attractive”). The influence of two potential factors on the appreciation of dwelling aspects is examined: (1) preference and (2) experience. It was hypothesized that residents who live according to their preferences give higher appreciation scores than residents who do not. This should even apply to low-quality housing. Furthermore, it was argued that residents appreciate their current housing situation more than residents who do not live in that particular housing situation. This effect should be independent of preference. The impact of both preference and of experience could be confirmed. The results also showed an interaction effect between preference and experience: the positive effect of experience on appreciation is larger in residents who live in a housing situation that they do not prefer. This result would be expected if the impact of experience works to decrease the ‘gap’ in residential satisfaction due to the discrepancy between what residents have and what they want. In conclusion, why is housing always satisfactory? In this paper, housing is satisfactory because the ‘gap’ between what residents want and what they have is small; residents seem to have realistic aspirations. Furthermore, residents appreciate what they already have, even if this is not what they prefer.     

Why is Housing Always Satisfactory? A Study into the Impact of Cognitive Restructuring and Future Perspectives on Housing Appreciation

The current study focuses on residents’ perceptions of residential quality. The influence of two psychological factors is examined: cognitive restructuring and future perspectives. For cognitive restructuring, it is hypothesized that residents who cannot change a suboptimal housing situation show higher appreciation scores in order to prevent unhappiness and psychosocial complaints. By contrast, the future perspectives hypothesis argues that residents who can change a suboptimal housing situation show higher appreciation scores because they have a better situation to look forward to. Respondents indicated their appreciation of 23 dwelling aspects on a scale ranging from 0 (extremely unattractive) to 100 (extremely attractive). A weak impact was found for cognitive restructuring: residents living in a suboptimal housing situation and who do not intend to move showed a higher mean appreciation for an owner-occupied house and for a traditional architectural design than similar residents who did intend to move. No effect was observed for future perspectives. Why is housing always satisfactory? A previous study and the current one show that residents who live in a suboptimal housing situation might show relatively high residential satisfaction because they lower their aspirations (“I don’t need much”), because they are satisfied with what they have (“what I have is fine”) and, to a lesser extent, because they make the best of a situation that they cannot change (cognitive restructuring).     

Non-Heterosexuality,Relationships, and Young Women’s Contraceptive Behavior

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women’s higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.     

‘How can we go on caring when nobody here cares about us?’ Australian public maternity units as contested care sites

BackgroundProvision of personalised, continuous care focused on ‘well women’ is now central to midwifery identity and work ideals, but it remains difficult in hospital contexts shaped by increased demand and by neoliberal policies. Previous accounts of occupational and work-family conflicts in midwifery and nursing have pointed to the ‘moral distress’ associated with managing conflicting expectations in health workplaces.QuestionThis paper examines these issues in the Australian context and considers further the ethical implications of midwives not feeling ‘cared for’ themselves in health care organisations.MethodsQualitative research in several Victorian maternity units included use of interviews and observational methods to explore staff experiences of organisational and professional change. Data were coded and analysed using NVivo.FindingsMidwives reported frequent contestation as they sought to practice their ideal of themselves as caregivers in what they reported as often ‘uncaring’ workplaces. To interpret this data, we argue for seeing midwifery caring as embodied social practice taking place within ‘organisation carescapes’.ConclusionTheoretical analysis of the moral and ethical dimensions of the contemporary organisational structure of maternity care suggests that a practice-based and dialogical ethic should form the core principle of care both for women in childbirth and for their carers.     

Staff Perceptions of Same-Gender Sexual Contacts in Long-Term Care Facilities

An ongoing fear in the gay and lesbian community is that long-term care (LTC) facilities may not be sensitive to their needs. In the present study, 218 LTC staff members responded to one of three vignettes in which resident sexual contact was observed, with only the gender of the characters changing, to create different gender pairings. Results suggested that staff rated male-male and female-female pairings more negatively than heterosexual intimacy. Knowledge about older adult sexuality made little difference in staff ratings. However, staff attitudes were directly related to ratings of negative reaction and level of acceptability of same-gender sexuality.     

Performativity Double Standards and the Sexual Orientation Climate at a Southern Liberal Arts University

This study employs quantitative and qualitative methods to examine how heterosexual, bisexual, and gay students rate and describe a Southern, religiously affiliated university’s sexual orientation climate. Using qualitative data, queer theory, and the concept tyranny of sexualized spaces, we explain why non-heterosexual students have more negative perceptions of the university climate than heterosexual male students, in both bivariate and multivariate analyses. Although heterosexual students see few problems with the campus sexual orientation climate, bisexual men and women describe being challenged on the authenticity of their orientation, and lesbian and, to a greater extent, gay male students report harassment and exclusion in a number of settings. These distinct processes are influenced by broader heteronormative standards. We also shed much-needed light on how gendered sexual performativity double standards within an important campus microclimate (fraternity parties) contribute to creating a tyrannical sexualized space and negatively affect overall campus climate perceptions.     

Enforcing Mobility: Spatial Mobility under the Regime of Activation

Abstract

Spatial mobility is rarely investigated with a view on social policy and welfare administrations. Yet, recent activation and workfare policies have increased pressures on the unemployed, with one of these pressures concerning spatial mobility, i.e. the requirement to accept jobs that entail long commuting hours or even relocation. This paper investigates the shift towards activation in Germany, focusing on increased demands on job-seekers’ mobility, and uses a governmentality perspective, supplemented by the concept of symbolic violence, to gain insight into the strategies and practices deployed by Public Employment Service (PES) staff to produce ‘mobile selves’. It demonstrates that perceptions of (im)mobility figure prominently in the assessment not only of job-seekers’ labour market prospects but also of their character and motivation to seek work. Thus, the personal and familial implications of mobility are considered as mitigating circumstances mainly in the case of older jobless with poor labour market prospects. The majority of job-seekers, and particularly those living in regions with high unemployment, are subject to efforts on the part of PES staff to make them understand the necessity of being as mobile as possible; if such insight is found wanting, pedagogical devices are deployed to enhance job-seekers’ mobility.     

Gay and lesbian perceptions of discrimination in retirement care facilities

Much research on older gay, lesbian, bisexual and transgender (GLBT) adults has focused on refuting the widely held misconceptions people have about GLBT lifestyles. To date, however, few studies on older GLBTs have examined their social and health care needs. Further, most studies have collected survey samples of older GLBT adults in large metropolitan areas and have not specifically addressed discrimination or bias in retirement care facilities. In the current exploratory study on perceptions of discrimination and bias in retirement care facilities, we surveyed a wide age range GLBT adults in a smaller metropolitan area of fewer than 400,000 people to discover the perceptions of both younger and older GLBTs. We surveyed perceptions of discrimination in retirement care facilities, sources of perceived discrimination, and suggestions for how discrimination might be reduced or eliminated in those settings. Respondents indicated that administration, care staff, and residents of retirement care facilities themselves were all potential sources of discrimination, and that education addressing awareness and acceptance of GLBTs is one potential remedy for discrimination against GLBTs in retirement care facilities. Respondents also indicated a strong desire for the development of GLBT-exclusive or GLBT-friendly retirement care facilities. Chi-square analyses of responses to the discrimination questions and respondents' demographic characteristics revealed significant differences with regard to age, income, gender, community size, and education level of the respondents.     

The perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women: An ethnographic study

BackgroundAcross the globe, many women including economic and humanitarian migrants receive inadequate antenatal care. Understanding the difficulties that migrant women encounter when accessing maternity care, including the approach of health professionals, is necessary because inadequate care is associated with increasing rates of morbidity and mortality. There are very few studies of migrant women’s access to and experience of maternity services when they have migrated from a low- to a middle-income country.AimTo examine the perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women, and to describe women’s experiences of their encounters with health professionals providing maternity care in Ranong Province in southern Thailand.MethodsEthnography informed the study design. Individual interviews were conducted with 13 healthcare professionals and 10 Burmese women before and after birth. Observations of interactions (130 h) between health care providers and Burmese women were also conducted. Data were analysed using thematic analysis.FindingsThe healthcare professionals’ practices differed between the antenatal clinics and the postnatal ward. Numerous barriers to accessing culturally appropriate antenatal care were evident. In contrast, the care provided in the postnatal ward was woman and family centered and culturally sensitive. One overarching theme, “The system is in control’ was identified, and comprised three sub-themes (1) ‘Being processed’ (2) ‘Insensitivity to cultural practices’ and, (3) ‘The space to care’.Discussion and conclusionsThe health system and healthcare professionals controlled the way antenatal care was provided to Burmese migrant women. This bureaucratic and culturally insensitive approach to antenatal care impacted on some women’s decision to engage in antenatal care. Conversely, the more positive examples of woman-centered care evident after birth in the postnatal ward, can inform service delivery.     

The comparison of the interpersonal action component of woman-centred care reported by healthy pregnant women in different sized practices in the Netherlands: A cross-sectional study

BackgroundThe number of interventions is lower, and the level of satisfaction is higher among women who receive midwife-led primary care from one or two midwives, compared to more midwives. This suggests that midwives in small-sized practices practice more women-centred. This has yet to be explored.ObjectiveTo examine pregnant women’s perceptions, of the interpersonal action component of woman-centred care by primary care midwives, working in different sized practices.MethodsA cross-sectional study using the Client Centred Care Questionnaire (CCCQ), administered during the third trimester of pregnancy among Dutch women receiving midwife-led primary care from midwives organised in small-sized practices (1−2 midwives), medium-sized (3−4 midwives) and large-sized practices (≥5 midwives). A Welch ANOVA with post hoc Bonferroni correction was performed to examine the differences.Results553 completed questionnaires were received from 91 small-sized practices/104 women, 98 medium-sized practices/258 women and 65 large-sized practices/191 women. The overall sum scores varied between 57–72 on a minimum/maximum scoring range of 15–75. Women reported significantly higher woman-centred care scores of midwives in small-sized practices (score 70.7) compared with midwives in medium-sized practices (score 63.6) (p < .001) and large-sized practices (score 57.9) (p < .001), showing a large effect (d .88; d 1.56). Women reported statistically significant higher woman-centred care scores of midwives in medium-sized practices compared with large-sized practices (p < .001), showing a medium effect (d .69).ConclusionThere is a significant variance in woman-centred care based on women’s perceptions of woman-midwife interactions in primary care midwifery, with highest scores reported by women receiving care from a maximum of two midwives. Although the CCCQ scores of all practices are relatively high, the significant differences in favour of small-sized practices may contribute to moving woman-centred care practice from ‘good’ to ‘excellent’ practice.     

A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

BackgroundImplementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and ‘any’ breastfeeding. However, implementation of the BFHI is challenging.AimTo identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation.MethodSeven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis.FindingsThree overarching themes were identified. First the BFHI was viewed variously as a ‘desirable innovation or an unfriendly imposition’. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial.ConclusionsHealth care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level.