Working With Lesbian, Gay, Bisexual, and Transgender People in Care Relationships

This chapter details some key considerations for health and human services professionals working with lesbian, gay, bisexual, and transgender (LGBT) people in care relationships. Reflecting on the impacts of stigma and discrimination as well as the social, cultural, and political contexts of LGBT communities and carers, this chapter will explore some of ways these factors (as well as heterosexist and cis-genderist assumptions about families and partners) impact the identification, support, and recognition of LGBT people in care relationships. Finally, this chapter will recommend strategies to reduce poor mental health and wellbeing outcomes among people in care relationships where one or all people involved are LGBT, and explore some key actions that may assist health and human services better support and include LGBT people in care relationships.

Working With Lesbian, Gay, Bisexual, and Transgender People in Care Relationships

This chapter details some key considerations for health and human services professionals working with lesbian, gay, bisexual, and transgender (LGBT) people in care relationships. Reflecting on the impacts of stigma and discrimination as well as the social, cultural, and political contexts of LGBT communities and carers, this chapter will explore some of ways these factors (as well as heterosexist and cis-genderist assumptions about families and partners) impact the identification, support, and recognition of LGBT people in care relationships. Finally, this chapter will recommend strategies to reduce poor mental health and wellbeing outcomes among people in care relationships where one or all people involved are LGBT, and explore some key actions that may assist health and human services better support and include LGBT people in care relationships.

Pflegekinderhilfe in der Sozialen Arbeit

Foster child support is an expanding field of work: In youth welfare offices and the foster child services of independent institutions, in guardianship, expert assessments and family courts, specialists have to deal with the key questions relating to foster child support. In addition, there are the people affected: foster children, parents and foster parents, siblings and other family members. This book provides a well-founded introduction to this subject area and links important practical issues to international research findings. It analyses current developments in this respect in Germany, Austria and Switzerland and illustrates the variety of forms of care relationships with case studies. In this way, the importance of professional services and the courses of action open to them become clear.

574. High Acceptance and Rapid Implementation of COVID-19 Vaccine in a Public HIV Clinic in Northern California: An Initial Analysis of Social Determinants

Background Safety net HIV providers face operational challenges during the COVID pandemic with services often transformed to telehealth. HIV infected persons are a priority population for SARS CoV-2 vaccination. Medical mistrust of COVID vaccines has been cited as a contributor to vaccine hesitancy. Data on efficient and successful vaccination efforts of HIV infected persons in safety net health systems is needed. In San Mateo County, Latino persons comprised 42% of all COVID cases, Whites 16%, and African Americans 2%. Methods SARS CoV2 vaccination with BNT162b2 (Pfizer–BioNTech), mRNA-1273 (Moderna) or Ad26.COV2.S (Janssen) vaccine were offered beginning February 2, 2021 through May 28, 2021 in a northern California public County HIV clinic. Clinic patients were contacted by bilingual English/Spanish speaking HIV clinic staff and appointments scheduled at County affiliated vaccination sites. Clinic staff followed up by phone with patients who did not initially accept vaccine. We calculate the percentage of patients who completed vaccine series and use multivariable logistic regression analysis to estimate the odds of series completion by patient race/ethnicity, gender and age. Results Virtually all, 95% (349/365) of HIV patients in our County HIV clinic were offered vaccine during a 17 week period. Among those, 86% (313/365) accepted and received at least one dose and 80% completed the series (292/365) at time of this analysis. Janssen vaccine was given to only 2% (7/313) patients. Series completion was highest among Latinos and Asians. Latinos had the highest odds of vaccine series completion (OR = 4.12; 95% CI 1.71 - 9.93). COVID-19 Vaccine Series Completion in a California Public HIV Clinic by Race/Ethnicity, Age and Sexual Orientation, n=364 Conclusion HIV patients offered SARS CoV2 vaccine by County HIV clinic staff with established patient care relationships had high vaccine acceptance (80%), comparable to 68% series completion in the county overall and 56% in the health equity quartile county census tracts. Latino HIV infected persons were most likely to complete the COVID vaccine series. Ryan White funded HIV clinics are ideal hubs to coordinate HIV patient COVID vaccination efforts. Adding COVID vaccine completion to HIV clinic performance measures would likely be beneficial. Disclosures All Authors: No reported disclosures

Family Social Reproduction: Conflict and Compromise in Cross-Border Marriages between Chinese Malaysian Men and Vietnamese Women

In this paper, we use the framework of family social reproduction to investigate care relationships within cross-border marriages in Malaysia. Examining the narratives of Chinese Malaysian men and their Vietnamese spouses, we find that (i) the Malaysian men’s labour migration during their twenties and thirties leads to the deferment as well as enablement of marriage, reconfiguring social reproduction temporally and spatially within their life courses, while (ii) the Vietnamese women’s aspirations for migration, work, and marriage interlink with their desire to seek a better life, and their motivations to secure better options to contribute to the social reproduction of their natal families. Tensions in cross-border marriage arise from unmet expectations of care and sustenance, leading to frictions over contested roles and responsibilities in daily household maintenance and care activities, and compromises as marriage partners formulate social reproductive strategies. Exchanges of care, reproductive labour, and money within these marriages are embedded in relational meanings, pointing to the significance of recognising that the care work that shapes and sustains marital relationships is bidirectional, reciprocal, and undertaken by husbands as much as wives.

CoronaCare study protocol: an ethnographic study of the risks to and potential for social health during the COVID-19 pandemic

IntroductionGerman government regulations such as physical distancing and limited group numbers, designed to curb the spread of COVID-19, have had far-reaching consequences for the very foundations of social life. They have, to name only a few, transformed greetings and goodbyes, blurred private and public worlds, and complicated basic communication with mandatory mask wearing. The ethnographic study CoronaCare investigates how these sociopolitical measures affect social health, a form of health which unfolds through and across social relations. It explores how caring as a fundamental human activity and one integral to sustaining social health is impacted when in-person and person-to-person contacts are restricted and everyone is radically redefined as at risk from others and a risk to others. It explores care relationships, relationships involving the giving or receiving of care in everyday life, institutional settings such as an assisted living facility, and informal settings, such as a housing block. Inside of the pandemic, relationships are a pivotal site at which the negotiation of caring and risk is intensified and where the consequences for social health and social life more generally are pronounced.Methods and analysisThis ethnographic project aims to understand the tensions that arise in the lives of individuals and communities living under the sociopolitical regulations and to analyse the tacit forms of practice that individuals and communities develop to uphold social health. Fueled by citizen science, the ethnography uses a variety of methods namely telephone and video interviews with 60–70 research participants, the collection of ethnographic material including video and audio diaries, storyboards, first-person camera footage, photographs and a survey to enrich the sample description based on the Copenhagen Psychosocial Questionnaire. The analysis will draw on elements of grounded theory and through the aid of the qualitative software MAXQDA it will rigorously document and explain how the social regulations are (re)shaping our ability to be cared for and to care for one another. The survey data will be analysed through the use of the quantitative software programme R.Ethics and disseminationThe ethics committee of the Brandenburg Medical School Theodor Fontane has approved the project (E-01-20200605). The dissemination strategy includes publications in medical, sociological and research methods journals, as well as a stakeholder discussion with political and civil society leaders where the research team will present its recommendations for future pandemic preparedness.

When Refugees Care for Refugees in Lebanon: Providing Contextually Appropriate Care from the Ground Up

Despite a surge in initiatives to integrate foreign-trained physicians into local health systems and a drive to learn from localised humanitarian initiatives under the COVID-19 pandemic, we still know little about the on-the-ground strategies developed by refugee doctors to meet the needs of refugee patients. In Lebanon, displaced Syrian health professionals have mounted informal, local responses to care for displaced Syrian patients. Drawing on ethnographic work shadowing these healthcare providers across their medical and non-medical activities, we explore how clinical encounters characterised by shared histories of displacement can inform humanitarian medicine. Our findings shed light on the creation of breathing spaces in crises. In particular, our study reveals how displaced healthcare workers cope with uncertainty, documents how displaced healthcare workers expand the category of ‘appropriate care’ to take into account the economic and safety challenges faced by patients, and locates the category of ‘informality’ within a complex landscape of myriad actors in Lebanon. This research article shows that refugee-to-refugee healthcare is not restricted to improvised clinical encounters between ‘frontliners’ and ‘victims of war’. Rather, it is proactively enacted from the ground up to foster appropriate care relationships in the midst of violent, repeated, and protracted disruptions to systems of care.

West African-diasporic social media users facing COVID-19: Care, emotions and power during the onset of the coronavirus pandemic

The arrival of the coronavirus pandemic in (West) Africa announced a health crisis that required increasing levels of care, on the physical as well as on the emotional level. At the same time, societies had to respect social distancing rules that impeded regular care relationships. This article analysed social media as one means for West African-diasporic actors to practice care in this situation of physical immobility. It is based on a critical discourse analysis of postings on Facebook, Twitter, LinkedIn and WhatsApp. This analysis showed that West African-diasporic actors used social media to perform emotional practices of care through informing on COVID-19-related issues, raising awareness and encouraging compliance with anti-COVID-19 measures. In addition, these practices of care unveil negotiations of sociopolitical power relations that oscillate between opportunities for solidarity and sociopolitical change, on the one hand, and intersectional exclusions, on the other hand.

Exploring the experiences of nurses’ moral distress in long-term care of older adults: a phenomenological study

Background Moral distress is a poorly defined and frequently misunderstood phenomenon, and little is known about its triggering factors during ICU end-of-life decisions for nurses in Iran. This study aimed to explore the experiences of nurses’ moral distress in the long-term care of older adults via a phenomenological study. Methods A qualitative, phenomenological study was conducted with 9 participants using in-depth semi-structured interviews. The purpose was to gain insight into the lived experiences and perceptions of moral distress among ICU nurses in hospitals affiliated with Tehran University of Medical Sciences during their long-term care of older adults. Results Five major themes are identified from the interviews: advocating, defense mechanisms, burden of care, relationships, and organizational issues. In addition, several subthemes emerged including respectful end of life care, symptom management, coping, spirituality, futile care, emotional work, powerlessness, relationships between patients and families, relationships with healthcare teams, relationships with institutions, inadequate staffing, inadequate training, preparedness, education/mentoring, workload, and support. Conclusions This qualitative study contributes to the limited knowledge and understanding of the challenges nurses face in the ICU. It also offers possible implications for implementing supportive interventions.

What matters to people aged 80 and over regarding ambulatory care? A systematic review and meta-synthesis of qualitative studies

The growing percentage of the population aged 80 and over is challenging for healthcare systems, as frailty and other complex health issues are common in this age group. In order to provide patient-centered ambulatory healthcare, their preferences and expectations need to be explored. Therefore, the aim of this study was to systematically search for and synthesize qualitative evidence on how people aged 80 and over believe ambulatory healthcare (medical and nursing care) should be delivered to them. Medline, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar were searched for full research reports of qualitative studies focusing on the preferences, wishes, needs, expectations and experiences of people aged 80 and over regarding ambulatory medical and nursing care. The results were screened by two independent reviewers using a two-step approach. The included studies were meta-synthesized using Thomas and Harden’s ‘thematic synthesis’ approach in order to gain a new, second-order interpretation of the findings of the primary studies. In the intermediate synthesis step, 14 aspects of healthcare structures and care relationships were identified as relevant. Based on these, three underlying wishes were found: feeling safe, feeling like a meaningful human being, and maintaining control and independence. The results of this review are in line with other research, such as reviews focusing on the preferences of the younger age group (65–80). However, the importance of aspects of care relationships as an integral part of favorable ambulatory healthcare and the wish to be strengthened as a meaningful human being are emphasized more strongly.