School of Social Welfare, University of California, Berkeley, California, USA.
J Gerontol B Psychol Sci Soc Sci. 2024 Sep 1;79(9). doi: 10.1093/geronb/gbae122.
Religious exemptions (exceptions to nondiscrimination laws for individual religious/moral beliefs) in health care have surged, negatively affecting LGBTQ+ older adults in nursing homes with some of the highest caregiving needs. Given job differences between floor staff and managers, this study asks: How does meaning-making differ between nursing home floor staff and managers when staff refuse to care for LGBTQ+ residents? To answer this question, this study uses social coherence as a conceptual framework to understand the process of reflection that staff employ when a colleague invokes a religious exemption to care.
This qualitative comparative study uses in-depth semistructured interviews to compare responses from nursing home floor staff and managers (n = 80). Qualitative content analysis incorporated inductive and deductive coding approaches.
Staff invoked 5 frames to reach social coherence: fairness, resident safety and comfort, individual religious beliefs, job obligations, and laws/policies. Floor staff and managers invoked the same 2 reasons (fairness, resident safety and comfort) to reach social coherence. However, floor staff differed from managers by also invoking individual religious beliefs and job obligations; whereas managers turned to laws and policies to reconcile tensions between religious rights and LGBTQ+ resident rights to care.
In an increasingly polarized world, findings from this study illuminate nuances (and potential new areas of allyship) in how floor staff and managers understand and use various frames when deciding whether or not to accommodate a colleague who refuses care to an LGBTQ+ resident because of religious or moral reasons.
医疗保健中的宗教豁免（对个人宗教/道德信仰的歧视法的例外）激增，对护理院中护理需求最高的 LGBTQ+ 老年人产生了负面影响。鉴于楼层工作人员和管理人员之间的工作差异，本研究提出了以下问题：当员工拒绝照顾 LGBTQ+居民时，护理院的楼层工作人员和管理人员在意义构建方面有何不同？为了回答这个问题，本研究使用社会连贯性作为概念框架，来理解员工在同事援引宗教豁免权拒绝护理时所采用的反思过程。
这项定性比较研究使用深入的半结构化访谈，比较了护理院楼层工作人员和管理人员（n=80）的反应。定性内容分析采用了归纳和演绎编码方法。
工作人员援引了 5 个框架来达到社会连贯性：公平、居民安全和舒适、个人宗教信仰、工作义务和法律/政策。楼层工作人员和管理人员援引了相同的 2 个理由（公平、居民安全和舒适）来达到社会连贯性。然而，楼层工作人员与管理人员不同，他们还援引了个人宗教信仰和工作义务；而管理人员则求助于法律和政策，以调和宗教权利与 LGBTQ+居民获得护理的权利之间的紧张关系。
在一个日益两极化的世界中，本研究的结果阐明了楼层工作人员和管理人员在决定是否容纳因宗教或道德原因拒绝照顾 LGBTQ+居民的同事时，理解和使用各种框架的细微差别（以及潜在的新的盟友关系领域）。
