Retrospective study of older patient characteristics that increase the likelihood that a fracture was associated with abuse

Searching for clinical manifestations of elder abuse may help healthcare professionals identify cases of elder abuse. The aim of the present study was to explore characteristics of older patients with fractures that increase the likelihood that the fracture was associated with abuse. This is a retrospective chart review study of 1,000 patients aged 65 and older who presented to an emergency department in northern-central Israel with a fracture during 2019. The chart review included participant characteristics - sociodemographic data, medical data, data regarding the fracture, and data on the presence of forensic markers of elder abuse in individual patients. Descriptive statistics and regression models were used for the analyses. Older age, presence of dementia, and hand and facial fractures were associated with the presence of forensic markers, and were also found to predict having at least one forensic factor. This study provides further support for the creation of clinical guidelines for identification of elder abuse.

Patients Who Leave the Emergency Department Before Treatment Completion: A Retrospective Cohort Study

BACKGROUND

Patients leaving the emergency department (ED) before treatment completion (LBTC) is a common universal occurrence. We hypothesized that the characteristics of the Israeli health care system, as well as its policy, intended to reduce the burden of nonurgent ED visits, may have an impact on factors associated with LBTC.

OBJECTIVES

The purpose of this study was to explore factors associated with LBTC in the Israeli context.

METHODS

This was a retrospective cohort study of patients who visited the ED in a major hospital located in northern-central Israel during 2016-2019. Characteristics of 130 randomly sampled LBTC patients and of 130 non-LBTC patients that constituted the control group, were compared. Odds ratios (OR) are presented.

RESULTS

A low-acuity triage score (OR 8.18, p < 0.01) and a longer length of stay (OR 1.15, p < 0.01) were found to be risk factors for LBTC, and female gender (OR 0.40, p < 0.01) was found to be a protective factor. In contrast, age and nationality were not found as risk factors. Significant differences were found between the two groups with regard to the main presenting complaint. However, both groups had similar rates of presentations with a psychiatric condition. Approximately half of the LBTC patients presented at times when primary clinics were active.

CONCLUSIONS

These findings reflect the strengths of the Israeli health care system. Despite the policy intended to reduce the burden of nonurgent ED visits, there are possible shortcomings in the system that should be addressed.

Comparison of two fall-risk assessment tools used in a long-term care facility

PURPOSE

The purpose of this paper is to compare the ability of the Morse Fall Scale (MFS) and Farmer's fall-risk assessment tool (FFAT) to identify correlations between risk factors and falls among older adult long-term care (LTC) facility residents.

DESIGN/METHODOLOGY/APPROACH

This was a correlational retrospective study. 200 medical records of older adults hospitalized in a LTC facility in central Israel, from January 2017 to January 2018, were examined.

FINDINGS

Of all the residents, 75% and 99.5% of the residents were identified as having a high fall risk according to the MFS and FFAT, respectively. Only 12.5% of residents actually fell. MFS score was weakly correlated with actual falls (odds ratio = 1.035). It was also found that all fallers fell during their first week at the facility.

RESEARCH LIMITATIONS/IMPLICATIONS

Future research should explore the ability of the tools to capture changes in the fall risk by repeat assessments, as this has not been examined in the present study.

PRACTICAL IMPLICATIONS

The MFS and FFAT tool may have little value in assessing fall risk in older adult LTC facility residents. Therefore, nurses should perform a clinical evaluation of each individual patient. In addition, nurses should place a particular emphasis on fall risk and prevention during the first week following admission.

ORIGINALITY/VALUE

The findings of the present study raise doubts regarding the utility of the common practice of assessing fall risk in older adult LTC facility residents using the tools MFS and the FFAT, thus emphasizing the need to adopt a different approach.

Compassion fatigue among nurses working in a long-term care facility: The Israeli experience

Nurses working in a long-term care facility could be at risk of developing compassion fatigue due to the nature of their work. In this descriptive, cross-sectional survey, we explored the level of compassion fatigue among nurses working in a long-term care facility, as well as the associated sociodemographic and occupational factors. In total, 103 nurses employed in various departments of a long-term care facility in central Israel completed the Hebrew version of the Professional Quality of Life Scale R-IV. Nurses scored moderate-high on the compassion fatigue (mean = 3.6, standard deviation = .5), burnout (mean = 3.5, standard deviation = .5), and compassion satisfaction (mean = 3.8, standard deviation = .5) scales. Older nurses scored lower on compassion fatigue, while nurses with higher qualifications scored higher on compassion satisfaction. In this study, we implicate that it is necessary to raise awareness about compassion fatigue, both in nursing education and training and in long-term care organizations. It is necessary to improve understanding of this phenomenon in order to help nurses acquire appropriate coping skills to address this critical issue.

Intention to undergo faecal occult blood testing in an ethnic minority

AIM

To explore factors associated with the intention of an ethnic minority of Israeli Arabs to undergo faecal occult blood testing using the Health Belief Model.

METHODS

This was a quantitative correlational study that utilized a questionnaire constructed based on the Health Belief Model. The questionnaire was administered to a convenience sample of 200 Israeli Arabs aged 50 and over. Data were collected during January to March 2018.

FINDINGS

The research findings show that respondents had a high intention to undergo faecal occult blood testing in the future, although only 66.5% of the respondents had ever undergone it in the past. Physicians and nurses were the most significant sources of information regarding the faecal occult blood testing. The Health Belief Model explained 46% of variance in the intention to undergo the faecal occult blood testing among Israeli Arabs, with perceived benefits of testing being the most significant predictor of this intention.

CONCLUSION

The Health Belief Model can serve as a basis for planning intervention programmes to be implemented by health care professionals to raise the intention of ethnic minorities to undergo faecal occult blood testing.

A coordination project for improvement of osteoporosis medication use among patients who sustained an osteoporotic fracture: The Israeli experience

Objectives

The aim of this study was to examine whether coordination between healthcare providers at an inpatient rehabilitation facility and healthcare providers in a community setting improves osteoporosis medication use in the community.

Methods

In 2012, a coordination project between an inpatient geriatric rehabilitation facility located in north-central Israel and general practitioners in the community setting was initiated. In this retrospective pseudo-experimental study, we compared osteoporosis medication use among patients who were hospitalized at the facility following an osteoporotic fracture during 2011–2012, and who constituted the control group (n=120), and patients who were hospitalized at the facility during 2013–2015, and who constituted the trial group (n=129). Data were collected from the patients' records and from records of the health maintenance organization concerning medications issued to the patients by pharmacies.

Results

Differences were observed between the trial and the control group in osteoporosis medication management by healthcare providers, both at the inpatient rehabilitation facility and in the community, suggesting favorable trends. However, osteoporosis medication use in the community was slightly lower in the trial group, then in the control group (32.8% vs. 34.2%, respectively). A regression analysis indicated that the only variable predicting use of osteoporosis medications in the community was a previous diagnosis of osteoporosis in the community.

Conclusions

The study results indicate that mere coordination between the healthcare settings is insufficient in order to ensure continued care in the community, emphasizing the need for an osteoporosis coordinator.

Breastfeeding knowledge, attitudes, intentions, and perception of support from educational institutions among nursing students and students from other faculties: A descriptive cross-sectional study

BACKGROUND

Nursing education aims to promote positive health practices among the general population as well as among nurses themselves. Breastfeeding is one of these important health practices. However, to date there is little evidence regarding the extent to which nursing education affects nursing students' attitudes, knowledge, intentions, and their perception of institutional support regarding breastfeeding.

OBJECTIVES

To compare breastfeeding attitudes and knowledge among nursing students and students from other faculties, as well as their perception of their academic institution's support for breastfeeding, and to explore the association between these factors and students' intention to breastfeed during the course of their studies.

DESIGN

This study was a descriptive cross-sectional study.

SETTINGS

The study was conducted at a large university in central Israel.

PARTICIPANTS

One hundred female students from the faculty of nursing and 100 female students from other faculties, of childbearing age, who were either pregnant or mothers.

METHODS

The students completed a questionnaire regarding their breastfeeding knowledge, intentions, attitudes, and their perception of their academic institution's support for breastfeeding.

RESULTS

Nursing students' level of breastfeeding knowledge was very high, and higher than that among students from other faculties. However, both groups had similar moderately positive overall scores for attitudes towards breastfeeding. In addition, both groups expressed similar moderate intentions to breastfeed during the course of their studies. Students' perception of their academic faculty as supportive of breastfeeding, their breastfeeding attitudes, and breastfeeding knowledge, were found to predict their intention to breastfeed during the course of their studies.

CONCLUSIONS

Nursing programs should place more emphasis on improving nursing students' attitudes towards breastfeeding. In order to promote breastfeeding among students during their studies, it is important to ensure a pro-breastfeeding environment on campus.

The clock-drawing test: normative data in adult and elderly Israeli Arabs

AIM

Despite the widespread use of the clock-drawing test (CDT), normative data and information regarding the influence of sociodemographic factors on test performance by adult and elderly Israeli Arabs are lacking. The current study aimed to establish normative data for this population group by exploring the impact of sociodemographic factors such as age, education, and gender on CDT performance. In addition, this study examined the association between CDT performance and Mini-Mental State Examination (MMSE) scores.

METHODS

The sample consisted of 295 community-dwelling healthy adult and elderly Israeli Arabs, aged 20-86 years, with a MMSE score ≥24. The MMSE and the CDT were administered to participants.

RESULTS

Statistical analyses revealed that age had a negative effect on CDT performance, which was most pronounced in the 60-86 age group, but education and occupation (academic vs non-academic) had a positive effect. Gender and place of residence (urban vs rural) had no effect. CDT performance predicted the MMSE score.

CONCLUSIONS

The present study provides preliminary normative data on adult and elderly Israeli Arabs. The CDT appears to be applicable to Israeli Arabs, while the normative data might help interpret cognitive function results in this population.

Factors associated with intention of Israeli-born women and immigrant women from the Former Soviet Union to take folic acid before and during pregnancy

AIM

Folic acid supplementation before and during pregnancy decreases rates of neural tube defects. However, many women fail to adhere to folic acid supplementation recommendations. This study explored factors associated with women's intention to take folic acid before and during pregnancy, using the Theory of Planned Behaviour, with an emphasis on differences between Israeli-born women and immigrant women from the Former Soviet Union.

METHODS

In this cross-sectional study, 100 Israeli born-women and 100 women from the Former Soviet Union of childbearing age completed a questionnaire, based on the Theory of Planned Behaviour.

RESULTS

The findings indicated a significant difference in the rates at which Israeli-born and FSU-born women took folic acid before and during pregnancy, as well as a significant difference in their intention to take folic acid supplementation in future pregnancies. The theoretical model explained 88.7% of variance in women's intention to take folic acid, with the most influential variable being behavioural attitudes towards taking folic acid.

CONCLUSION

The study emphasizes the need to increase knowledge and change attitudes and beliefs about folic acid supplementation among women and their significant others, as well as the importance of cultural, language, and economic barriers when treating Former Soviet Union immigrant populations.

The Impact of Mental Health Reform on Mental Illness Stigmas in Israel

This study examined public perception of stigmas relating to mental illness six months after a reform, which integrated mental health care into primary care in Israel. The results reveal that the public feels uncomfortable seeking referral to mental health services through the public health system, with Arab Israelis and men expressing lower levels of comfort than did Jewish Israelis. The current reform has not solved the issue of public stigma regarding mental health care. The study suggests that the current reforms must be accompanied over time with appropriate public education regarding mental illness.

Factors affecting nursing students' intention to report medication errors: An application of the theory of planned behavior

BACKGROUND

Medication errors are common among nursing students. Nonetheless, these errors are often underreported.

OBJECTIVES

To examine factors related to nursing students' intention to report medication errors, using the Theory of Planned Behavior, and to examine whether the theory is useful in predicting students' intention to report errors.

DESIGN

This study has a descriptive cross-sectional design.

SETTINGS

Study population was recruited in a university and a large nursing school in central and northern Israel.

PARTICIPANTS

A convenience sample of 250 nursing students took part in the study.

METHODS

The students completed a self-report questionnaire, based on the Theory of Planned Behavior.

RESULTS

The findings indicate that students' intention to report medication errors was high. The Theory of Planned Behavior constructs explained 38% of variance in students' intention to report medication errors. The constructs of behavioral beliefs, subjective norms, and perceived behavioral control were found as affecting this intention, while the most significant factor was behavioral beliefs. The findings also reveal that students' fear of the reaction to disclosure of the error from superiors and colleagues may impede them from reporting the error.

CONCLUSIONS

Understanding factors related to reporting medication errors is crucial to designing interventions that foster error reporting.

What drives pregnant women's decisions to accept the pertussis vaccine?

The aims of this study were to identify factors associated with pregnant women's intention to receive the pertussis vaccine during pregnancy, using the Health Belief Model; while comparing between pregnant native-born Israeli women and Israeli women born in the former Soviet Union. Convenience and snowball sampling methods were used to recruit 200 pregnant Israeli native-born women and women born in the former Soviet Union. Data were collected using a cross-sectional questionnaire survey. Regression results revealed that susceptibility to pertussis, seriousness of pertussis, perceived benefits of the vaccine, knowledge of risk factors of pertussis, and general health motivation together explained 76% of the variance of women's intention to receive the pertussis vaccine. Perceived benefits of the vaccine was the most significant factor affecting pregnant women's intention to receive the pertussis vaccine during pregnancy (p<0.05). Native-born women had higher intention to be vaccinated and more positive health beliefs (p<0.05).

Prediction of geriatric rehabilitation outcomes: Comparison between three cognitive screening tools

AIM

Comparison between the predictions of functional rehabilitation outcomes at a department of geriatric rehabilitation using three cognitive screening tools - Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

METHODS

This study is a prospective study. The study participants were 212 patients aged 65 and older admitted to rehabilitation departments at a geriatric facility in central Israel, from April 2016 to October 2016. The cognitive functioning of each patient was assessed using the MMSE, MoCA, and IQCODE. Upon discharge, rehabilitation outcomes were examined using the Functional Independence Measure (FIM), cognitive FIM, delta FIM (Δ FIM), and ADL.

RESULTS

Cognitive impairment was found to interfere with the rehabilitation process. The MMSE was the best predictor of functional rehabilitation outcomes at discharge, compared to the IQCODE, while the MoCA did not predict these measures. In addition, when distinguishing between patients by ethnicity (Jewish versus Arab), the MMSE and the IQCODE predicted FIM upon discharge among Jewish patients, while only the IQCODE predicted FIM upon discharge among Arab patients.

CONCLUSIONS

The research findings show that cognitive assessment upon admission for rehabilitation - MMSE among Jewish patients and IQCODE among Arab patients - can help predict functional rehabilitation outcomes and make the appropriate adaptations in the rehabilitation program. Geriatr Gerontol Int 2017; 17: 2507-2513.

Intention of Mothers in Israel to Vaccinate their Sons against the Human Papilloma Virus

PURPOSE

This study investigated the intention of mothers in Israel to vaccinate their sons against HPV, using the Health Belief Model (HBM) as a framework, while comparing between Arab and Jewish mothers.

DESIGN AND METHODS

The study has a quantitative cross-sectional design. A convenience sample of 200 Jewish and Arab mothers of boys aged 5-18 completed a questionnaire based on the HBM.

RESULTS

The research findings indicate that only 14% of the mothers, constituting mostly Arab mothers, vaccinated their sons against HPV. Moreover, mothers showed a moderate level of intention to vaccinate their sons. This level was similar among Arab and Jewish mothers. However, the health beliefs of Jewish and Arab mothers differed. The HBM was found to explain 68% of mothers' intention to vaccinate their sons against HPV, and the perceived benefits of the vaccine were the factor most affecting this intention.

CONCLUSIONS

Although mothers' health beliefs concerning vaccinating their sons against HPV may vary between sectors, the HBM can be used to explain what motivates mothers to vaccinate their sons.

PRACTICE IMPLICATIONS

The research findings can assist in designing a national project among mothers of boys aimed at raising HPV vaccination rates, in both the Jewish and the Arab sector.

Intention to receive the seasonal influenza vaccine among nurses working in a long-term care facility

The factors affecting influenza vaccine uptake among nurses might vary between different medical facilities. The purpose of the present study was to explore factors that affect the intention of nurses at a long-term care facility to receive the influenza vaccine and whether the health belief model predicts this intention. In this cross-sectional quantitative correlational study, a convenience sample of 150 nurses employed at a large long-term care facility in central Israel completed a questionnaire based on the health belief model. Data collection took place between January and February of 2016. Forty-two percent of the respondents reported having been vaccinated against influenza in the current year. The health belief model explained 53% of the variance (p < .01), with perceived (personal) benefits of the vaccine being the most significant factor. The number of times of receiving the influenza vaccine in the past was strongly correlated with the intention to receive the vaccine (p < .01). To improve nurses' compliance with influenza vaccination at long-term care facilities, we find that it is necessary to emphasize the benefits of vaccination and, particularly, the personal benefits. Annual vaccination behavior should be promoted to make it become a routine.

Patient Violence Toward Psychiatric Health Care Workers in Israel as Viewed Through Incident Reports

BACKGROUND

Rates of violence perpetrated by patients toward health care workers are known to be higher in psychiatry than in other fields. Objective standardized reports of violent incidents may clarify this phenomenon.

OBJECTIVE

The purpose of this study was to assess the characteristics of patient violence, as evident from objective reports.

STUDY DESIGN

In this retrospective chart review study, conducted at a large mental health hospital in Israel between 2013 and 2015, reports of violent incidents perpetrated by people diagnosed with mental health problems against health care workers of the hospital were reviewed.

RESULTS

A total of 80 violent incidents were recorded. The findings outline the characteristics of a typical assailant, a typical victim, and a typical incident, and demonstrate associations between some of these characteristics.

CONCLUSIONS

This information may be beneficial for planning interventions for efficient coping with and prevention of violence at psychiatric inpatient facilities.

Readiness of nursing students to screen women for domestic violence

BACKGROUND

Although domestic violence against women is common in Israel and elsewhere, and though medical staff in Israel have a universal obligation to screen women for domestic violence, actual screening rates remain low.

OBJECTIVES

To examine which variables affect nursing students' intention to screen women for domestic violence when providing treatment, and whether the Theory of Planned Behavior (TPB) developed by Ajzen (1991) predicts this intention.

DESIGN

This study is a quantitative cross sectional study.

SETTINGS

A large academic nursing school in central Israel.

PARTICIPANTS

A convenience sample of 200 nursing students who had completed at least one year of studies took part in the study.

METHODS

Students completed a questionnaire based on the TPB.

RESULTS

Nursing students showed high intention to screen women for domestic violence when providing treatment. Normative beliefs, subjective norms, behavioral beliefs, perceived control, and knowledge were found to affect students' intention to screen women for domestic violence. The opinion of the clinical instructor was most significant for students.

CONCLUSIONS

The theoretical model predicted 32% of students' intention to screen women for domestic violence, with normative beliefs being the most significant variable.

Factors That Influence Israeli Muslim Arab Parents' Intention to Vaccinate Their Children Against Influenza

The purpose of the current study was to explore factors related to the intention of parents from the Muslim Arab ethnic minority in Israel to vaccinate their children against influenza, using the Health Belief Model (HBM).

DESIGN AND METHODS

This study is a cross sectional quantitative study. A convenience sample of 200 parents of children aged 12 and younger completed a questionnaire based on the HBM.

RESULTS

Perceived susceptibility, severity, benefits, and barriers predicted 88% of parents' intention to vaccinate their children. Parents who vaccinated their children in the past year were younger and had fewer children. Community nurses and physicians were identified as important cues to action.

CONCLUSIONS

The HBM components predicted a high percentage of parents' intention to vaccinate their children

PRACTICE IMPLICATIONS

Interventions to raise vaccination coverage rates among children belonging to an ethnic minority of Israeli Muslim Arabs should begin on the micro level of the parent-health care professional encounter.

Interest in nursing among academic degree holders in Israel: A cross-sectional quantitative study

BACKGROUND

The shortage of nurses is a global problem. One strategy for producing more registered nurses worldwide and in Israel in particular is to offer graduate entry nursing programs for individuals with non-nursing academic degrees. In order to recruit academic degree holders into the nursing profession, it is important to identify factors that might attract them.

OBJECTIVES

The purpose of this study was to explore whether the perception of nurse characteristics by academic degree holders is associated with their interest in enrolling in a graduate entry nursing program or in recommending this program to a family member, and whether ethnic background, gender and interaction with a nurse have an effect on this interest.

DESIGN

A cross-sectional quantitative study.

SETTINGS

The setting of the study was on the campus of Tel Aviv University.

PARTICIPANTS

A convenience sample of 522 individuals with an academic education, men and women, aged 18-60 and equally distributed between Jewish and Arab Israelis, took part in the study.

METHODS

Participants completed a questionnaire based on the Porter Nursing Image Scale.

RESULTS

A moderate positive correlation was found between perception of nurses and interest in nursing (r=0.32, p<0.01). Arab Israelis, women, and individuals who have or have had interactions with nurses, viewed nurses in a more positive light and had a higher interest in nursing than their counterparts.

CONCLUSIONS

Efforts should be made to foster a positive public image of nursing among the population of people with an academic education. Recruitment strategies should be tailored to each of this population's subgroups.

Willingness of Future Nursing Workforce to Report for Duty During an Avian Influenza Pandemic

Nursing students are the future nursing workforce. Exploring factors associated with nursing students' willingness to report for duty during an avian influenza (flu) pandemic, might help nurse managers develop strategies in advance for efficient management of personnel during a pandemic of avian flu.

AIM

To examine the factors associated with the willingness of future nursing workforce to report for duty during an avian flu pandemic, using the theory of self-efficacy.

METHODS

The study employed a cross-sectional quantitative correlational design. A convenience sample of 200 Israeli nursing students completed a questionnaire based on the theory and the literature review.

RESULTS

Approximately one-half (49%) of the students intended to report for duty during an avian flu pandemic in the future. Perceived self-efficacy and working conditions were found associated with this willingness. Male students and students from the Arab Muslim sector were more willing to report for duty during a pandemic than female students or students from the Jewish sector.

DISCUSSION

These finding may have implications for disaster planning and staffing management in health care settings during an avian flu pandemic, with the aim to ensure optimal nursing care and an efficient functioning of the entire health care system.

Factors Related to the Intention of Israelis to Use Complementary and Alternative Medicine

PURPOSE

Despite the significant rise in the use of complementary and alternative medicine (CAM) in Israel, the factors affecting the decision to do so remain unclear. Thus, the purpose of the study was to explore factors that affect Israelis' intention to use CAM, using the theory of planned behavior (TPB).

DESIGN

A quantitative correlational study.

METHOD

A convenience sample of 200 Hebrew-speaking Israelis aged 21+ completed a questionnaire based on the TPB.

FINDINGS

Respondents expressed moderate intention to use CAM. The TPB predictability of this intention was 57% (R² = .57), with behavioral beliefs being the most influential factor. The family was identified as another significant factor. Previous experience with CAM was also found to raise the intention to use it in the future.

CONCLUSIONS

When referring a patient for services of CAM, it is important to provide in-depth explanations emphasizing positive anticipated outcomes of these services in order to effect a change in the patient's behavioral beliefs. Patient's family should be considered as a possible resource to promote usage of CAM.