Arab male physicians' perceptions about their own smoking behaviors: a qualitative study

BACKGROUND

Smoking remains the leading preventable cause of disease, disability, and death worldwide. Although physicians have high levels of health literacy with awareness of the consequences of smoking and their essential role in smoking cessation of patients, some physicians continue to smoke. Rates of smoking among Arab male physicians are high. This study aimed to gain insights into Arab male physician's perceptions of their own smoking behaviors and their professional role in health promotion.

METHODS

Using purposive sampling, we recruited 25 Arab male physicians working in hospital and community clinic settings who currently smoke. Semi-structured, hour-long, interviews were held during January-June 2022. We then performed a thematic analysis of the interview data.

RESULTS

The analysis revealed three categories, two sub-categories, and 15 emerging themes. The category 'Antecedents: prior to becoming a physician' revealed the themes: smoking experience during adolescence; social and ethnic culture; stress during medical studies; and on & off periods of quitting smoking. The category 'Physicians' perception of smoking' was sorted into two sub-categories: (1) Personal aspects, including the themes 'relaxation from stress', 'self-compensation', 'addiction', and 'enjoyable experience', and (2) Professional aspects, including the themes 'lack of knowledge about cessation', 'inadequate workplace support', 'motivation to consult patients', and 'awareness of their role as primary care physicians'. The category'Impacts' revealed the themes 'personal health and well-being', 'professional competence', and 'professional image in public'.

CONCLUSIONS

This study provides an in-depth understanding of the personal, socio-cultural, and professional aspects of the phenomenon of Arab male smoking physicians from their perspective. Based on this information, we recommend developing programs that support and empower all physicians to cope better with their personal and professional stress as well as instituting programs that will provide all physicians with specific knowledge and skills related to smoking cessation. These programs should improve the ability of physicians to serve as positive role models for their patients for preventing and ceasing smoking, thus enhancing the image of the medical profession and, most importantly, improving the health of the public.

Longitudinal analysis of Israeli nurses’ perceptions, trust & emotions during the COVID-19 pandemic

Background

The nursing sector is the largest human resource in the healthcare system providing direct patient care. The Covid-19 pandemic has forced nursing teams into a sustained state of emergency, and with it, much uncertainty and risk taking.

Aims

Examining the emotions, risk and threat perceptions, trust in the healthcare system and compliance with Ministry of Health (MOH) regulations among nurses at two points in time during the COVID-19 pandemic in Israel.

Methods

Research questionnaires were distributed to nurses at the height of the pandemic’s first wave (March-May 2020). Among the respondents, 140 agreed to continue with the follow-up study. During the pandemic’s third wave (January 2021), the research questionnaire was re-sent to these respondents. Of these, 80 filled-in the second questionnaire.

Findings

Naturally, there was a higher level of experience among the nursing staffs in dealing with the virus in the second as compared to the first period in time. During the first wave, approximately a fifth of the participants (21%) reported that they had cared for patients who had been confirmed as having COVID-19, while during the third wave, most of the participants (66%) reported caring for people who had been confirmed as having contracted the virus. The findings demonstrate significantly lower levels of compliance with regulations and risk perception, and a significantly higher level of emotions in the third wave as compared to the first. However, there was no change in the level of trust in the healthcare system or in the pandemic-related threat perception.

Conclusions

The findings provide us with some information regarding the process the nursing staffs have undergone (and are still undergoing) in dealing with the pandemic, and may point at a ‘pandemic fatigue’ amongst them. This concept relates to progressively lower regulation compliance levels appearing over time, affected by the target population’s emotions, experiences and perceptions.

Key messages

• It is important to assist the nurses’ emotional regulation with the help of professionals in the organization, form colleagues’ support groups and ensure management recognition of the situation.

• Resilience-raising steps should be taken, for example by ensuring rest times and sufficient medical and protective equipment.

Adapting a palliative care-focused cancer self- and family management intervention for use in Israel

BACKGROUND

In Israel, there is a need to improve quality of life and health outcomes among patients and families facing cancer. Increasing awareness of, literacy about, and availability of palliative care may further this goal.

AIMS

This study aimed to adapt a palliative care-focused cancer self- and family management intervention developed in the US for use in Israel.

METHODS

The Managing Cancer Care (MCC) psycho-educational intervention is comprised of Managing Cancer Care: A Personal Guide (MCC-PT^©) for patients and Managing Cancer Care: A Caregiver's Guide (MCC-CG^©) for family caregivers. Following translation into Hebrew, an expert panel of Israeli nurses edited the MCC tool for cultural relevance. The authors then conducted qualitative interviews with patients with breast cancer and their family caregivers to obtain feedback. Data were analysed using qualitative content analysis.

FINDINGS

Following recommendations from Israeli experts in oncology and/or palliative care (n=3), the authors revised intervention content specific to the US healthcare system and culture. Patients' (n=13) and family caregivers' (n=10) reported MCC as attractive (70%, 80%), topically relevant (80%, 70%), and culturally appropriate, but felt that palliative care resources should be more Israel-specific.

CONCLUSION

The MCC tool is acceptable to potential users, warranting further pilot-testing.

Physicians’ Compliance with COVID-19 Regulations: The Role of Emotions and Trust

(1) Background: Medical teams are at the forefront of the COVID-19 pandemic. Decision making among medical staff is important for promoting and maintaining the health of patients and staff. This study examines factors associated with physicians’ decision making and preventive behavior during the COVID-19 pandemic in Israel. (2) Methods: An online survey was conducted among 187 Israeli physicians in April and May 2020 during the COVID-19 pandemic. The questionnaire included the levels of physicians’ perceived threat and perceived risk during the epidemic, trust in the health system, emotions, and the degree of compliance with hygiene rules and mandated behaviors. (3) Results: Most physicians reported complying with the rules of hygiene at work (73%) and full compliance with Ministry of Health guidelines (61%). The findings show that higher levels of trust, positive emotions, and threat and risk perceptions were associated with a higher degree of compliance with Ministry of Health guidelines and more careful decision making among physicians. (4) Conclusions: Levels of trust in the health system and positive emotions among healthcare staff during the pandemic are related to careful adherence to guidelines. Taking steps to maintain physical and mental health among healthcare staff is important for their functioning and for maintaining public health.

Factors associated with physicians' decision making during the first wave of the COVID-19 pandemic

Background

Frontline medical staff, combating the Covid-19 pandemic are forced to make clinical and behavioral decisions daily. Their decision-making process and the factors associated with it, are of utmost importance in preserving and supporting their own health and their patient's health.

Aims

Tto explore the factors associated with physicians' decision-making during the first wave of the COVID-19 pandemic in Israel

Methods

Cross- sectional data were collected among 200 physicians at the Israeli health care system between March and May 2020 via an online questionnaire. A multiple hierarchical regression was calculated to assess the contribution of the study variables to the physicians' decision making.

Results

Most physicians reported that they complied with hygiene guidelines at work, issued by the Israeli ministry of health (MOH), fully (42%) or very often (31%), and with the MOH COVID-19 behavior guidelines fully (27%), very often (34%), or in general (23%). According to the study

Results

trust, positive emotions, perception of COVID-19 threat, and risk perceptions were found significant and positive. In other words, higher trust, more positive emotions, and perceptions of greater threat and risk, were associated with higher compliance with the MOH guidelines and more cautious decision making.

Conclusions

While threat and risk perceptions may be inevitable during the pandemic, trust and positive emotions may act as protective factors, encouraging cautious decision making among physicians.

Key messages

Physicians' decision making is a complex process affected by their perceptions, emotions, and trust levels. High levels of trust and positive emotions may facilitate carful decision making.

A multi-level examination of nursing students' resilience in the face of the COVID-19 outbreak: A cross-sectional design

Aims

To examine nursing students' stress and coping with the coronavirus disease 2019 (COVID‐19) pandemic through an ecological model of resilience. Specifically, to examine the relative contribution of different resilience levels in decreasing nursing students' strain symptoms: at the individual level, resilience trait; at the relational level, students' coping strategies; at the university level, nursing students' perceptions on their university's readiness to handle the virus outbreak; and at the national level, nursing students' trust in policymakers' decisions.

Design

The study used a cross‐sectional design.

Methods

Undergraduate students of five universities were recruited via an electronic link sent to their emails during the first months of the COVID‐19 outbreak: May–July 2020. Of them, 492 participants completed the research questionnaire.

Results

Hierarchical Regression Analysis revealed that nursing students' resilience, as a multi‐level factor, decreased the students' level of strain symptoms above and beyond their stress levels and control variables. Specifically, the nursing students' trait resilience, perceptions of their university's positive response to the pandemic and trust in their national policymakers were negatively associated with their strain symptoms. Conversely, disengagement‐in‐emotion coping strategies was positively associated with the students' strain symptoms.

Conclusions

Nursing students' resilience should be seen as a flexible resource that can be developed and influenced by their academic and clinical training, and by the intentions and actions of their university and the nursing administration at the Ministry of Health (MOH).

Impact

The findings call for the nursing administration at the MOH and for the university deans and department heads to prepare in advance a crisis plan that could be rapidly and effectively implemented when needed. Furthermore, topics such as developing flexible coping strategies should be integrated into the nursing curricula. These would allow students to prepare and cope better with adversity in their routine and in times of crisis.

How psychology might alleviate violence in queues: Perceived future wait and perceived load moderate violence against service providers

INTRODUCTION

Queues are inherent to service encounters, as it is not always possible to provide service to all clients at the exact moment they request service. Queues involve waiting for a service in a specific place that might also be crowded, they obstruct the client's' goal of receiving service, and at times lead clients to mistreat service providers and in extreme cases even attack them violently. We show, in a hospital setting, that perceived predicted future wait and load can buffer the causes of violence towards service staff.

METHODS

We combine objective data on crowdedness, reports of violence, and durations of time people waited, with psychological measures of perceived load and perceived future wait, collected from 226 people in the Emergency Department (ED) of a large hospital. Visitors to the ED were recruited as they waited for service. They indicated their perceived load in the ED and their perceived remaining wait for service. This data was then triangulated with objective operational data regarding the actual number of people waiting for service (i.e., crowdedness) and objective data regarding staff calls to security to stop violent accounts.

RESULTS

We find that with increased crowdedness, there are more calls to security reporting violence. However, this relationship is moderated by two factors: when people perceive the future wait to be short and when they perceive the load on the system to be high. Moreover, a three-way interaction shows that crowdedness is associated with more incidents of violence, however high perceived load and low perceived future wait are associated with fewer violent incidents.

CONCLUSIONS

This paper demonstrates the relationship between crowded queues and violence towards service staff, and suggests two psychological mechanisms for buffering such violence: reducing perceived future wait and elevating perceived load.

Patient-centered care via health information technology: a qualitative study with experts from Israel and the U.S

Although patient-centered care (PCC) is one of the cornerstones of modern healthcare, the role that health information technology (HIT) plays in supporting PCC remains unclear. In this qualitative study, we interviewed academic and clinical experts from the US and Israel to understand to what extent current HIT systems are supportive of PCC and how PCC should be supported by HIT in the future. A maximum variation sampling approach was used to identify nine experts in both HIT and PCC from clinical and academic settings in Israel and the US. A qualitative descriptive method was used to analyze the interviews and identify major themes. Experts suggested that patient ownership of their disease is a core component of PCC. The majority of the experts agreed that in both Israel and the US, the current situation of PCC implementation is relatively poor. However, HIT should play an important role in making patients owners of their health and treatment and helping providers in delivering better PCC. Central domains of PCC via HIT were providing clear information and support for patients and promoting care that is based on patient values and preferences.

Characteristics and behaviours of formal versus informal nurse champions and their relationship to innovation success

AIMS

To identify the sociodemographic attributes, project characteristics and champion strategies that differentiate formal from informal nursing champions, and to test their success in terms of project spread and novelty.

BACKGROUND

Champions spread innovation in healthcare organizations. Empirical research has not explored the differences between formal and informal champions in terms of their antecedents and success.

DESIGN

A quantitative cross-sectional design.

METHOD

Data were collected on 93 nursing champions in three hospitals from 2015 - 2016. Champions were identified according to a validated approach; data on their sociodemographic attributes, project characteristics and strategies were assembled through interviews and validated questionnaires. Their success in terms of novelty and spread was assessed via expert ratings and validated questionnaire.

FINDINGS

Informal champions had longer tenure and were involved mainly in bottom-up projects aimed mostly at improving human resources and services; formal champions were mostly involved in top-down projects aimed at quality control. Informal champions expressed more enthusiasm and confidence about the innovation; formal champions tended to use more online resources and peer-monitoring strategies. Projects of informal champions were more novel than those of formal champions. Project spread did not differ between the two groups.

CONCLUSION

Formal and informal champions differ in their characteristics and implementation strategies. To encourage project's innovation, the organizational climate should encourage the emergence of informal champions; formal and informal champions should be chosen wisely, assuring that they possess enough organizational resources; and coaching programmes for junior champions should be planned to equip them with championing behaviours.

Nursing students' stress and satisfaction in clinical practice along different stages: A cross-sectional study

BACKGROUND

Research in the field of nursing students' stress shifted internationally in recent decades from Western to Eastern countries with an emphasis on Middle East and Far East countries. The clinical experience has always been at the heart of nursing education cross-culturally and is a major source of stress and attrition.

OBJECTIVES

To investigate the perceptions of stress and satisfaction of undergraduate nursing students during three stages of clinical learning experiences: preclinical, clinical and advanced clinical.

DESIGN

A cross-sectional study.

SETTINGS

Three Bachelor's in Nursing programs in three higher educational institutions in Israel.

PARTICIPANTS

Nursing undergraduate students in their second, third and fourth year of study (n = 892).

METHODS

The Nursing Students Stress Scale and the Nursing Students Professional Satisfaction questionnaires were used for data collection. Descriptive statistics used to analyze the data included: Pearson correlation, Cronbach's alpha, one way ANOVA, t-test, Kruskal Wallis and Mann Whitney U tests.

RESULTS

Overall mean level of stress was mild-moderate (2.67) and overall satisfaction moderate-high (3.57). Year of study and gender were the most significant predictors of nursing students' stress. The level of stress and satisfaction of second year students in the preclinical stage was significantly higher compared to peers in their third and fourth year. Female students experienced significantly higher levels of stress and satisfaction. The top most stressful situations for second year students were related to inadequate preparation to cope with knowledge and skill demands, whereas for third and fourth year students they were conflicts between professional beliefs and the reality in hospital practice.

CONCLUSIONS

Nurse Educators are challenged to tailor stress reduction interventions according to the students' perceptions of stress. It is not only critical for their wellbeing and attrition, but also important in developing nursing professionals who will provide better care and caring for patients.

Complementary Medicine and the Role of Oncology Nurses in an Acute Care Hospital: The Gap Between Attitudes and Practice

PURPOSE/OBJECTIVES

To describe hospital nurses' knowledge, attitudes, and practices regarding complementary medicine (CM); to compare the knowledge and attitudes of nurse managers to staff nurses with diverse oncology experience; and to assess attitudes toward integrating CM into the role of the hospital oncology nurse. 
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DESIGN

Descriptive, cross-sectional study.
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SETTING

Rambam Health Care Campus in northern Israel.
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SAMPLE

A convenience sample of 434 hospital nurses with varied oncology experience.
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METHODS

Nurses completed a knowledge and attitude questionnaire developed for the current study. Data were analyzed using parametric and nonparametric statistical tests. 
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MAIN RESEARCH VARIABLES

Hospital nurses' knowledge of and attitudes toward CM, and attitudes toward integrating CM into the role of the hospital oncology nurse.
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FINDINGS

Nurses lack knowledge and are unaware of the risks associated with CM. However, they believe this approach can improve the quality of life of patients with cancer; 51% expressed an interest in receiving training. Oncology nurses were ambivalent about the feasibility of applying an integrative approach, whereas nurse managers expressed significantly more positive attitudes toward integrating CM within the scope of nursing practices.
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CONCLUSIONS

A large discrepancy remains between nurses' strong interest in CM and awareness of associated benefits, and their ambivalence toward its integration in their nursing practice. 
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IMPLICATIONS FOR NURSING

Although improving nurses' knowledge should be mandatory, it remains insufficient; a shift in the approach to integrating CM into conventional health care is needed, from practitioners' responsibility to healthcare policymakers' responsibility. Legislations and policies are necessary, along with providing respectable infrastructures.

[FUNCTIONAL TRAJECTORIES BEFORE, DURING AND AFTER ACUTE HOSPITALIZATION OF OLDER ADULTS IN INTERNAL MEDICINE WARDS]

INTRODUCTION

Hospital-associated functional decline (HAFD) is recognized as a leading cause of adverse hospitalization outcomes, such as prolonged hospitalization, falls, readmission, and mortality. Since most patients hospitalized in internal medicine wards are older-adults, HAFD presents a major challenge to internal medicine.

OBJECTIVES

Describe functional trajectories of older-adults (aged ≥70 years) before, during and after acute hospitalization in internal-medicine units.

METHODS

A prospective cohort study was conducted of 741 older-adults, hospitalized in two tertiary hospitals in Israel during the period 2009-2011. Basic functional status two weeks before admission, on-admission, at-discharge and one-month post-discharge was assessed using the modified Barthel Index (BI). Eight trajectories were identified.

RESULTS

Two-thirds of the participants were completely or almost independent at the pre-morbid period. About a half of the older-adults were hospitalized with pre-admission functional decline, a quarter deteriorated or died during hospitalization, and one-third improved during hospitalization. Most of the older-adults who were stable in functioning at the pre-admission period (57.1%) remained stable during and post-hospitalization; however, about a third of them did not return to their pre-morbid functioning levels. Approximately half of those with pre-morbid functional decline experienced additional deterioration of at least 5 points on the BI scale. Pre-morbid instrumental functional status, comorbidity and depressive symptoms have been found to distinguish older adults with similar pre-admission and in-hospital functional trends.

DISCUSSION

Eight functional trajectories describe the hospitalization period of older-adults in internal-medicine units. On-admission personal characteristics may be used to identify older-adults who are at risk of unwarranted hospitalization outcomes and thus allow intervention in the hospital-community interface.

Improving work conditions through strike: Examination of nurses' attitudes through perceptions of two physician strikes in Israel

BACKGROUND

Strikes are means to influence policies related to working conditions, yet raise ethical dilemmas for healthcare workers. Nurse strikes have become more prominent around the world.

OBJECTIVE

To assess the change in Israeli nurses' attitudes towards strikes in light of two physician strikes that have preceded a nursing strike.

METHODS

An anonymous survey was administered once in 2000 (N = 106) and again in 2011 (n = 175) following 110 days of a physician strike, to assess nurses' attitudes towards the strike and resulting ethical issues.

RESULTS

A statistically significant change (p < 0.05) between administrations revealed that in 2011 more nurses identified striking as a legitimate mechanism, would strike under the same circumstances, and felt that collaboration with physicians persisted despite the strike. Additionally, an increasing number of nurses said that the suffering of patients due to the strike is somewhat or entirely justified, although they were faced with a difficult dilemma of loyalty to physician colleagues vs.

PATIENTS

Nurses reported finding ways to mitigate the suffering of patients resulting from the strike.

CONCLUSIONS

While patient-centered care remains nurses' first and foremost priority, findings indicate an increasing support of collective bargaining and strike to promote working conditions related to professional and public health agendas.

Do hospital shift charge nurses from different cultures experience similar stress? An international cross sectional study

BACKGROUND

There is a need to improve understanding of role stress and how it affects nurses' wellbeing, burnout and health; and hence the quality and safety of patients' care, organizational outcomes and costs. The focus is on shift charge nurses in hospitals who are accountable during a specific shift for the patients' care and staff functioning in accordance with hospital and unit policy.

OBJECTIVE

To compare perceptions of stress and its intensity among hospital shift charge nurses amongst three countries: Israel, USA (state of Ohio) and Thailand.

DESIGN

A cross-sectional study was performed across three countries, focusing on a convenience sample of 2616 hospital shift charge nurses recruited from 23 general hospitals.

METHODS

A validated shift Charge Nurse Stress Questionnaire was used to assess impacts of four factors: patient & family complaints, lack of resources, responsibility burden and professional conflict. Descriptive statistics were used to describe demographic and professional characteristics of the participants. Chi square and the Fisher Exact Test were performed to test for demographic differences amongst the three samples. Parametric and non-parametric tests were used to compare mean stress levels amongst the study samples.

RESULTS

The mean stress level for the total sample was 2.84 (±0.71) on a Likert scale of 1-5, implying moderate stress levels. Significant differences in stress levels were found among countries, with Thai nurses scoring the highest and Israeli nurses the lowest. Similar perceptions of stress intensity were found for all countries, with the factors "responsibility burden" and "lack of resources" considered the most stressful. Israeli and American nurses perceived similar situations as stressful and different from those perceived by Thai nurses. The findings can be partially explained by demographic, professional and cultural differences.

CONCLUSIONS

Similarities along with differences were found in the nature and levels of stress experienced across the studied countries. A prerequisite educational program should be mandatory for nurses prior to their nomination as shift charge nurses. Programs should be tailored to address the stress experienced by shift charge nurses. Ongoing mentorship and workshops are recommended to develop and maintain leadership abilities to cope with role stress. Future research should explore internationally the unique nature and stress of the shift charge nurse's role and replicate this study by using the Charge Nurse Stress Questionnaire in other countries. Further international comparative studies are recommended to evaluate stress perceptions of nurses in other roles and in different practice areas.

Stress measurement among charge nurses: developing a cross-cultural tool

AIM

The aim of this study was to develop a cross-cultural tool for the measurement of stress among charge nurses in general hospitals.

BACKGROUND

Studies of the specific stressors unique to different nursing roles are few, particularly those related to hospital charge nurses. The Charge Nurse Stress Questionnaire is a well-validated Israeli-developed scale. However, it has not been tested cross-culturally.

DESIGN

A descriptive methodological study was conducted in Israel, Ohio and Thailand.

METHOD

A total of 2616 nurses from 23 hospitals (small to large size) completed the questionnaire between 2011-2013. The questionnaire was translated into English and Thai. To establish tool validity and reliability, content validity, internal consistency reliability, exploratory and confirmatory factor analysis were performed.

RESULTS

Analyses resulted in a final abbreviated version of the questionnaire with 25 items and four stress subscales. Internal consistency for the subscales indicated very good internal consistency.

CONCLUSIONS

We developed a self-reported, cross-cultural, valid and reliable tool for evaluating the specific stressors of the role of charge nurses. A rigorous assessment of charge nurse stress provides a good basis for planning tailored stress reduction interventions. It is recommended to further use the tool in different settings across different countries.

From research to reality: minimizing the effects of hospitalization on older adults

This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient's acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.

Transitions from hospital to community care: the role of patient-provider language concordance

Background

Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care.

Methods

This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit.

Results

Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01).

Conclusion

Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

Human factors-focused reporting system for improving care quality and safety in hospital wards

OBJECTIVE

The aim was to develop a reporting system for collecting human factors problem reports to establish a database to guide activities for improving health care quality and patient safety.

BACKGROUND

The current error and incident report systems do not provide sufficient and adequate coverage of the factors contributing to impaired safety and care quality. They fail to examine the range of difficulties that clinical staff encounters in the conduct of daily work.

METHOD

A voluntary problem-reporting system was developed to be used by hospital wards' clinicians and was tested in four wards of two hospitals in Israel. The system is based on human factors--formatted problem reports submitted by physicians and nurses on difficulties and hazards they confront in their daily work. Reports are grouped and evaluated by a team of human factor professionals.

RESULTS

A total of 359 reports were collected in the wards during 12 weeks, as compared with a total of 200 incidents reports that were collected during a period of 5 years with the existing obligatory incident reporting system. In-depth observational studies conducted on the wards confirmed the ability of the new system to highlight major human factors problems, differentially identifying specific problems in each of the wards studied. Problems reported were directly related to general factors affecting care quality and patient safety.

CONCLUSION

Validation studies confirmed the reliability of the reporting system in pinpointing major problems per investigated unit according to its specific characteristics.

APPLICATION

This type of reporting system could fill an important information gap with the potential to be a cost-effective initial database source to guide human factors efforts to improve care quality, reduce errors, and increase patient safety.

Low mobility during hospitalization and functional decline in older adults

OBJECTIVES

To examine the association between mobility levels of older hospitalized adults and functional outcomes.

DESIGN

Prospective cohort study.

SETTING

A 900-bed teaching hospital in Israel.

PARTICIPANTS

Five hundred twenty-five older (≥70) acute medical patients hospitalized for a nondisabling condition.

MEASUREMENTS

In-hospital mobility was assessed using a previously validated scale. The main outcomes were decline from premorbid baseline functional status at discharge (activities of daily living (ADLs)) and at 1-month follow-up (ADLs and instrumental ADLs (IADLs)). Hospital mobility levels and functional outcomes were assessed according to prehospitalization functional trajectories. Logistic regressions were modeled for each outcome, controlling for functional status, morbidity, and demographic characteristics.

RESULTS

Forty-six percent of participants had declined in ADLs at discharge and 49% at follow-up; 57% had declined in IADLs at follow-up. Mobility during hospitalization was twice as high in participants with no preadmission functional decline. Low versus high in-hospital mobility was associated with worse basic functional status at discharge (adjusted odds ratio (AOR)=18.03, 95% confidence interval (CI)=7.68-42.28) and at follow-up (AOR=4.72, 95% CI=1.98-11.28) and worse IADLs at follow-up (AOR=2.00, 95% CI=1.05-3.78). The association with poorer discharge functional outcomes was present in participants with preadmission functional decline (AOR for low vs high mobility=15.26, 95% CI=4.80-48.42) and in those who were functionally stable (AOR for low vs high mobility=10.12, 95% CI=2.28-44.92).

CONCLUSION

In-hospital mobility is an important modifiable factor related to functional decline in older adults in immediate and short-term (1-month follow-up) functional outcomes.

Stress among charge nurses: tool development and stress measurement

The aim of this study was to develop and implement a tool for measuring the role stress of charge nurses. Tools are lacking regarding measurement of nursing role stressors, particularly for charge nurses. Based on focus groups and in-depth interviews with charge nurses within a large tertiary hospital, a charge nurse stress questionnaire was developed which measures six factors of stress: authority-responsibility conflict, patient-nurse interaction, deficient resources, managerial decision making, role conflict, and overload. The prominent stressors on charge nurses were specific to the role. Mean levels of stress were significantly higher for nurses who attended post-graduate clinical courses than for those who did not. The mean level of stress was higher for department nurse managers than for nurses without a managerial position. This tool was designed to measure charge nurse stress demonstrates reliability, and highlights the specific stressors demanded by the role. Preparation and ongoing support for fulfilling this position are recommended.

Cancer care at the hospital-community interface: perspectives of patients from different cultural and ethnic groups

OBJECTIVE

To examine perceptions of cancer patients from different cultural and ethnic groups regarding the quality of their care at the hospital-community interface.

METHODS

Cross-sectional study of cancer patients from a large tertiary center in Israel. Patients were surveyed on the quality of their primary-care and on their transition from the hospital. Regression analyses were used to examine differences among Hebrew-, Russian-, and Arabic-speaking patients in their assessment of six primary-care domains and of their care transition process.

RESULTS

422 patients completed the survey. Russian speakers gave the lowest and Arabic speakers the highest ratings for all primary care domains. Arabic speakers also gave higher ratings for their care transition process than the other two groups. Minority patients' primary-care physicians were significantly more likely than Hebrew speakers' physicians to facilitate the hospital transition process by reviewing the discharge recommendations.

CONCLUSIONS

Cancer patients from different ethnic groups differ in their primary-care experience and their perceptions of their hospital to community transition. Primary-care physicians serve as facilitators of care transitions by discussing discharge recommendations with their minority patients.

PRACTICE IMPLICATIONS

Reviewing the discharge recommendations with the patient at the post-discharge primary-care visit is an important contributor to high quality transitional care.

Shift work in nursing: is it really a risk factor for nurses' health and patients' safety?

There is evidence in the scientific literature of the adverse physiological and psychological effects of shift work, including disruption to biological rhythm, sleep disorders, health problems, diminished performance at work, job dissatisfaction, and social isolation. In this study, the results of health problems and sleep disorders between female and male nurses, between daytime and shift nurses, and between sleep-adjusted and non-sleep-adjusted shift nurses were compared. Also the relationship between adjustment to shift work and organizational outcomes (errors and incidents and absenteeism from work) was analyzed. Gender, age, and weight were more significant factors than shift work in determining the well-being of nurses. Shift work by itself was not found to be a risk factor for nurses' health and organizational outcomes in this study. Moreover, nurses who were identified as being "non-adaptive" to shift work were found to work as effectively and safely as their adaptive colleagues in terms of absenteeism from work and involvement in professional errors and accidents. This research adds two additional findings to the field of shift work studies. The first finding is that female shift workers complain significantly more about sleep disorders than male shift workers. Second, although high rates of nurses whose sleep was not adapted to shift work were found, this did not have a more adverse impact on their health, absenteeism rates, or performance (reported errors and incidents), compared to their "adaptive" and "daytime" colleagues.

Oncology patients' experience at the interface between hospital and community care: a mixed method investigation

Introduction

Oncology patients often experience breakdowns in care when transitioning between care settings.

Aims and objectives

To examine the experience of oncology patients at the transition between hospital and community care and identify factors which affect fragmentation.

Methods

We used a complementary mixed method approach. Qualitative phase: semi-structured interviews and focus groups were conducted with patients and their caregivers, nurses, social workers, physicians and medical administrators. Quantitative phase: a survey was administered to 400 oncology patients of a large tertiary medical center in Northern Israel. Patients who were discharged from the hospital completed a validated questionnaire on their transition from the hospital to the community and on their perceptions of the quality of their primary care. The surveys were administered in Hebrew, Arabic, and Russian.

Results

From the preliminary analysis of the qualitative data four broad themes emerged: (1) responsibility for care, (2) administrative and bureaucratic burden, (3) informal routes of communication, and (4) cultural barriers. The regression analyses examined the effect of patient characteristics (gender, age, education, income, health status, and language group) and showed that patients' language accounted for most of the variance in quality scores. Russian speaking patients reported poorer quality of care and Arabic speaking patients reported better quality of care, than Hebrew speakers, in all primary care domains. Both Arabic and Russian speakers scored significantly higher on the Care Transition Measure than Hebrew speakers.

Conclusions

The differences between sub-groups found here suggest that avoidable variations in care exist. To enable a more streamlined process, cultural issues need to be addressed at the interface between care settings. Further research should examine the causes for such differences.

Living with epilepsy: ordinary people coping with extraordinary situations

This replicated study explores the ordinary people theory generated in the original research among American youth with cystic fibrosis through the experience of Israeli youth with epilepsy. The authors used the qualitative life history method in a sample of 14 adolescents and young adults with epilepsy. They employed the constant comparative method of analysis to analyze the data collected from the in-depth interviews. The results show that epilepsy was not central to the participants' everyday lives. Their perceptions of the disease followed developmental stages. The authors found that coping methods were adaptive and took into account social stigma and practical outcomes. This study provides a positive and normalcy perspective of exploring the lifestyle of people with chronic diseases and disabilities as opposed to deficit models. It adds to the trustworthiness of the model's cross-cultural applicability through its use in a different context among a population with a different diagnosis.

Healthcare climate: A framework for measuring and improving patient safety*

OBJECTIVES

Reviews of patient safety efforts suggest that technical/administrative change must be augmented by global factors such as organizational culture and climate. The objective was to outline a comprehensive model for healthcare climate and test one of its elements, the nursing subclimate, in terms of several patient safety outcomes.

DESIGN

Measure organizational climate in nursing units, followed by random sampling of patient safety practices in each unit 6 months later.

SETTING

Sixty-nine inpatient units in three hospitals that make up the entire tertiary care system in one metropolitan area.

SUBJECTS

A total of 955 nurses.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

A two-part Nursing Climate Scale referring to hospital- and unit-level climates, followed by five randomly timed observations of patient safety practices covering routine and emergency care in each unit. Climate scales met the criteria of internal reliability, within-unit agreement, and between-unit variability, using standard statistics of climate research. Both the hospital and unit nursing climates exhibited significant variation, which predicted the routine medication safety scores (Z = 2.65 and 2.93 accordingly, p < .01), with similar results for emergency safety scores. A significant interaction (Z = 2.78, p < .01) indicated that best/worst safety is obtained when the unit and hospital climates are aligned (for better or worse) and that positive unit climate can compensate for the detrimental effect of poor hospital climate. Furthermore, climate's strength increased its predictive power with regard to patient safety practices (Z = 3.64 for medication and 2.28 for emergency safety; p < .01). The small number of participating hospitals limits organization-level analyses.

CONCLUSIONS

The nursing climate identifies units where the likelihood of adverse events is greater or lower than the hospital's average. Such information can guide prevention efforts in selected units. These data encourage the development of additional climate subscales subsumed under the healthcare climate model (e.g., physicians subclimate).

Ten-fold expansion of a burn unit in mass casualty: how to recruit the nursing staff

The first hours after a mass casualty event (MCE) are critical for the care of injured patients, especially for those with major burns. Burn patients are best treated in a specialized unit, however, transfer may not always be practical or possible. If transfer is not an option, hospitals need to find another solution to provide safe, effective, and efficient care. A critical element in providing burn care is to have a sufficient number of capable trained nurses. The Rambam Medical Center in Haifa, Israel evaluated past experience and has developed an innovative and comprehensive plan to provide treatment for a large influx of burn patients. The plan allows the 15-bed burn unit to expand and treat up to 136 burn victims, uses supplementary personnel, and allocates hospital beds and equipment as needed. This article describes the educational program that is used to prepare supplemental nurses.

Comparisons of American, Israeli, Italian and Mexican physicians and nurses on the total and factor scores of the Jefferson scale of attitudes toward physician-nurse collaborative relationships

This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician-nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians' dominance). Results showed inter- and intra-cultural similarities and differences among the study groups providing support for the social role theory (Hardy and Conway, Role Theory: Perspectives for Health Professionals, Appelton-Century-Crofts, New York, 1978) and the principle of least interest (Waller and Hill, The Family: A Dynamic Interpretation, Dryden, New York, 1951) in inter-professional relationships. Implications for promoting physician-nurse education and inter-professional collaboration are discussed.

National strategy for mass casualty situations and its effects on the hospital

A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized. The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested. In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs). A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent.

Nursing Students' Stress During the Initial Clinical Experience

The purpose of this exploratory longitudinal study was to identify nursing students' perceptions of stress in their initial clinical experiences in a hospital setting. Guided by the relational view of stress, a Nursing Student's Stress Scale (NSSS) was developed to include six subscales: adequate knowledge, close supervision, averse sights, causing pain, insufficient resources, and reality conflict. The NSSS was administered three times during the clinical experience to 46 nursing students. Results showed significant differences between the students' preclinical expected stress levels and the actual levels of stress in the clinical setting. Theoretical, methodological, and practical implications of the findings are discussed. Nurse educators are encouraged to acknowledge students' perceptions of stressful situations as a basis for stress reduction intervention. Students must first cope with their own stress in the clinical reality before being expected to deal with patients' stress.

Stress Intervention: A Model of Stress Inoculation Training

1. The initial clinical experience in a hospital setting has been identified as a major area of threat for beginning nursing students. 2. A stress inoculation program, in which students were exposed to situation similar to future clinical experience, was used to help students develop confidence and coping skills. 3. The program was found to be an effective preparation for clinical experience, mainly in terms of the students clinical performance.

"Nothing to hide and nothing to advertise". Managing disease-related information

The purpose of this study was to explore the process of managing disease-related information through various developmental stages from the inside perspective of those who live with a long-term health condition. The retrospective, longitudinal, life history method was used to generate a descriptive theory from accounts constructed with 21 informants: 10 adolescents and young adults with cystic fibrosis (CF) aged 16 to 25 years, and 11 of their significant family members. People chose a specific telling strategy according to the perceived ability of the audience to deal with the information and the situational context. Four strategies of managing disease-related information emerged: visibility, direct telling, silent telling, and concealment. The informants frequently chose information management strategies that enabled an ordinary style of living. These strategies neither reflect feelings of shame nor of pride, as it is suggested in the existing literature. Implications for theory, health care practice, and further research are discussed.