A Conflict of Values: Nurses' Willingness to Work Under Threatening Conditions.

PURPOSE: The purpose of this study was to determine the willingness of Israeli registered nurses to work under threatening conditions, their perceived level of threat, and perceptions of peer willingness to report to work. DESIGN: This descriptive study was based on a convenience sample of registered nurses working in four hospitals throughout Israel from internal medicine, surgical, emergency, and intensive care units. METHODS: A questionnaire designed by the investigators was administered to registered nurses while on duty. The questionnaire consisted of three sections: personal characteristics, perceived level of personal threat from five situations (caring for a patient with a dangerous infection, terror attack, war, radiation or chemical disaster, or natural disaster), and perceived personal and peer willingness to work under these threats. FINDINGS: A convenience sample of 249 registered nurses from four hospitals responded. The highest level of perceived threat was a natural disaster (earthquake; M = 2.15, SD = 0.9). Terror (M = 0.83, SD = 0.6) and war (M = 1.01, SD = 0.6) received the lowest mean perceived threat scores. Most respondents were not willing to work during a natural disaster but were willing to care for patients with dangerous infections and during times of war. Weak positive statistically significant correlations were found between the level of perceived threat and willingness to work for all of the threats, except for terror (Spearman rank correlation = .16-.35). CONCLUSIONS: Local culture, perceptions of the level of threat, and perceived peer responsiveness are associated with registered nurses' willingness to work under threat. CLINICAL RELEVANCE: When faced with a threat to personal safety or security, many registered nurses might not be willing to work as usual. What is perceived as threatening is influenced by the local culture and environment. Therefore, managers should be aware of potential cultural and peer influences on this possible conflict of values.

Cultural safety and nursing education in divided societies.

AIM: This research explores the experiences of cultural safety among nursing students from majority and minority groups in a divided society with implications for academic satisfaction and success. BACKGROUND: The study takes place in an academic nursing program in Israel, where Arab and Jewish students study together. METHODS: A researcher-developed questionnaire was used with 17 statements concerning social relations between students, faculty support, and the effects of social relations on academic satisfaction and outcomes. RESULTS: Significant differences were found in the ways Arab and Jewish students perceived the cultural safety of the environment. Arab students perceived social relations and faculty attitude as less positive than Jewish students and perceived cultural safety as having greater influence on academic satisfaction and success. CONCLUSION: The findings indicate that students from different groups will perceive the same shared reality in significantly different ways. Nurse faculty and administrators need to make efforts to bring perceptions into closer alignment and to minimize the negative impact of external conflicts on feelings of cultural safety.

Accepting responsibility for long-term care--a paradox in times of a global nursing shortage?

UNLABELLED: Need for long-term care (LTC) is increasing globally, and nurses have a professional imperative to address the growing need for long-term care (LTC). The author reviews the effect of globalization and the epidemiologic transition upon the growing need for LTC. I also summarize the lessons learned in the developing world, as well as in the industrialized world, based on the existing research evidence. The purpose of this paper is to explain the need for nursing as a profession to accept responsibility for LTC as part of nursing's raison d'etre, despite the global nursing shortage. This includes responsibility for innovative policy, health service, practice, research, nursing education development, and health promotion, because prevention is key to slowing the steep increase in LTC needs. CLINICAL RELEVANCE: Nurses must develop strategies for clinical practice, management, education, and research in order to increase our ability to meet future needs for LTC.

Moral distress questionnaire for clinical nurses: instrument development.

AIM: This paper is a report of a study to develop and test the psychometric properties of a culture-sensitive moral distress questionnaire among nurses employed in a variety of work settings. BACKGROUND: In the course of the last decade, there has been increased interest in capturing healthcare professionals' experiences of stress associated with ethical dilemmas. Ethical issues emerge in grey areas and are often blurred, and have thus received insufficient attention. METHOD: The study comprised two phases: a qualitative phase to elicit the culture-specific themes and a quantitative phase, comprising the design of a 15-item questionnaire. The questionnaire was then completed by a convenience sample of 179 nurses from a variety of work settings. The data were collected in 2006. RESULTS: Factor analysis resulted in three factors representing moral distress: (1) problems caused by work relationships among staff; (2) problems due to lack of resources; and (3) problems caused by time pressure. With regard to the construct validity of the questionnaire, differences between community and hospital nurses were tested, and a statistically significant difference was found between them in two among the three factors (relationships and time). The stability of the measures was examined by test-retest reliability and revealed statistically significant results. CONCLUSIONS: The instrument exhibits acceptable reliability and validity in the Israeli cultural context. Further research is needed to evaluate the measure in other cultural settings.

The changing roles of community nurses: the case of health plan nurses in Israel.

BACKGROUND: In Israel, approximately one-third of the country's nurses work in community settings - primarily as salaried employees in Israel's four non-profit health plans. Many health system leaders believe that the roles of health plan nurses have changed significantly in recent years due to a mix of universal developments (such as population aging and academization of the profession) and Israel-specific changes (such as the introduction of extensive quality monitoring in primary care). OBJECTIVES: The main objectives of the study were to identify recent changes in the roles of health plan nurses and their current areas of activity. It also explored the experience of front-line nurses with regard to autonomy, work satisfaction, and barriers to further role development. METHODS: The study integrated interviews and surveys of nurses and other professionals conducted across 4 years. Data generated from earlier study components were used to guide questions and focus for later components. In 2013, in-depth interviews were held with 55 senior nursing and medical professionals supplemented by interviews in mid-2017 with the head nurses in the four health plans. In addition, a national survey was conducted in 2014-5 among a representative sample of 1019 community nurses who work for the health plans and who are engaged in direct patient care. Six hundred ninety-two nurses responded to the survey, yielding a response rate of 69%. The survey sample consisted of an equal number of nurses from each health plan, and the observations were weighted accordingly. FINDINGS: Senior professionals identified general themes associated with a shift in nursing roles, including a transition from reactive to initiated work, increased specialization, and a shifting of tasks from hospitals to community settings. They identified the current main areas of activity in the health plans as being: routine care, chronic care, health promotion, quality monitoring and improvement, specialized care (such as wound care), and home care. In the survey of front-line nurses, 38% of the nurses identified "caring for chronically ill patients" as their main area of activity aside from routine care; 30% did so regarding "health promotion", and 26% did so regarding "a specific area of specialization" e.g., diabetes, wound care or women's health). In response to a separate question, 77% reported "great" or "very great" involvement in quality measurement programs. Four out of five front-line nurses were satisfied with their work to a great or very great extent, and approximately three out of four of them (73%) felt that they had autonomy at work to a great or very great extent. About half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them. A large majority of the nurses (85%) indicated that the nature of their work had changed substantially in recent years, with an increase in autonomy noted as one of the key changes. Perceived barriers to further role development include attitudes on the part of some physicians and nurses, an insufficient number of dedicated nursing positions, and insufficiently attractive wage levels. CONCLUSIONS: The findings, gathered over 4 years, indicate alignment between universal and Israel-specific trends in health care and the evolving roles of nurses in Israel's health plans. The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training - both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.

Multi-faceted identities and interactions in mixed health teams.

The literature in the area of the health workforce and societies in conflict encompasses a wide range of studies and potential directions. Lately, Keshet and Popper-Giveon reported on a study based on interviews with 13 Arab Israeli nurses who work in Israeli hospitals. This preliminary study describes how being an Arab nurse in Israel is experienced and perceived by those nurses. The results indicate the need for further studies on the complexity of health workers' experiences in their changing and multi-faceted professional, cultural, gender and national identities. In order to manage health systems, in particular in divided societies that are characterized by inter-group conflicts, special attention should be given to studying the everyday processes in mixed teams.

[Worldwide view of health and home care]. / Visão panorâmica da saúde no mundo e a inserção do home care.

Worldwide overview of health and home care. It describes the World Health Organization (WHO) in its historical background, pointing out the Brazilian participation in its foundation and some of the most relevant facts and events that preceded its creation. Also, it depicts the history of the Pan-American Health Organization (PAHO) founded in December 1902 and its celebration of the first centennial. A general overview regarding the world's health is given including globalization, as an irreversible fact, demographical and epidemiological changes, dependence and care delivery, home care services and policies on home care.

Home-based care in Botswana: experiences of older women and young girls.

In this exploratory and descriptive study we investigated the experiences of and impact on young girls and older women caring for family members living with HIV/AIDS and other chronic and terminal illnesses at home in three districts of Botswana. Using qualitative research methods, we conducted 70 interviews with family caregivers and key informants such as community home-based care (CHBC) team members and government officials. Older women reported feeling overwhelmed with the magnitude and multiplicity of tasks they had to perform. They reported feeling exhausted, malnourished, depressed, and often neglectful of their own health. Young girls often missed school and they were sexually and physically abused, sexually exploited, and depressed. In addition, these caregivers experienced poverty, social isolation, stigma, psychological distress, and a lack of basic caregiving education. We made recommendations to improve services and care to the CHBC teams and to the national government.

Care of the frail elderly in developed and developing countries: the experience and the challenges.

Demographic and epidemiological changes will result in dramatic changes in the health needs of the world's populations. Everywhere there is a steep increase in the need for management of chronic diseases and for long-term care. Therefore, the search for effective policies to care for the frail elderly in general and long-term care (LTC) policies in particular, is one of the most pressing challenges facing modern society. There is no single converging paradigm and countries are experimenting with a number of different approaches. This section of the Monograph presents the experience in several developed and developing countries: Canada, United States, Italy, Germany, Sweden, Japan, Thailand and Chile. This effort is important because there is much to be learned from the experience of developed and developing countries in defining the range of policy options and in identifying successful and unsuccessful practices. In-depth understanding of the existing situations in developed and developing countries, and the nature of the variance among countries are important to provide insight for development of care policies by learning from what already exists. This article focuses on LTC, that is, on addressing the needs of the functionally disabled elderly. Our reflections are based on an international initiative to develop a decision-making framework for LTC policies launched by the World Health Organization (WHO) with the JDC-Brookdale Institute leading this effort.

Current and future worldwide prevalence of dependency, its relationship to total population, and dependency ratios.

OBJECTIVE: To estimate the number of people worldwide requiring daily assistance from another person in carrying out health, domestic or personal tasks. METHODS: Data from the Global Burden of Disease Study were used to calculate the prevalence of severe levels of disability, and consequently, to estimate dependency. Population projections were used to forecast changes over the next 50 years. FINDINGS: The greatest burden of dependency currently falls in sub-Saharan Africa, where the "dependency ratio" (ratio of dependent people to the population of working age) is about 10%, compared with 7-8% elsewhere. Large increases in prevalence are predicted in sub-Saharan Africa, the Middle East, Asia and Latin America of up to 5-fold or 6-fold in some cases. These increases will occur in the context of generally increasing populations, and dependency ratios will increase modestly to about 10%. The dependency ratio will increase more in China (14%) and India (12%) than in other areas with large prevalence increases. Established market economies, especially Europe and Japan, will experience modest increases in the prevalence of dependency (30%), and in the dependency ratio (up to 10%). Former Socialist economies of Europe will have static or declining numbers of dependent people, but will have large increases in the dependency ratio (up to 13%). CONCLUSION: Many countries will be greatly affected by the increasing number of dependent people and will need to identify the human and financial resources to support them. Much improved collection of data on disability and on the needs of caregivers is required. The prevention of disability and provision of support for caregivers needs greater priority.

Visão panorâmica da saúde no mundo e a inserção do home care / Worldwide overview of health and home care

Visão panorâmica da saúde no mundo e a inserção do home care. Descreve a Organização Mundial da Saúde (OMS) em seu aspecto histórico, enfatizando a participação brasileira em sua fundação e alguns dos fatos e eventos mais relevantes que antecederam essa criação. Também descreve a história da Organização Pan-Americana de Saúde (OPS), fundada em dezembro de 1902 e a celebração do seu primeiro centenário em 2002. Uma visão geral da saúde no mundo é oferecida, incluindo-se os aspectos da globalização, como fato irreversível, mudanças demográficas e epidemiológicas, dependência e o trabalho de prestação de cuidados de home care, serviços de home care e políticas de home care.