Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

Coping with preoperative anxiety in cesarean section: physiological, cognitive, and emotional effects of listening to favorite music.

BACKGROUND: Listening to music has a stress-reducing effect in surgical procedures. The effects of listening to music immediately before a cesarean section have not been studied. The objective of this study was to assess the effects of listening to selected music while waiting for a cesarean section on emotional reactions, on cognitive appraisal of the threat of surgery, and on stress-related physiological reactions. METHODS: A total of 60 healthy women waiting alone to undergo an elective cesarean section for medical reasons only were randomly assigned either to an experimental or a control group. An hour before surgery they reported mood, and threat perception. Vital signs were assessed by a nurse. The experimental group listened to preselected favorite music for 40 minutes, and the control group waited for the operation without music. At the end of this period, all participants responded to a questionnaire assessing mood and threat perception, and the nurse measured vital signs. RESULTS: Women who listened to music before a cesarean section had a significant increase in positive emotions and a significant decline in negative emotions and perceived threat of the situation when compared with women in the control group, who exhibited a decline in positive emotions, an increase in the perceived threat of the situation, and had no change in negative emotions. Women who listened to music also exhibited a significant reduction in systolic blood pressure compared with a significant increase in diastolic blood pressure and respiratory rate in the control group. CONCLUSION: Listening to favorite music immediately before a cesarean section may be a cost-effective, emotion-focused coping strategy. (BIRTH 39:2 June 2012).

Nursing and midwifery education, practice, and issues in Israel.

Nurses deliver most of Israel's healthcare services, yet its nurse per population ratio is only 5.9 per 1000, one of the lowest in the developed world. For several years, the managers of the profession have been pushing to upgrade nursing and to move it into the academic sphere. The semiskilled qualification of the practical nurse has been eliminated and training programs for registered nurses are being transformed from diploma training to academic degree programs. A midwifery license is accessible only to registered nurses who take a further 1 year of advanced training and sit the State Midwifery Licensing Examination. Most deliveries in Israel are carried out by midwives. Alongside the Western-standard hospital system there operates both a well-developed community nursing network and a strong mother-and-child clinic system. The acute shortage of nurses in Israel is now coinciding with a rising number of academic job-seekers, which has encouraged the Ministry of Health to offer university graduates a career-change program. Special scholarships are on offer in return for a 4 year commitment to work in nursing after completing an accelerated training curriculum (2.5 years instead of the usual 3 years), plus a starting monthly wage that is higher than the national average wage.

The effects of a coaching project in nursing on the coaches' training motivation, training outcomes, and job performance: an experimental study.

BACKGROUND: Coaching is known to benefit both the trainees and the coaches, yet research in nursing has mainly focused on the benefits to the trainees. There is little knowledge regarding the psycho-educational effects of being a coach. OBJECTIVES: To determine the effects of participation in a coaching project in nursing, on the coaches' training motivation, skills acquisition, self-efficacy, professional attitudes, transfer of training and professional performance. It was hypothesized that participation in the project would significantly improve all these outcomes among the coaches but not in a control group. DESIGN: An experimental study. SETTINGS: An innovative educational program was instituted over the last 10 years in an academic School of Nursing in Israel. Recent graduates in nursing (i.e., coaches) assisted junior students in their studies. METHODS: All graduates of one class were randomly assigned to either the experimental (22 coaches) or control group (30 similar graduates who would not be coaches). The groups were similar in the demographic details and grade-point average. Research instruments included self-report measures and performance in a simulation test (Objective Structured Clinical Examination). RESULTS: Compared with the control group the coaches improved in training motivation, self-efficacy and behavioral transfer of several nursing skills. Participation also prevented deterioration of some skills (e.g., medication management, communication skills). This stability was in contrast with the decline in most outcomes in the control group. The coaches also obtained positive behavioral transfer and demonstrated superior professional performance (OSCE). Professional attitudes were not affected. CONCLUSIONS: Participation in the project enabled the coaches to enhance some of their professional skills, and improve their training motivation and self-efficacy in performing complex nursing skills. Coaching made an important contribution in facilitating the nurses' passage from school to the professional work field and could be a form of staff development.

Nursing in Israel.

Nurses in Israel struggle with many of the same problems faced by nurses in other parts of the world, such as increased use of technology, overwhelming amounts of information, and demands for high quality of services to larger numbers of people within tighter budgets. In addition to the aging of the general population, the country has welcomed large numbers of immigrants. The nation's expenditures for healthcare and nursing education have, at times, had to take a back seat to the government's efforts to house new immigrants, to relocate groups, and to defend the nation against politically motivated violence and attacks. All of this is in the context of regional conflicts and international debates.

A psycho-educational program for improving women's attitudes and coping with menopause symptoms.

OBJECTIVE: To examine the impact of participation in a psycho-educational program on women's attitudes toward menopause, the perceived severity of their symptoms, and the association between the two. DESIGN: Quasi-experimental. Data were gathered at baseline and 3 months after termination of the program. SETTING: Two health maintenance organization clinics. PARTICIPANTS: Eighty-two healthy 40- to 60-year-old women who chose to participate in the study. Thirty-six women participated in the program, and 46 women comprised the control group. INTERVENTION: Program participants met for 10 weekly sessions to receive information from a professional team on subjects related to menopause and to share and discuss their experiences. MAIN OUTCOME MEASURES: Attitudes toward menopause and severity of menopause symptoms. RESULTS: The more negative the attitudes, the higher was the severity of symptoms. Participants reported significant improvements in attitudes and reductions in symptom severity compared to their own baseline scores and compared with the control group. CONCLUSIONS: Participation in a program that combines delivery of information and processing of experiences on the cognitive, emotional, and social levels may improve women's attitudes toward menopause and ease the perceived severity of their symptoms, thereby increasing quality of life.

Multi-ethnic high school students' perceptions of nursing in the USA and Israel: a descriptive quantitative study.

BACKGROUND: In order to target new recruits or future generation of ethnic minority nurses about their potential fit in nursing, it is necessary to understand their perceptions of the profession. Successful recruitment of high school students into nursing in part requires congruency between perceptions of an ideal career and perceptions of nursing as a career. The purposes of this study were to compare ethnic minority high school students in the USA and in Israel on their perceptions of nursing as a career, and to understand how those perceptions compare to their perceptions of an ideal career. DESIGN: A descriptive quantitative design was employed to study a sample of 330 ethnic minority high school students from the USA and from Israel. METHODS: The Mann-Whitney U procedure was used to compare the groups' perceptions; a two-sided Wilcoxon Signed-Ranks test was used to determine the differences between their perceptions of an ideal career and of nursing as a career. RESULTS: The USA students had more positive perceptions of nursing as a career than did the Israeli students. Both groups of students did not perceive nursing as an ideal career: They perceived nurses as hard workers, performing arduous tasks and busy work, not academically challenged, with limited opportunity for leadership and autonomy, and earning less money than they would want in an ideal career. Caring for others was a highly valued attribute for an ideal career and for nursing as a career. CONCLUSION: A minority career development plan that underscores the positive attributes of nursing should be designed in both the USA and in Israel for ethnic minority high school students. The plan should effectively communicate nursing as a caring profession that is academically rigorous and intellectually challenging with available leadership opportunities in institutions and society.

Concept mapping: an educational strategy for advancing nursing education.

TOPIC: Application of concept mapping as a tool in nursing education. PURPOSE: To highlight the use of concept mapping as a method for advanced learning in nursing education. SOURCES OF INFORMATION: Literature from nursing and general education, instructor and student experiences, and opinions from using concept maps as a method of teaching/learning. CONCLUSIONS: Instructors and students reported satisfaction from use of concept maps in the educational process. Teaching with the aid of concept maps has been incorporated as an innovative and viable teaching method in nursing education.

Does the conservation of resources motivate middle-aged women to perform physical activity?

This article aims to examine the factors that motivate middle-aged women to engage in leisure physical activity (LPA) and to explore the relationship between resources loss and gains and engaging in LPA. It is a cross-sectional study based on a self-reported questionnaire (n = 949), using variables of the conservation of resources theory and the theory of planned behavior. Results show that women who engage in physical activity experience lower resources loss than inactive women. The longer they engage in physical activity, the less they experience losses such as youth, attractiveness, optimism, health, and beauty. Conservation of resources, perceived behavioral control, attitudes, and normative beliefs predict 41% (p < .0001) of the variance in the engagement in leisure physical activity. Findings suggest that constructing effective strategies to promote LPA requires also addressing these factors, which are valued by middle-aged women.

Stress, self-efficacy and quality of life in cancer patients.

The purpose of the study was to examine the effect of different stressors on various domains of quality of life (QOL) in cancer patients. The study focused on testing a model describing interrelations between two kinds of stress antecedents, two mediating variables--perceived stress and self-efficacy--and QOL. The participants were 60 cancer patients of both genders and various diagnoses. They were administered questionnaires of background information, QOL, perceived stress and general self-efficacy. Two stress indices were defined empirically: health stress (based on advanced disease stage, long disease duration, and undergoing treatment) and social stress (based on unemployment, recent immigration, and older age). Confirmatory factor analysis enabled defining five factors of QOL. Hierarchical regression analyses showed that the index of social stress was related to more QOL scales than the index of health stress and very few interactions with the mediating variables. Structural equation modeling provided a more comprehensive and accurate view. It showed that the index of health stress affected QOL mainly through perceived stress, and that self-efficacy affected QOL by reducing perceived stress and increasing QOL. The major conclusions are that QOL is affected negatively by both health stresses and social stresses, but the former are mediated primarily by the experience of perceived stress.

Genetic testing, genetic information, and the role of maternal-child health nurses in Israel.

PURPOSE: To examine the rate of genetic testing, the characteristics of those who had these tests, and to examine the public's openness to the possibility of expanding nurses' roles in maternal-child health (MCH) clinics to include providing genetic information. DESIGN: The study was conducted in nine MCH clinics in the central district of Israel. All women attending the clinics during 1 week were requested to complete the questionnaire. The sample consisted of 361 participants. FINDINGS: A high rate of genetic testing (80.4%) was shown. Higher education, being secular, and native-born Israeli predicted testing performance. Half of the tested participants reported that they did not understand the test results and were interested in receiving explanations regarding these results. Forty-four percent of respondents were interested in receiving genetic information from an MCH nurse. CONCLUSIONS: A high rate of genetic testing performance was reported. The public reported lack of information regarding genetic tests and their results. An appropriate setting for providing this information is the maternal-child health clinics.

Sexual harassment of nurses and nursing students.

BACKGROUND: Nursing has dealt with sexual harassment long before the term was coined during the 1970s. The current study investigated sexual harassment of nurses and nursing students in Israel following new legislation against sexual harassment in the workplace. METHODS: A self-report questionnaire was administered to 281 nurses and 206 nursing students (80% women) from five medical centres in Israel. Seven types of sexual harassment behaviour patterns were evaluated. FINDINGS: Frequency of sexual harassment decreased as the behaviour became more intimate and offensive. Ninety percent of subjects reported experiencing at least one type of sexual harassment and 30% described at least four types. A significant difference was found between nurses and nursing students. Furthermore, "severe" types of behaviour were experienced by 33% of nurses, in comparison with 23% of nursing students. Women were significantly more exposed than men to "mild" and "moderate" types of sexual harassment, while 35% of men vs. 26% of women were exposed to "severe" types of harassment. However, women responded significantly more assertively than men to "severe" sexual harassment. CONCLUSIONS: Particular attention is needed when sexual harassment occurs to male students and nurses because they may be subjected to the more offensive sexual conducts and at the same time may lack the ability to respond assertively.