Choosing a nursing specialty: connection to nursing students' personality traits, clinical self-efficacy, adoption of technology changes, and specialty prestige; a cross-sectional study.

BACKGROUND: Choosing a field of specialization within the nursing profession is affected by nurses' personality traits, self-confidence in performing clinical skills, and the field's prestige. A successful choice of area of expertise may improve nurses' job satisfaction and reduce job mobility. This study aims to examine the relationship between personality traits, clinical self-efficacy, perceived prestige, adoption of technological changes, and choice of specialty field among nursing students. METHODS: A cross-sectional study was conducted. One-hundred-twenty-seven undergraduate nursing students in their fourth year of studies at a large university in Israel participated in the study. The questionnaire administered was comprised of six parts: demographic data, personality traits, adoption of technological changes, clinical self-efficacy, perceived prestige, and intention to select a field of specialization. RESULTS: Acute disciplines were rated more prestigious than chronic disciplines, with intensive care and emergency medicine considered the most prestigious, while mental health and geriatrics were the least prestigious. Students' mean perceived confidence in performing nursing clinical skills was high and more than half considered themselves open to technology changes. Positive correlations were found between prestige and intention to choose a field of expertise (r = 0.41, p < 0.001) and the personality trait of openness and the intention to choose an acute care area (r = 0.26, p < 0.01). CONCLUSIONS: Despite the gradual aging of the population and the increase in chronic morbidity, which demand a greater nursing focus on older adults, and notwithstanding the mental health reforms, nursing students perceive geriatrics and mental health as less prestigious fields. A career development path can be applied by developing a tool for occupational guidance designed to rank students' suitability for specialty fields and thus help them choose the area that best suits them.

The role of sense of coherence in workplace violence directed at nurses in the shadow of COVID-19: A cross-sectional study.

AIMS: To explore (a) the associations between sense of coherence (SOC), previous exposure to COVID-19, and the intention to act violently towards nurses, and (b) the role of SOC and sociodemographic variables as risk or protective factors involved in the intention to act violently. DESIGN: A cross-sectional study with a convenience sample. METHODS: A structured self-report questionnaire was distributed from February to March 2022. The questionnaire included socioeconomic variables, previous exposure to COVID-19, and a validated questionnaire on SOC. Three vignettes (online shaming, verbal and physical violence) describing nurse-patient communication conflicts were presented to participants. A multinomial logistic regression was conducted to explore the associations with acting violently by comparing three options of no/sometimes/high intention to act violently. The study adhered to STROBE guidelines. RESULTS: Questionnaires were completed by 808 adults. SOC and religiosity were revealed as protective factors in the three vignettes. Verbal violent behaviour was found to be a risk factor for online and physical violent behaviour intention. Previous exposure to COVID-19, non-academic education, and ethnicity were found to be risk factors for the intention to behave violently toward nurses. CONCLUSION: The findings suggest that training nurses in practical SOC dimensions (enhancing comprehensible, manageable and meaningful treatment processes) may reduce patients' lack of understanding and frustration and, in turn, reduce the tendency to behave violently. IMPACT: This study focused on SOC as a variable that may affect the intention to act violently towards nurses. The results reveal that SOC may be a protective factor, where people with higher SOC will have less intention to behave violently towards nurses. The results can provide an insight for nurses, nurse leaders and policymakers, towards supplying coherent and cultural competency treatment processes for patients and assisting nurses in dealing with stressful situations during normal routines and pandemics. PATIENT OR PUBLIC CONTRIBUTION: The questionnaire was distributed among the general public by master's degree nursing students. The students distributed the questionnaires among their friends and acquaintances using a snowball-sampling approach.

Use of Health Information Exchange in the Continuity of Care as Viewed by Patients and Nurses: A Cross-Sectional Study.

Patients' attitudes toward sharing their personal health information are critical for implementation of health information exchange. Nurses contribute significantly to information sharing within the care continuum in hospitals and community. This study aimed to examine the awareness and readiness of patients with chronic illness and nurses to the use health information exchange. A cross-sectional study was conducted among 314 inpatients with a chronic illness, 110 nurses working in internal wards, and 55 contact nurses working in a large health maintenance organization. The findings showed that the mean level of awareness was low across all three groups. Contact nurses expressed more positive attitudes than internal ward nurses or patients and were more willing than patients to share information with healthcare workers. Knowledge, attitudes, and being a nurse predicted the intention to share information with medical healthcare providers and with agents not involved in direct care. Before implementation of a health information exchange system, it is important to raise awareness, readiness, and intention to use it among the public, nurses, and other medical staff. Policy makers should organize national campaigns under the auspices of the Ministry of Health to present the advantages and provide detailed information about the system.

The Healthcare Environment Survey: A multicountry psychometric evaluation of nurses' job satisfaction.

AIM: To evaluate the properties of a reduced-item Healthcare Environment Survey measuring nurses' job satisfaction across eight countries. BACKGROUND: There is currently no rigorously tested international measure of nurses' job satisfaction that can be used internationally to improve the nurse work environment. METHODS: Nursing staff from 11 hospitals in eight countries participated in this study. The original 57-item, 11-facet Healthcare Environment Survey was evaluated for reliability, validity, and measurement invariance: Cronbach's alpha was used to test for reliability; construct, discriminate, and convergent testing were used to test validity; and invariance testing including configural, metric, and scalar tests were used to study measurement invariance between the countries. RESULTS: 2,046 nursing staff completed the survey. Reliability was established for all six subscales and the combined composite score. Both validity and measurement invariance were supported in every test conducted. An excellent model fit was found for the final 19-item, 6-facet Healthcare Environment Survey that explained 82% of the variance of nurses' job satisfaction. CONCLUSIONS: Findings suggest the instrument is an efficient measure of nurses' job satisfaction across multiple countries. Longitudinal testing for invariance will be needed to ensure the model remains a good fit. Testing more countries will also verify model fit. IMPLICATIONS FOR NURSING: The instrument can be used to measure nurse job satisfaction globally. IMPLICATIONS FOR NURSING POLICY: The instrument can be used to assess interventions to improve the social (patient, unit manager, and coworker) and technical (professional rewards, autonomy, and professional growth) aspects of nurse job satisfaction.

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.

The public's mixed emotional responses to violence directed at nurses: A mixed methods study.

AIMS AND OBJECTIVES: To understand whether exposure to an incident of violence directed at nurses, evoke among the public a sense of identification with the victim or with the perpetrator. BACKGROUND: Worldwide, evidence regarding workplace violence (WPV) in healthcare systems, explored the characteristics of the perpetrator, the healthcare settings and staff. Nevertheless, no studies examine the emotions of the public towards WPV in the healthcare systems. DESIGN: A convergent mixed method parallel design. METHODS: A structured questionnaire was distributed among 925 adults. Two scenarios were presented, with verbal and physical violence towards nurses. The participants rated how intensely they felt positive and negative emotions regarding the nurse and the perpetrator (quantitative stage). Sixty participants were also interviewed concerning their emotions regarding violence committed towards nurses (qualitative stage). Paired samples t-test were used to compare the emotions that were aroused regarding the perpetrator and the nurse. The effect size and Bonferroni correction for multiple comparisons were calculated. Constant comparative analysis method was used to analyzed the qualitative data. The STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting. RESULTS: Positive emotions were significantly higher towards the nurse than the perpetrator. Nevertheless, there were both positive and negative emotions towards the perpetrator and the nurse. The qualitative findings yielded two themes: (1) Mixed emotions towards the perpetrator, and (2) Mixed emotions towards the nurse. CONCLUSIONS: The public may emotionally identify with both the nurse and the perpetrator while positive and negative emotions are intertwined. Likewise, positive emotions are more intensely felt for the victims in both verbally and physically violent scenarios. RELEVANCE TO CLINICAL PRACTICE: These complemented findings highlight the need for campaigns promoting positive emotions toward healthcare professionals in an attempt to reduce and eliminate WPV in healthcare.

When a child is hospitalized in a Covid-19 ward: An emotional roller coaster for parents.

PURPOSE: To examine the emotions demonstrated by parents of children hospitalized in a pediatric Covid-19 ward. BACKGROUND: Although Covid-19 is mostly a mild disease in children, a small proportion develop severe disease requiring prolonged intensive care support. METHODS: On October 1st, 2020, a unique ward for children with Covid-19 was established in a large hospital in Israel. Interviews were conducted with parents of children who had been hospitalized in a pediatric Covid-19 ward. FINDINGS: A total of 22 parents of children aged 3 weeks to18 years were interviewed. Three themes emerged: Theme 1: Recognizing their child needed hospitalization in the Covid-19 ward, caused parents anxiety and fear of the unknown. Theme 2: Their child's hospitalization in the Covid-19 ward caused fear and worry at their child's condition, parental stress, shame, boredom, and acceptance. Theme 3: Parents initially felt emotional loneliness towards the healthcare staff in the Covid-19 ward, as well as loss of control, later replaced by feelings of confidence. CONCLUSION: Parents have diverse emotions in response to needing to accompany their children who are hospitalized and isolated in a closed ward due to Covid-19. PRACTICAL IMPLICATIONS: Health care professionals are immensely important in providing support for parents and for their children suffering from Covid-19. A national plan should be established to address inpatient childcare during an epidemic. Nurses can encourage parents and family to be involved in the child's care and communicate effectively to reduce both the parents' and the child's uncertainty, shame, fear and stress.

Emotion management of women at risk for premature birth: The association with optimism and social support.

OBJECTIVE: To examine the emotion management of women at risk for premature birth, and the connection to their optimism and social support. BACKGROUND: A shortened uterus cervix in early pregnancy (24-34 weeks gestation) is a predictor of preterm birth and is a common reason for hospitalization in a high-risk unit. Women hospitalized for this reason often feel a wide spectrum of emotions that may require emotional work, where deep acting techniques are used to evoke or suppress emotions in order to meet social expectations. The emotions, optimism, and social support of women with high-risk pregnancies have implications for their health and well-being. DESIGN: A cross sectional study at a high-risk pregnancy unit in a large hospital in Israel. METHOD: Eighty-six pregnant women hospitalized between 24 and 34 weeks of gestation in a high-risk unit due to premature contractions and/or cervical shortening, responded to a structured questionnaire. Data were analyzed using reliability testing, descriptive statistics, correlation analysis, and multiple linear regressions. RESULTS: A significant correlation was found between social support and optimism (r = 0.45, p < .01). A negative correlation was found between optimism and emotion management (r = -0.24, p < .05) and deep acting emotion management (r = -0.21, p < .05). CONCLUSION: High-risk pregnant women manage their emotions mainly through deep emotion work. Social support and optimism contribute to their emotional coping. It is recommended that healthcare professionals working in high-risk pregnancy units, and especially nurses, employ interventions designed to provide professional support and legitimize the sharing of emotions.

A Mixed-Methods Study of Nurse Managers' Managerial and Clinical Challenges in Mental Health Centers During the COVID-19 Pandemic.

PURPOSE: The worldwide outbreak of the COVID-19 pandemic has posed challenges for nurses. The aim of this study was to examine the managerial and clinical challenges of nurse managers in mental health centers during the current COVID-19 pandemic. DESIGN: A mixed-methods study based on an analysis of data obtained in focus groups with 25 nurse managers from two mental health centers in Israel. METHODS: The quantitative phase was conducted prior to the group sessions using a structured self-administered questionnaire that examined the nurse managers' (a) background data, (b) communication with the staff nurses, (c) perceptions of nurses' functioning, (d) perceptions of their own functioning, and (e) management as impacted by the pandemic. The qualitative phase included three sessions of focus groups in which the nurse managers discussed both their challenging and positive issues during the pandemic. FINDINGS: The most important challenges were related to the need to protect patients from infection and communicating with families and primary caregivers. Work policies and procedures were less well adapted to pandemic conditions; nevertheless, nurse managers felt a sense of purpose, duty, and pride in their work. Three themes emerged: (a) "management complexity" included the change from a familiar routine to a new reality, working in capsules, protecting against infection, functional confusion, and insights into future epidemics; (b) "challenging communication" included communication with patients through glass walls and communication with staff through screens and (c) "bright spots" referred to staff cohesion and the provision of respectful care. CONCLUSIONS: Mental health nurse managers have experienced during the pandemic a change in their roles from being less managerial to focusing more on clinical work. Communication between nurse managers and staff nurses and between mental health patients and staff were the main challenges. Nurse managers favorably noted the uniformity and humanity of the staff, sense of cohesion, and shared responsibility. CLINICAL RELEVANCE: In the first wave of the pandemic, there was confusion as to the functional role of ward nurse managers, as the focus of their activities became more clinical and less managerial. During and after the pandemic, preventive interventions should be carried out in order to assist patients, staff nurses, and nurse managers in mental health centers.

Association Between Witnessing and Justifying Workplace Violence Towards Nurses in Israel.

BACKGROUND: Workplace violence perpetrated by patients and their families towards nurses has become a global problem. PURPOSE: The present study explores associations between individuals' having witnessed violent incidents in the past and holding attitudes justifying violence in the present, and their intention to behave violently in a nurse-patient interaction at a healthcare facility. DESIGN: A cross-sectional study sampled 1,350 participants from among the general public in Israel. METHODS: A self-administered questionnaire measured attitudes regarding violence towards nurses and confronted the participants with two vignettes eliciting verbal and physical violence towards nurses. Multiple logistic regression was conducted to explore the association between attitudes and intention to act violently. A mediation analysis (using the PROCESS macro) was conducted to explore the mediation factors. RESULTS: Over half of the participants witnessed an incident of verbal violence in health care and substantially fewer witnessed a physically violent event (51.5% and 16.1%, respectively). An attitude of highly justifying violence was found to be directly associated with the intention to act verbally and physically violent. Past witnessing of verbal or physical violence in healthcare settings had an indirect association through an attitude that justifies violence, which served as a mediating factor for the intention to act verbally and physically violent in a situation presented via the vignettes. CONCLUSIONS: Witnessing a violent event in healthcare systems has social consequences that may cause normalization of violence and lead to the intention to use verbal or even physical violence towards nurses. CLINICAL RELEVANCE: Nurses should be encouraged to report incidents of violence, while healthcare and judicial systems must address this issue seriously. It is recommended that systems alerting for risk indicators be applied, to identify patients with a potential for violence in healthcare facilities. Healthcare policymakers and workers must act to promote an environment of zero tolerance for violence in order to minimize such events. In order to prevent violence towards healthcare staff, a holistic multisystem approach should be implemented, involving a focus by sociocultural elements on social values and structures, as violence in healthcare reflects violence in society at large.

Public knowledge, attitudes, and intention to act violently, with regard to violence directed at health care staff.

BACKGROUND: Violence directed at health care staff is widely prevalent. Few studies have explored public attitudes regarding violence against health care staff. PURPOSES: To examine the Israeli public's attitudes regarding violence against health care staff and their intention to act violently in various health care settings. METHOD: A cross-sectional study among 609 adult participants used a self-report questionnaire. The questionnaire dealt with attitudes regarding violence toward health care staff and presented the participants with three scenarios of violence in a health care setting. Logistic regression was conducted to explore variables that may explain the public's intentions to act violently. FINDINGS: The participants expressed condemnation of violence toward health care staff. Men displayed more violent attitudes than women. Participants who justified violence and were supportive of violent behavior displayed significantly more intentions to act violently. DISCUSSION: Actions taken to eliminate violence in the health system must be based on cooperation between health policymakers, health care workers, and the public.

Nurse and Nurse Student Attitudes and Perceived Self-efficacy in Use of Information and Communication Technologies: Professional and Cultural Differences.

Information and communication technologies have become essential and design-effective tools in the global healthcare system. Evidence suggests that information and communication technologies can promote nursing practice and patient satisfaction and quality of care. Competency with information and communication technologies is essential for both nurses and nursing students, and attitudes toward its use and perceived self-efficacy are important for implementation in the workplace. This study aimed to explore nurse and nursing student attitudes and perceived self-efficacy regarding information and communication technologies use in clinical practice and to examine professional and cultural differences between these groups in their attitudes and perceived self-efficacy in information and communication technologies use. A cross-sectional study was conducted among Israeli nursing students (n = 144) and registered nurses (n = 104). The findings revealed that respondents held overall positive attitudes toward information and communication technologies' use in clinical practice and perceived themselves as competent in this context. Significant differences were found between nurses and students in their attitudes toward information and communication technologies and information and communication technologies self-efficacy. Cultural group (Jewish/Arab) was found related to positive attitudes toward use of information and communication technologies in clinical practice. Nurse educators and managers should be aware of the potential impact of cultural and professional differences on the adoption and implementation of information and communication technologies and should institute initiatives within the organization and academia to manage cultural and professional discrepancies.

Age-Group and Gender Differences in Stroke Knowledge in an Israeli Jewish Adult Population.

BACKGROUND: Stroke is a leading cause of long-term disability and the fifth leading cause of death in Israel. Knowledge of stroke warning signs has been linked to early seeking of medical help. Little is known about knowledge of stroke warning signs in Israeli Jewish adults. METHODS: Stroke knowledge was examined among Jewish Israeli adults. Using a structured questionnaire, registered nurses interviewed a convenience sample of the respondents, 18 years or older, with no stroke history. Stroke knowledge and demographics were examined by 3 age groups (<45, 45-64, and >64 years) in men and women. RESULTS: In total, 1137 Jewish Israelis were interviewed, 457 (40.2%) men and 680 women (59.8%); 493 (43.4%) were younger than 45 years, 541 (47.6%) were aged 45 to 64 years, and 102 (9%) were older than 64 years; 1 (0.1%) did not report age. On average, each interview lasted for 25 to 30 minutes. Participants younger than 45 years showed the lowest knowledge of stroke cause. Women younger than 45 years were less likely to identify at least 2 stroke warning signs. Participants younger than 45 years were less likely to identify at least 2 risk factors, compared with participants aged 45 to 64 years and older than 64 years. Women younger than 45 years were less likely to identify at least 2 stroke prevention strategies. CONCLUSION: Participants younger than 45 years showed the lowest levels of stroke knowledge. The highest stroke knowledge was found in the 45 to 64 years age group. Stroke knowledge among different age groups was similar in both genders. Educational campaigns aimed at increasing knowledge of stroke among the general population and targeting the younger population are recommended.

Social Inclusion of Children With Down Syndrome: Jewish and Muslim Mothers' Knowledge, Attitudes, Beliefs, and Behavioral Intentions.

PURPOSE: The current study examined mothers' knowledge, beliefs, attitudes, and intention to socially integrate children with Down syndrome (DS) in the family, with children without disabilities and school system. DESIGN AND METHODS: A questionnaire based on a descriptive, cross-sectional design was administered to Jewish and Muslim mothers. The questionnaire included demographics, knowledge, beliefs, attitudes, and intention to integrate children with DS. Analysis included a regression test of intention to integrate children with DS and a one-way ANOVA for differences between Jewish and Muslim mothers. RESULTS: Nearly all the Jewish mothers (93.7%) and about half the Muslim mothers (52.8%) had performed screening tests for DS during their pregnancy. All mothers displayed low knowledge level about DS. Being Jewish (t=2.89; p=0.005) and holding more positive beliefs (t=3.39; p=0.001) were associated with a higher intention to socially integrate children with DS. Significant positive correlations were found between beliefs and attitudes (r=0.65; p<0.001) and between attitudes and intention to socially integrate children with DS (r=0.39; p<0.001). CONCLUSIONS: This study shows that Jewish and Muslim mothers' beliefs and attitudes towards social inclusion of children with DS are quite positive and the intention to integrate children with DS in the family, with children without disabilities, and in the mainstream school system is high. However, their level of knowledge about DS is low. PRACTICE IMPLICATIONS: Nurses, as a critical source of information about DS, should develop an ethno-cultural sensitivity to diverse populations in order to influence attitudes and beliefs regarding the social integration of children with DS.

Nursing Students' Attitudes and Intention to Work with Mentally Ill Patients Before and After a Planned Intervention.

OBJECTIVES: The authors examined changes in attitudes and intention to work with mentally ill patients (treat, specialize, or work in the field) among nursing students after a planned intervention consisting of a mental health course. METHODS: Data were collected before and after a planned intervention. The nature of the intervention was educational, for third year undergraduate nursing students. The core intervention included lectures on mental illness, encounters with people coping with mental illness, simulations, and a film on coping with mental illness. Behavioral intention to work with mentally ill patients and three dimensions of nursing students' attitudes (perceived functional characteristics, perceived danger, and value diminution of mentally ill patients) were measured before and after the intervention. The post-intervention impact of the intervention on participants' attitudes and behavioral intention was measured. RESULTS: One hundred and one undergraduate third year nursing students studying at four nursing schools in Israel participated in the study. The planned intervention improved the students' attitudes towards mentally ill patients but did not improve their intention of working with them. Post-intervention, older and less religious students had more intention to work with mentally ill patients. Moreover, older and Jewish students held better attitudes towards the functional characteristics of mentally ill patients. Being older was also correlated with the perception of mentally ill patients as less dangerous and male students ascribed to them more value diminution. CONCLUSIONS: Students' attitudes towards mentally ill patients and their behavioral intention to work in the psychiatry field should be addressed during the initial training and in continuing education. Teaching methods should include theoretical learning on multicultural mental health practice concurrently with clinical placements.

Differences Between New Immigrants From the Former Soviet Union and Veteran Residents in Knowledge, Perception, and Risk Factors of Stroke.

BACKGROUND: Stroke is the fourth most common cause of death in developed countries and a leading cause of acquired disability in adults. Awareness of risk factors and warning signs for stroke has a considerable impact on early arrival at the hospital and early thrombolytic treatment. Delays in seeking medical treatment following the onset of stroke symptoms have been shown to be more common among ethnic minorities. OBJECTIVE: The aim of the current study was to examine stroke awareness and knowledge among new immigrants from the Former Soviet Union (IFSUs) compared with veteran residents (VRs). METHODS: The study was conducted by students of the nursing master of arts program. Data were collected during March 2010 and June 2014. Trained registered nurses conducted interviews, using a structured, pretested, open-ended questionnaire. Participants were recruited by a snowball method from among the interviewers' friends and family members, 40 years or older with no history of stroke. RESULTS: A total of 643 Israelis, 420 VRs (65.3%) and 223 IFSUs (34.7%), were interviewed; 40.7% were men, with a mean age of 52.6 (SD, 9.3) years. Compared with VRs, IFSUs were more likely to report previous myocardial infarction (P = .022), hypertension (P < .001), and diabetes (P = .012). The mean number of stroke warning signs reported by IFSUs was higher than that reported by VRs (P = .031). When asked about risk factors for stroke, IFSUs more often stated hypertension (P = .03), whereas VRs more often reported family history (P = .03). Immigrants from the Former Soviet Union were more aware of strategies for the prevention of stroke than VRs (P = .02). The preferred sources of information about stroke for IFSUs, as distinguished from VRs, were personal doctors (P = .001) and radio programs (P = .03). CONCLUSIONS: Veteran residents showed lower levels of knowledge about stroke. Educational campaigns aimed at increasing knowledge of stroke among Israel's general population in Israel, as well as culturally targeting specific subgroups, are recommended.

Gender differences in feelings and knowledge about stroke.

AIMS AND OBJECTIVES: To examine gender differences in knowledge and feelings about stroke among ≥40 years old population. BACKGROUND: Knowledge of stroke is consistently found to be poor among both genders in general populations, however, it has been reported to be better among women than men. Gender differences in feelings about stroke in the general population have not been examined. DESIGN AND METHODS: Data were collected from a convenience sample using semi-structured personal interviews. Participants were representative of Israeli sub-populations aged ≥40 with no history of stroke. Knowledge of stroke was studied with quantitative methods while constant comparative analysis was used for the qualitative data analysis of feelings evoked by stroke. RESULTS: One hundred and seventy-seven participants were interviewed, 79/177 (44·6%) men and 98/177 (55·4%) women. Rates of self-reported hypertension [33/79 (41·8%) men, 25/98 (25·5%) women] and current smoking [29/79 (36·7%) men, 18/98 (18·4%) women] were significantly higher in men than women. Over 50% men and women mentioned one-side sudden weakness or paralysis as a stroke symptom, however, other stroke symptoms were not recognised by most participants. Education was associated with the number of identified stroke signs. Knowledge of stroke-warning signs was better in women. The main feelings expressed by both genders were fear of dying and disability, self-concern about survival, blaming fate and self-accusation. CONCLUSION: Stroke knowledge is poor among men and women. Higher level of education is a predictor of stroke knowledge among both genders. Gender-specific differences in stroke risk factors and feelings about stroke in different sub-populations should be taken into account to improve prevention of stroke through education programmes. RELEVANCE TO CLINICAL PRACTICE: Health education on stroke prevention should be tailored to population groups differing in level of education. Health promotion recommendations should be provided by nurses with regard to beliefs of both men and women regarding prevention of stroke.

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.

Israeli nurses' intention to report for work in an emergency or disaster.

PURPOSE: This study investigates the effect of personal characteristics and organizational factors on nurses' intention to report for work in a national emergency. DESIGN: A convenience sample was drawn of 243 Israeli registered nurses. A structured self-administered questionnaire collected data on (a) intention to report for work, (b) barriers preventing nurses from reporting for work, (c) perceived self-efficacy in emergency conditions, (d) risk appraisal of health hazards, (e) knowledge of nurses' roles in emergency work, (f) access to institutional support services, and (g) reporting to work in a past emergency. METHODS: Data were analyzed by descriptive statistics, Pearson correlation coefficients, t tests, and multiple regression analysis. FINDINGS: Less than half of the nurses who said they had been asked to report for work in a past emergency had actually done so. The major barrier to reporting for work was childcare demands. There was a significant correlation between perceived knowledge, risk appraisal, self-efficacy, and intention to report. Self-efficacy, risk appraisal, working through an earlier emergency, perceived knowledge, and full or part-time working altogether. CONCLUSIONS: Personal factors, such as perceived knowledge, risk appraisal, and self-efficacy, are more important to Israeli nurses than objective barriers in preventing them from reporting for emergency work. The level of perceived knowledge as to the demands on and duties of nurses in a large-scale emergency is low. Self-efficacy enhancing activities need to be introduced into nurse training for emergency preparedness. CLINICAL RELEVANCE: This study makes an important contribution to research on the importance of perceived self-efficacy in the context of disaster planning.

Intentions of nurses and nursing students to tell the whole truth to patients and family members.

AIMS AND OBJECTIVES: To investigate the intentions of nurses and nursing students to telling the truth to patients and families, based on the Theory of Planned Behavior which examines intention to perform behaviours. BACKGROUND: In recent decades, the perception that patients have a moral and legal right to truthful and reliable information has become dominant. However, the study of telling the truth to non-oncology patients has received scant attention and little is known about the intention of nurses and nursing students to tell the truth. DESIGN: A cross-sectional design. METHODS: We used a scenario-based questionnaire, illustrating eight different situations in which nurses/nursing students are asked to tell the truth to a patient or family member regarding a devastating disease with which the patient is afflicted. Data were analysed using the Mann-Whitney U-test and ridge regression. RESULTS: The sample included 150 participants, 110 registered nurses and 40 third year nursing students, with a response rate of 87%. The results show that nurses and nursing students intend to tell the whole truth even if this is not easy for them. Nurses more than students think that it is important to tell the whole truth and intend to do so. Head nurses tend to tell the truth more than staff nurses. For nurses, the components of the Theory of Planned Behaviour predicted intention to tell the truth, whereas among students subjective norms were the only predictor of intention. CONCLUSION: The Theory of Planned Behaviour is a powerful predictor of nurse intention to tell the whole truth to patients and their families. Students perceive social pressure as the most important incentive of their intention to tell the truth. RELEVANCE TO CLINICAL PRACTICE: Nurses and nursing students should receive additional training in dealing with various situations involving truth telling.