Lived experiences: Growing up with a seriously mentally ill parent.

INTRODUCTION: Individuals with serious mental illness often have persistent and disruptive symptoms. These can profoundly affect their children's lives, exposing them to adverse social and psychological conditions. Such conditions can result in traumatic lived experiences during childhood, which can carry over into adulthood, influencing their self-perceptions and shaping their attitudes toward themselves and society. To gain insights into this phenomenon, this study explored the lived experiences of adults who grew up with a parent with serious mental illness and their perceptions of their lives in adulthood. DESIGN: This study used an interpretive phenomenological design. METHODS: Participants were invited to voluntarily participate in the study through a call posted on social media. Semi-structured interviews were conducted with 30 adults (age range, 20-55 years) who grew up with a parent with serious mental illness. The interviews were recorded and transcribed, and inductive thematic analysis was used to identify main and overarching themes. RESULTS: The overarching theme of transition from childhood survival to adulthood survival emerged and included four main themes: (1) a traumatic childhood, (2) perceived control, (3) resilience and general self-efficacy, and (4) adult quality of life. A traumatic childhood consisted of experiences of neglect and abuse, while participants used perceived control to achieve personal growth, self-care, and care of others. Resilience and general self-efficacy emerged during the transition to adulthood and helped participants further their social status and strengthen family bonds. Lastly, adult quality of life was described as being disturbed by feelings of loneliness and being burdensome, stemming from an inherent tendency to rely solely on themselves, leading to trust issues and mental health complications. Therefore, these adults found it difficult to reach out and get help or treatment for their concerns, as they initially did not want to appear dysfunctional or in need. CONCLUSION: This study has illuminated the lived experiences of a specific, vulnerable population that has not been intentionally explored until now. To delve into these experiences, we employed a distinctive qualitative approach, merging the interpretive phenomenological perspective with an inductive thematic analysis. This allowed for rich insight with a relatively large group of participants and enabled an in-depth exploration within this methodological framework. Consequently, this study constitutes a notable contribution to the extant body of knowledge, exploring the intricacies of personal growth and its impact on participants' quality of life. It uncovers the essence of resilience and general self-efficacy, revealing how these elements intertwine with the negative results observed. However, the study findings emphasize the need for healthcare professionals, including nurses and other caregivers, to be mindful of the long-lasting effects of the adverse experiences of children of patients with serious mental illness. Prioritizing active clinical assessment and implementing tailored interventions to address such children's specific needs and difficulties across different developmental stages is imperative. Such comprehensive and targeted approaches are crucial in providing appropriate support and promoting the well-being of these individuals. CLINICAL RELEVANCE: Enhanced clinical attention in holistic psychiatric care is crucial for individuals and their relatives, especially children. Comprehensive assessments of children and adults raised by seriously mentally ill parents can enable tailored and preventive interventions, positively impacting overall quality of life.

Vaccinating without complete willingness against COVID-19: Personal and social aspects of Israeli nursing students and faculty members.

Soon after the coronavirus disease 2019 (COVID-19) pandemic outbreak, it became clear that vaccination will be the most useful tool to combat the disease. Despite the apparent safety and efficacy of the developed anti-COVID-19 vaccines, relatively high percentages of the population worldwide refused to get vaccinated, including many health workers and health students. The present cross-sectional study examined the motives, attitudes, and personal characteristics of those who did not get vaccinated against COVID-19 or vaccinated without complete willingness among nursing students and nursing faculty members in Israel (n = 472). Results show that the vast majority of the study participants (97%) received at least one dose of the anti-COVID-19 vaccine. Nearly 37% of the participants indicated that they received the vaccine without complete willingness. As compared to faculty members, nursing students reported lower trust in the efficacy of the vaccine, perceived the COVID-19 pandemic as a health threat to a lesser extent, exhibited lower institutional and personal trust, and had higher levels of posttraumatic stress disorder symptoms. Non-Jewish participants were at risk of vaccinating without complete willingness. These findings underscore the need for developing evidence-based strategies to promote the safety and efficacy of the anti-COVID-19 vaccines in nursing schools.

An immune-protein score combining TRAIL, IP-10 and CRP for predicting severe COVID-19 disease.

COVID-19 patients are oftentimes over- or under-treated due to a deficit in predictive management tools. This study reports derivation of an algorithm that integrates the host levels of TRAIL, IP-10, and CRP into a single numeric score that is an early indicator of severe outcome for COVID-19 patients and can identify patients at-risk to deteriorate. 394 COVID-19 patients were eligible; 29% meeting a severe outcome (intensive care unit admission/non-invasive or invasive ventilation/death). The score's area under the receiver operating characteristic curve (AUC) was 0.86, superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The score differentiated severe patients who further deteriorated from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001). The score accurately predicted COVID-19 patients at-risk for severe outcome, and therefore has potential to facilitate timely care escalation and de-escalation and appropriate resource allocation.

Public views on healthcare workers' burnout before and during COVID-19: A comparative study.

INTRODUCTION: Understanding burnout among nurses and physicians may mobilize public support for increasing budgets, personnel, and trust in both routine and pandemic times. The study aimed to examine public views of nurse and physician burnout both before and 1 year after the COVID-19 outbreak. DESIGN: This study was conducted in two phases in a pre-post design. METHODS: The general public (a random sample) responded to a structured questionnaire with 1-2 open-ended questions: (a) before the COVID-19 pandemic, in 2019 during routine life (n = 504) and (b) 1 year after the COVID-19 outbreak, in 2021 (n = 500). Quantitative and qualitative data on public perceptions of nurse and physician burnout, its sources and consequences, were collected. RESULTS: The public view was that hospital physicians and even more so hospital nurses suffer from higher burnout than those working in the community, and that this worsened during the pandemic. Three themes related to caregiver burnout were identified: (a) work overload, (b) lack of sensitivity, empathy, and motivation, and (c) impaired ability to provide quality care. CONCLUSIONS: The public is aware of the experiences of caregivers both in times of routine and in emergency. Healthcare management must influence public opinion in order to receive support for organizational steps. CLINICAL RELEVANCE: Healthcare leaders should leverage public support in order to receive backing for organizational moves aimed at improving work conditions and, in turn, the quality of care and patient outcomes.

Frequent attenders in primary health care: a mixed-methods study of patient and staff perspectives.

AIMS AND OBJECTIVE: To understand the frequent attendance phenomenon from the perspective of patients and healthcare professionals and how it can be reduced. BACKGROUND: Frequent attenders (FAs) are characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP). Although FAs constitute about 10% of all primary clinic attendees, they are responsible for ~40-50% of clinic visits, affecting the efficiency, accessibility and quality of health services provided to other patients. DESIGN: Mixed methods (STROBE Statement: Data S1; COREQ checklist: Data S2). METHODS: Eighteen FAs were interviewed in a qualitative approach. PCPs and nurses (n = 184) completed a cross-sectional survey. RESULTS: FAs are driven by their personal, emotional and mental state. FAs viewed clinics as a source for information and resolving medical problems. They perceived PCPs as authoritative and knowledgeable, and nurses as treatment managers and mediators between PCPs and patients. In contrast, FAs evoked more negative emotions than positive ones among medical staff. PCPs and nurses attributed frequent visits to FAs' personal and emotional states. A model based on the findings was constructed to provide a framework for grasping frequent attendance from a sociological perspective and for planning and managing it. CONCLUSIONS: The accessibility and availability of health services at primary clinics, and collaboration and trust in medical staff facilitate the frequent attendance phenomenon. RELEVANCE TO CLINICAL PRACTICE: The frequent attendance phenomenon should be proactively prevented, even before patients become FA, using the model constructed, which serves as a foundation for introducing an intervention program to identify and prevent frequent attendance. PCPs and nurses working in primary care clinics should be made aware of the FA phenomenon and should be educated and given tools to deal with it within the clinic. The process should be facilitated by organisational support. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.

Israeli parents` views on coronavirus (COVID-19) vaccinations for children: A cross-sectional study.

BACKGROUND: Parents play the decisive role in children's vaccination. Our study aimed as assessing attitudes of parents toward the COVID-19 vaccine for children aged 5-18 and to define sources of influence on these attitudes, the barriers and reasons for hesitation. METHODS: In this cross-sectional study, 138 Israeli parents of 5-18 aged children completed a self-administered structured questionnaire. FINDINGS: More than a quarter of parents reported that they did not intend to vaccinate their children. Independent of other demographic characteristics, parents who do not vaccinate their children accordingly to the routine vaccinations have five-fold significant odds not to vaccinate with COVID-19 vaccine (OR = 4.8, 95% CI: 1.8-12.7). Greater social influence was significantly and negatively associated with intentions not to vaccinate a child. Among parents who do not intend to vaccinate their children, the most frequent reasons were fear of possible side effects (92%), vaccine novelty (92%) and lack of belief in its effectiveness (69%). DISCUSSION: This study found that vaccination in the past as part of routine government immunization programs predict a tendency to vaccinate children during the pandemic. Among the factors associated with the intention not to vaccinate, concerns and uncertainty about the necessity of the vaccine, its side effects and reliability have been emphasized. APPLICATION TO PRACTICE: Cultural-religious adjustments should be applied when implementing interventions aiming to promote vaccination in routines and emergencies. Social influence is important in adopting a positive attitude toward vaccines. Public health professionals should incorporate those parents who have vaccinated their children and have a positive attitude toward vaccination.

Outcome of Kidney Transplantation in Israel Following Uncontrolled Donation after Cardiocirculatory Determination of Death.

BACKGROUND: A limited program for kidney donation from uncontrolled donation after cardiocirculatory determination of death (uDCDD) was implemented at four hospitals in Israel in close cooperation with Magen David Adom (MDA), the national emergency medical service. OBJECTIVES: To assess the outcome of transplantations performed between January 2017 and June 2022. METHODS: Donor data included age, sex, and cause of death. Recipient data included age, sex, and yearly serum creatinine levels. A retrospective study of out-of-hospital cardiac arrest cases treated by MDA during 2021 were analyzed to assess their compatibility as potential uDCDD donors. RESULTS: In total, 49 potential donors were referred to hospitals by MDA. Consent was obtained in 40 cases (83%), organ retrieval was performed in 28 cases, and 40 kidneys were transplanted from 21 donors (75% retrieval rate). At 1-year follow-up, 36 recipients had a functioning graft (4 returned to dialysis) and mean serum creatinine 1.59 ± 0.92 mg% (90% graft survival). Outcome after transplantation showed serum creatinine levels (mg%) at 2 years 1.41 ± 0.83, n=26; 3 years 1.48 ± 0.99, n=16; 4 years 1.07 ± 1.06, n=7; and 5 years 1.12 ± 0.31, n=5. One patient died of multiple myeloma at 3 years. The MDA audit revealed an unutilized pool of 125 potential cases, 90 of whom were transported to hospitals and 35 were declared dead at the scene. CONCLUSIONS: Transplant outcomes were encouraging, suggesting that more intensive implementation of the program may increase the number of kidneys transplanted, thus shortening recipient waiting lists.

Self-efficacy, uncertainty and anxiety among nursing graduates in response to licensing test postponement due to the COVID-19 pandemic: A mixed-methods study.

AIM: To examine the relationships between self-efficacy, uncertainty and anxiety among nursing graduates waiting for a mandatory nursing licensing test that was postponed due to the COVID-19 pandemic. METHODS: A total of 352 graduates of nursing education programs participated in this mixed-methods study. The data were collected using an online questionnaire in June 2020. RESULTS: The participants demonstrated high uncertainty and anxiety and low self-efficacy towards the ability to succeed in the licensing exam. Graduates, who started working, reported lower uncertainty. Self-efficacy, uncertainty, gender and family status contributed significantly to the explanation of 24% of the variance of the anxiety. The qualitative analysis revealed three themes: (a) emotional distress, cognitive challenge and social implications, (b) consequences for significant others and (c) strengthening of professional values and norms. CONCLUSIONS: A significant crisis like a pandemic is accompanied by acute cognitive burden and stressful emotional experiences and creates an unconventional situation that requires unusual solutions. Granting a temporary permit for employment as a nurse following the postponement of a licensing test contributed to the ability of nursing graduates to cope with the situation. Policies to deal with similar situations in the future emergencies should be developed and implemented.

Factors associated with the extent of nurses' involvement in promotion of the nursing profession: a cross-sectional study among nurses working in diverse healthcare settings.

AIMS AND OBJECTIVES: To examine factors associated with promotion of the nursing profession, to the nursing community, other healthcare professionals and the general public, by nurses employed in diverse healthcare settings. BACKGROUND: Little is known about the factors that contribute to nurses' involvement in the promotion of the nursing profession. METHODS: This cross-sectional study comprises a convenience sample of registered nurses (n = 526) with ≥ 3 months' experience in nursing, who are employed in internal and surgical units, pediatric wards, psychiatric wards or in the community across Israel. Participants completed a self-administered questionnaire addressing socio-demographic, occupational and organizational factors relating to the nursing work environment and to the extent of nurses' involvement in promotion of the nursing profession. Descriptive statistics, one-way analysis of variance, Pearson's correlation analysis, and multivariate linear regression were performed. RESULTS: Nurses in all the surveyed healthcare settings reported relatively low levels of involvement in promotion of the profession, either to the nursing community or to other healthcare professionals and the public. Being a female-nurse was significantly negatively associated with nurses' involvement in promotion of the nursing profession. In contrast, holding a master's degree in nursing, having a managerial role, and working in a supportive organizational nursing work environment were the principal factors associated with positive promotion of the nursing profession. CONCLUSION: The extent of nurses' involvement in promotion of the nursing profession mainly depends on occupational factors and a supportive organizational nursing work environment. CLINICAL RELEVANCE: Healthcare managers may advance nurses' involvement in promotion of the profession by modifying the organizational nursing work environment. Specifically, we recommend nurse leaders to dedicate efforts to make professional promotion an integral part of a nurse's role.

Alert-Grouping: Smart Personalization of Monitoring System Thresholds to Help Healthcare Teams Struggle with Alarm Fatigue in Intensive Care.

In Intensive Care Units (ICUs), patients are monitored using various devices that generate alerts when specific metrics, such as heart rate and oxygen saturation, exceed predetermined thresholds. However, these alerts can be inaccurate and lead to alert fatigue, resulting in errors and inaccurate diagnoses. We propose Alert grouping, a "Smart Personalization of Monitoring System Thresholds to Help Healthcare Teams Struggle Alarm Fatigue in Intensive Care" model. The alert grouping looks at patients at the individual and cluster levels, and healthcare-related constraints to assist medical and nursing teams in setting personalized alert thresholds of vital parameters. By simulating the function of ICU patient bed devices, we demonstrate that the proposed alert grouping model effectively reduces the number of alarms overall, improving the alert system's validity and reducing alarm fatigue. Implementing this personalized alert model in ICUs boosts medical and nursing teams' confidence in the alert system, leading to better care for ICU patients by significantly reducing alarm fatigue, thereby improving the quality of care for ICU patients.

Teachers' characteristics predict students' guidance for healthy lifestyle: a cross-sectional study in Arab-speaking schools.

INTRODUCTION: Schools are valuable settings for implementing healthy lifestyle interventions. Teachers' health behaviors affect their health and well-being and might affect their position as role models for students. This study aimed a) to assess health behaviors, health perceptions, burnout, job satisfaction, and organizational commitment among Arab school teachers in Israel; b) to examine the relationship between these variables; and c) to explain the variance of healthy lifestyle promotion among students. METHODS: A cross-sectional study using a structured questionnaire was conducted among 150 teachers (mean age 39 years, 85% women) in May-June 2020. RESULTS: Most respondents (79%) were overweight and obese, 79% reported unhealthy nutrition and not reaching the recommended physical activity target, 47% slept >7 hours at night and 54% defined their health status as very good or excellent. Reported burnout levels were high. Organizational commitment and job satisfaction were high while students' guidance towards a healthy lifestyle was moderate. Burnout was negatively correlated with health perception, organizational commitment, and job satisfaction. Health perception was positively correlated with organizational commitment, job satisfaction and promoting a healthy lifestyle among students. Logistic regression analysis revealed that job satisfaction, performance of PA according to the recommendations and burnout predicted 51% of the variance of healthy lifestyle promotion among students. CONCLUSIONS: Teachers in Israeli Arab schools report unfavorable health behaviors and health perception as well as high burnout levels. The findings suggest implementing intervention programs to reduce teacher burnout and creating organizational conditions that would encourage teachers to adopt a healthy lifestyle and help them promote healthy lifestyle habits among their students.

Hidradenitis suppurativa: Evaluating activity patterns and predictors of recalcitrant course-A population-based study.

BACKGROUND: Epidemiological evidence regarding the course and activity patterns of hidradenitis suppurativa (HS) is yet to be delineated. OBJECTIVE: To identify activity patterns of HS throughout the time axis and to outline predictors of recalcitrant disease course. METHODS: A population-based retrospective cohort study was performed to follow patients with HS (n = 4417) throughout the initial 10 years following their diagnosis. The disease was considered active in a certain month if one of the following criteria was fulfilled: (i) purchase of an HS-related drug, (ii) admission to a dermatological ward and (iii) referral to a dermatological consultation in an emergency room. Patients with a recalcitrant disease were defined as those with ≥5 years of follow-up with ≥6 'active months' each. Patients with an indolent course were defined as those experiencing ≥9 years of follow-up with ≤1 'active months' each. RESULTS: The average (SD) number of months in which patients had an active disease was 1.37 (1.28) months per year. While 98 (2.2%) patients pursued a recalcitrant course, 1390 (31.5%) went through an indolent disease course. Older age (≥38 years; adjusted OR, 6.17; 95% CI, 3.33-11.43), Arab ethnicity (adjusted OR, 2.04; 95% CI, 1.20-3.48), low socioeconomic status (adjusted OR, 1.64; 95% CI, 1.03-2.60), obesity (adjusted OR, 3.47; 95% CI, 2.25-5.34) and smoking (adjusted OR, 2.65; 95% CI, 1.57-4.47) were found to independently predict recalcitrant course of HS. CONCLUSIONS: Mild course is more frequently encountered than severe course among Israeli patients with HS. Modifiable risk factors of recalcitrant course should be carefully addressed.

Experiences and psychosocial predictors of professional function among intensive care nurses under the shadow of Covid-19: A mixed-methods study.

BACKGROUND: The outbreak of the Corona virus (COVID-19) pandemic led to a sharp rise in morbidity and hospitalizations, and a significant therapeutic burden fell on intensive care units (ICUs). Intensive care nurses reported physical and emotional stress in response to the extra workload caused by caring for critically ill COVID-19 patients. However, at the time of publication of the study, to the best of our knowledge there have been no studies that examined uncertainty, stress, or hope in the context of functioning among intensive care nurses. AIM: To examine: (a) the challenges of operating and managing intensive care units during the COVID-19 pandemic among nurse managers in intensive care units, and (b) the relationships between uncertainty, stress, burnout, hope, and professional functioning among intensive care nurses during the COVID-19 pandemic. DESIGN: This mixed-methods study was conducted in intensive care units (ICUs) at a large tertiary medical center in Israel, during February-May 2021. METHODS: The data were collected in two phases. In the first phase, qualitative data were collected from focus groups attended by 15 senior managerial nurses. The second phase involved a cross-sectional study among 100 staff nurses working in 5 ICUs. The data were collected using a structured questionnaire. RESULTS: Qualitative data analysis revealed two main themes: (a) challenges of the COVID-19 pandemic and (b) positive aspects of the COVID-19 pandemic. The nurses reported high levels of burnout, emotional stress and uncertainty, but moderate State Hope Scale scores, and moderate levels of professional functioning. There were no statistical differences in study variables by exposure to COVID-19 patients. State Hope Scale levels, uncertainty, and burnout variables contributed significantly and explained 46% of the variance of the professional functioning. CONCLUSIONS: The intensity of the experiences and psych-social phenomena, is not affected by exposure to treatment of COVID-19 patients. The relationships between the study variables emphasize the importance of initiated and ongoing interventions to reduce uncertainty, address burnout, and strengthen hope. Improvement in these indices may lead to better ICU nurses' professional functioning and their work life well-being.

Diabetes nurse practitioners in the shadow of the COVID-19 pandemic: Challenges, insights, and suggestions for improvement.

PURPOSE: The study examined the role of diabetes nurse practitioners (DiNPs) and their contribution to the quality of care of individuals with diabetes during the COVID-19 pandemic. Specifically, we examined the benefits and barriers of using telemedicine for managing diabetes. DESIGN: A descriptive qualitative research using content analysis of interviews. METHODS: Participants were invited through the National DiNPs' Forum. Semi-structured interviews were conducted with 24 licensed DiNPs (age range, 37-58 years) who were involved in the clinical care of individuals with diabetes during the COVID-19 pandemic. The interviews were recorded and transcribed, and content analysis was then used for extracting themes and their related categories. FINDINGS: Content analysis revealed five themes: (a) Benefits and barriers of remote diabetes treatment; (b) Teamwork and its implications to DiNPs; (c) Technological challenges, resourcefulness, and creativity; (d) Changed perception of DiNP roles; and (e) Cultural diversity and improving communication skills. The benefits of telemedicine included improved control, efficiency, convenience and satisfaction, while the disadvantages of this method included the inability to provide optimal practical guidance on technical aspects of physical assessments and care. Sectors with limited digital literacy and language barriers had difficulties using telemedicine. Teamwork was reported as a facilitator to managing treatment. Telemedicine provided an opportunity for DiNPs to become more efficient and focused and to clearly define their role in the organization. CONCLUSIONS: The COVID-19 pandemic has posed new challenges. Along with the need to adapt the therapeutic approach to remote care, DiNPs improved their professional status, acquired new skills, and were satisfied with their personal and professional growth. CLINICAL RELEVANCE: Telemedicine should become an integral part of diabetes management to enable access to populations who cannot come to the clinic. Patients should be guided on using telemedicine platforms.

Effect of ethnicity, country of origin and workplace on health behaviors and health perception among nurses: Cross-sectional study.

PURPOSE: The study aimed to (1) examine health behaviors and perceived health among nurses; (2) analyze the effect of nurses' personal and work characteristics on these variables; and (3) explore the relationship between health behaviors and nurses' health perception. DESIGN AND METHODS: A cross-sectional study was conducted among nurses working in health care organizations (HCOs) across Israel. An email with the online questionnaire was sent to nurses working in 19 HCOs across Israel during September-December 2018. FINDINGS: Of 18,120 nurses employed, 3542 completed the survey. Mean age was 44.8 years, 91% were female), 64.6% were hospital nurses and 52.8% were clinical staff nurses. Two-thirds of nurses did not achieve the physical activity (PA) target; the majority reported unfavorable eating habits; 66% slept less than 7 h at night and 15% smoke. Hospital nurses working night shifts reported the least favorable health behaviors. Non-Jewish nurses had less eating habits compared with Jewish nurses. Nurses born in the Former Soviet Union perceived their health as significantly worse than that of the other respondents. Binomial logistic regression demonstrated that, age, Israeli origin, achieving the PA target, having food breaks during work, consuming a Mediterranean diet, sleeping at least 7 h, undergoing screening tests as recommended, and not smoking predicted better health perception among nurses. CONCLUSIONS: Nurses, particularly hospital-based, non-Jewish and immigrants from the Soviet Union, demonstrated unfavorable health behaviors that may negatively affect their wellbeing and health perception. CLINICAL RELEVANCE: Interventions aimed at improving the health promoting mindset of nurses have the potential to improve their health and wellbeing and to enable them to become role models and health educators for patients and their families.

Are emotional intelligence and compassion associated with nursing safety and quality care? A cross-sectional investigation in pediatric settings.

PURPOSE: To assess and compare the perceptions of emotional intelligence, compassion, and safety and quality care held by parents of hospitalized children and nurses, and to examine the association between emotional intelligence, compassion, and safety and quality care among nurses. DESIGN AND METHODS: This cross-sectional study comprised 80 parents whose children were hospitalized for at least three days, and 71 nurses who treated these children. The data were collected during April-June 2018 using a self-administered questionnaire addressing socio-demographic characteristics, safety and quality care in the ward, emotional intelligence, and compassion. A hierarchical multiple regression model was used to assess whether emotional intelligence and compassion could be associated with safety and quality care among pediatric nurses. RESULTS: Parents considered the safety and quality care in the ward to be significantly (p = .003) higher (M = 4.23 ± 0.61) than did nurses (M = 3.97 ± 0.46). Compassion had a significant positive effect on safety and quality of care (ß = 0.260; p = .041), while seniority in nursing had a significant negative effect on safety and quality care (ß = -0.289;p = .021). Null effect was found between emotional intelligence and safety and quality care. CONCLUSION: Compassionate care should be targeted to improve the safety and quality of nursing care delivered to children and their parents. PRACTICE IMPLICATIONS: Nurse ward managers should promote procedures and guidelines concerning safety and quality care processes among older nurses. Specifically, we recommend nurse ward managers to leverage the results and dedicate efforts to continue to provide compassionate care in pediatric settings as an integral part of safety and quality care.

Practices and experiences of European frontline nurses under the shadow of COVID-19.

The COVID-19 pandemic has caused health professionals to deal with new situations they have not encountered before. Nurses were forced to cope with increased workloads, seriously ill patients, numerous patient deaths, and unresolved ethical dilemmas. This study aimed to examine the lived experiences of nurses across Europe during the first wave of the COVID-19 pandemic. This was a qualitative narrative research study. Eighteen nurses from eight European countries (four each from the UK and Israel, three from Portugal, two each from the Netherlands and Ireland, and one each from Belgium, Italy, and Sweden) submitted narratives about their professional experiences during May-June 2020. The narratives were analyzed using thematic analysis. Seven categories across the narratives were condensed and interpreted into three themes: opportunities and growth, care management, and emotional and ethical challenges. The COVID-19 pandemic has affected nurses emotionally and provided an opportunity to actively develop systems and skills needed to minimize harm and maximize benefits to patients and nurses.

Sexual harassment of religious Jewish nurses by patients and its relation to the ward's listening climate, care avoidance and quality of nursing care.

AIM: This study aimed to examine the associations between religious Jewish nurses' exposure to sexual harassment by patients, the ward's listening climate, the quality of nursing care and nurses' avoidance of therapeutic contact with harassing patients. BACKGROUND: A few studies have examined nurses' exposure to sexual harassment by patients, but this phenomenon has not been studied among religious Jewish nurses. METHODS: This is a cross-sectional study of 85 nurses who study at a religious Jewish nursing school. Respondents completed self-administered structured questionnaires. Multiple regression analysis was performed to reveal antecedents of the quality of nursing care provided to sexually harassing patients. RESULTS: The more religious the nurses, the more they avoided therapeutic contact with harassing patients. The strongest predictor of reported quality of care for harassing patients was the avoidance of therapeutic contact. Forty-two per cent of the variance in reported quality of nursing care was explained by the employment type and by the avoidance of therapeutic contact, which was related to the nurses' level of religiosity. CONCLUSIONS: Nurses' level of religiosity is related to the quality of care provided to sexually harassing patients. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leadership must raise awareness of sexual harassment by patients and develop policy and implementation programmes with sensitivity to religious nurses.

Public image of the profession is associated with the choice of nursing career among Arab high school students: A cross-sectional study.

AIMS: The aim of this study is to examine (a) public image of nursing and the intention to choose nursing as a future career and (b) the relationship between the public image, gender roles and the choice of the nursing career among Arab high school students. BACKGROUND: School graduates from the Arab sector represent an important social group with the potential to provide quality candidates for the nursing profession in Israel. METHODS: In this cross-sectional study, 138 high school students from two Arab schools in Israel completed a structured questionnaire. RESULTS: One third of the sample intended to choose nursing as a future career. Students from families with a higher level of paternal education and those exposed to the work of nurses perceived nursing as more positive. The profession's public image contributed to the explanation of 21% of the variance of the intention to choose a nursing career. CONCLUSION: A positive public image of nursing contributes to decisions about choosing a nursing career in the future among Arab high school students. IMPLICATIONS FOR NURSING MANAGEMENT: School graduates may be influenced by providing information and presenting the role of a nurse as significant, as well as by emphasizing the positive image of nursing to parents and influential people in the Arab community.

Feasibility of achieving different protein targets using a hypocaloric high-protein enteral formula in critically ill patients.

BACKGROUND AND AIMS: Combining energy and protein targets during the acute phase of critical illness is challenging. Energy should be provided progressively to reach targets while avoiding overfeeding and ensuring sufficient protein provision. This prospective observational study evaluated the feasibility of achieving protein targets guided by 24-h urinary nitrogen excretion while avoiding overfeeding when administering a high protein-to-energy ratio enteral nutrition (EN) formula. METHODS: Critically ill adult mechanically ventilated patients with an APACHE II score > 15, SOFA > 4 and without gastrointestinal dysfunction received EN with hypocaloric content for 7 days. Protein need was determined by 24-h urinary nitrogen excretion, up to 1.2 g/kg (Group A, N = 10) or up to 1.5 g/kg (Group B, N = 22). Variables assessed included nitrogen intake, excretion, balance; resting energy expenditure (REE); phase angle (PhA); gastrointestinal tolerance of EN. RESULTS: Demographic characteristics of groups were similar. Protein target was achieved using urinary nitrogen excretion measurements. Nitrogen balance worsened in Group A but improved in Group B. Daily protein and calorie intake and balance were significantly increased in Group B compared to Group A. REE was correlated to PhA measurements. Gastric tolerance of EN was good. CONCLUSIONS: Achieving the protein target using urinary nitrogen loss up to 1.5 g/kg/day was feasible in this hypercatabolic population. Reaching a higher protein and calorie target did not induce higher nitrogen excretion and was associated with improved nitrogen balance and a better energy intake without overfeeding. PhA appears to be related to REE and may reflect metabolism level, suggestive of a new phenotype for nutritional status. Trial registration 0795-18-RMC.