Navigating moral and ethical dilemmas in digital transformation processes within healthcare organizations.

Objective: Healthcare systems around the world face a turbulent and unstable global and local ecosystem that changes daily and impacts the healthcare organization and its workforce. This challenging environment, coupled with economic pressures, is forcing healthcare systems to change and adopt strategic and technological processes to adapt to change at all levels of the system (macro-holistic multi-systemic, mezzo-organizational, and micro-personal). Methods: In this study, through 32 in-depth, semi-structured interviews with healthcare professionals working in public general hospitals in central Israel, we examined, mapped, and highlighted the conflicts and moral dilemmas they have faced in recent years, alongside the processes of strategic, technological, and digital changes that the healthcare system has undergone. Results: The findings from both a categorical-deductive approach and an inductive approach analysis reveals four main themes: innovation paradox, quality and treatment conflict, information and knowledge conflict, and personal needs and values. The themes and sub-themes are sorted across the three levels of the healthcare system. Conclusions: These findings represent a wide range of conflicts and moral dilemmas that arise from the implementation of strategic change and digital transformation, adding to the already numerous ethical issues and moral dilemmas in healthcare and bioethics that are associated with three levels of the system. These challenges and moral conflicts can be barriers to implementing the necessary changes, as well as challenging individuals' internal values, potentially leading to burnout and moral distress. Given the importance of this issue and the intensification of change processes over the next few years, it is up to the management and key stakeholders to implement these processes in a way that addresses the conflicts and challenges that health professionals face. Minimizing the level of challenges and moral distress in the health sector will be to the benefit of the system, its workers, and the patients it serves.

Strategic technological processes in hospitals: Conflicts and personal experiences of healthcare teams.

BACKGROUND: Global health systems operate amid dynamic factors, including demographic shifts, economic variations, political changes, technological progress, and societal trends that lead to VUCA reality (Volatility, Uncertainty, Complexity, and Ambiguity). To address these challenges, healthcare organizations are increasingly turning to Strategic Technological Processes and digital transformation. RESEARCH OBJECTIVE: Against this background, the current study examined the personal experiences, conflicts, difficulties, and moral dilemmas attendant upon accommodating this digital transformation of healthcare professionals. PARTICIPANTS: The study involved 27 healthcare professionals working in Israeli hospitals, whose experiences and perspectives were central to understanding the impact of digital transformation in healthcare settings. RESEARCH DESIGN: The study methodology rested on in-depth interviews, which were analyzed through the prism of the Listening Guide analytical technique. ETHICAL CONSIDERATIONS: The research obtained pre-approval from the Ethics Committee at the researcher's institution. FINDINGS: The study revealed that the healthcare professionals are indeed facing ethical conflicts and personal challenges related to digitalization (such as providing the best quality of care, being the best caregiver, and acting for the betterment of the hospital). It also identified dilemmas resulting from conflicts between the needs and demands of the health system and the healthcare professionals' values and resources. DISCUSSION: The study findings highlight the impact of ethical and moral challenges accompanying strategic organizational and digital transformation changes implemented by healthcare organizations worldwide. These challenges arise as healthcare institutions adapt to the demands of the 21st century, potentially leading to burnout and moral distress among healthcare professionals, further exacerbating the already stressful reality they face. CONCLUSION: In conclusion, the study emphasizes the critical necessity for comprehensive support strategies to alleviate stress and burnout among healthcare professionals. As healthcare organizations and personnel navigate significant organizational changes to address contemporary challenges, prioritizing the well-being of healthcare workers through effective support mechanisms becomes imperative.

"Routine trauma"-Awareness of combat trauma in women combatants.

OBJECTIVE: The current research aims to explore the nature of trauma experienced by female combatants. METHOD: Data were collected from two focus groups and a series of personal interviews with 100 women military veterans who had served in the Israel Defense Forces as combat or combat-support soldiers. RESULTS: Interviews with these veterans revealed a variety of narratives about their war experiences, including an intertwining of the emotional and the physical. The ongoing danger and traumatic events that the combatants and combat-support soldiers faced on a daily basis were woven into their stories. These narratives indicated that-alongside their exposure to traumatic and potentially life-threatening situations-the soldiers also felt empowered and valued as a result of their military service. The women soldiers' perspectives regarding their military service covered three main themes, "experiencing trauma," "meaningful combat experiences," and "the need to be heard." CONCLUSIONS: Through qualitative research and narrative analysis, this study offers mental health professionals, policy makers, and scholars ways to gain a nuanced insight into women's combat trauma that avoids categorization. Based on the research findings, we suggest that additional aspects of trauma can be understood through the study of women soldiers, who face a "double battle"-combat, with the attendant trauma, and the gendered biases of the masculine military environment. Our findings suggest that there is value in engaging with and listening to diverse narratives of trauma and emphasize the need for a critical perspective in the study of trauma and combat trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Medical Somatic Dissociation Questionnaire Assessment For Childhood Sexual Abuse: A Brief Report.

Child sexual abuse is a prevalent phenomenon worldwide. However, a gap exists between its incidence and its disclosure rate. Furthermore, assessment tools and techniques capable to identify the source of symptoms are lacking. This study investigates the extent to which the validated Medical Somatic Dissociation Questionnaire (MSDQ) can differentiate between sexually and non-sexually abused children. A total of 794 children and youth between the ages of 8 and 18 (mean age: 12.2 (SD = 2.3); 42% female, 58% male) were recruited from the general population; other participants were residents of boarding schools and children who were referred to medical treatment. The anonymous online questionnaire included queries about demographics, a condensed version of the Traumatic Life Events Questionnaire, and the MSDQ. Findings indicate strong internal consistency, reliability, incremental validity, and predictive validity of the instrument, indicating the superiority of the MSDQ's ability to predict sexual abuse compared to physical abuse or the loss of a family member. It is concluded that the MSDQ can be integrated into the evaluation process performed by healthcare professionals in the diagnosis of minors with unexplained symptomatology.

Introduction to the Special IssueThe Use of Creative Art Therapies in the Prevention, Screening, and Treatment of Child Sexual Abuse.

The significant gap between the prevalence of child sexual abuse and disclosure underscores the need for new, innovative, and creative screening tools to identify victims to end the abuse and provide these victims with appropriate treatment. This article presents the cumulative efforts of a series of innovative studies dealing with sexually abused survivors and offenders that concentrates on preventing, assessing, screening, and treating Child Sexual Abuse (CSA). We start by describing the need and rationale for using the arts for purposes of identification and treatment. We discuss how these arts help bypass censorship and dissociation mechanisms involving the body as a critical factor during the assessment and the treatment. Each of the articles is then presented. The introduction is organized to show how non-verbal techniques for the prevention, screening, assessment and treatment of sexual abuse in chidren can move beyond verbal techniques that are known to be limited in their effectiveness.

Thank You for Hearing My Voice - Listening to Women Combat Veterans in the United States and Israeli Militaries.

The military service of combat soldiers may pose many threats to their well being and often take a toll on body and mind, influencing the physical and emotional make-up of combatants and veterans. The current study aims to enhance our knowledge about the combat experiences and the challenges that female soldiers face both during and after their service. The study is based on qualitative methods and narrative analysis of in-depth semi-structured personal interviews with twenty military veterans. It aims to analyze the narratives of American and Israeli female combat soldiers regarding their military service, with emphasis on the soldiers' descriptions, in their own words, about their difficulties, challenges, coping and successes during their service and transition to civilian life. A recurring theme in the interviews with the veterans of both militaries was the need to be heard and the fact that societies, therapists, and military institutions do not always truly listen to female veterans' experiences and are not really interested in what actually ails them. Our research suggests that conventional methods used in research relating to veterans might at times be inadequate, because the inherent categorization might abstract, pathologize, and fragment a wide array of soldiers' modes of post-combat being. Moreover, female veterans' voices will not be fully heard unless we allow them to be active participants in generating knowledge about themselves.

Listening to Hospital Personnel's Narratives during the COVID-19 Outbreak.

Healthcare workers (HCWs) facing the COVID-19 pandemic are required to deal with unexpectedly traumatic situations, concern about contamination, and mounting patient deaths. As a means to address the changing needs of our hospital's HCWs, we conducted a narrative analysis study in the early stages of the covid-19 outbreak. A focus group of medical experts, conducted as the initial step, recommended that a bottom-up research tool be used for exploring HCWs' traumatic experiences and needs. We therefore conducted 450 semi-structured in-depth interviews with hospital personnel. The interviews were based on Maslow's Pyramid of Needs model, and the narratives were analyzed by applying the Listening Guide methodology. The interviewees expressed a need for physical and psychological security in the battle against Covid-19, in addition to the need for attachment and meaning. Importantly, we also found that the interview itself may serve as a therapeutic tool. In light of our findings, we recommended changes in hospital practices, which were subsequently implemented. Further research on HCWs' traumatic experiences and needs will provide evidence-based knowledge and may enable novel approaches in the battle against Covid-19. To conclude, the knowledge generated by listening to HCWs' narratives may provide suitable support programs for professionals.

Fighting for Equal Spiritual Voice: The Case of the "Women of the Wall".

Our study contributes to the ongoing debate about women's rights and religious feminism. The context for analysis of women's experiences is the "Women of the Wall" who have been struggling for the past 30 years for their right to practice their spiritual rituals (praying at the Western Wall) in a hegemonic and masculine arena. We suggest that the "Women of the Wall" and their battle for spiritual equality threaten the hegemonic masculinity. Moreover, this feminist battle expands the feminist revolution and the fights for women's equality to the religious arena which is dominated by hegemonic masculinity. The implementation of the Listening Guide, a feminist methodology, assists us in uncovering various voices, representing different aspects of the experiences of the "Women of the Wall" in a conflict zone. These narratives reveal juxtapositions of feelings of competence, determination and vulnerability and shed light on the women's struggle for gender equality in a hegemonic masculine domain.

A Novel Screening Tool for Assessing Child Abuse: The Medical Somatic Dissociation Questionnaire-MSDQ.

Somatic dissociation is known to be associated with childhood abuse, particularly with childhood sexual abuse (CSA). Currently, the diagnosis of CSA is hampered by the lack of a validated questionnaire. While some questionnaires are excellent research tools, there is no suitable applied measure for the assessment of distress due to CSA. The current study's objective was to validate a novel questionnaire, designated the Medical Somatic Dissociation Questionnaire-MSDQ, for evaluating somatic dissociation in the healthcare system setting. A total of 541 adults, 160 (30%) male and 381 (70%) female, of average age 35 years were recruited from the general population via the Internet. The Life Events Checklist for DSM-5 (LEC-5) was used for screening subjects for reporting a history of CSA. Our examination of the MSDQ indicated powerful internal consistency, reliability, and convergent validity of the instrument, with high correlations between the MSDQ and the SDQ-20 and also between the MSDQ and psychological symptomatology. In addition, there was known-groups validity when differences between adults who experienced CSA and those who did not were compared. Importantly, the MSDQ can be easily integrated into the evaluation process performed by medical professionals in the diagnosis of adult patients with apparently unexplained symptomatology.

Recovery of Repressed Memories in Fibromyalgia Patients Treated With Hyperbaric Oxygen - Case Series Presentation and Suggested Bio-Psycho-Social Mechanism.

Fibromyalgia Syndrome (FMS) is a condition considered to represent a prototype of central sensitization syndrome, characterized by chronic widespread pain and along with symptoms of fatigue, non-restorative sleep and cognitive difficulties. FMS can be induced by trauma, infection or emotional stress with cumulative evidence that dissociation is relatively frequent in FMS patients. Two randomized controlled trials have shown that hyperbaric oxygen therapy (HBOT) can induce neuroplasticity and be effective in patients suffering from FMS. In this paper we present, for the first time, case series of female fibromyalgia patients who, in the course of HBOT, suddenly recalled repressed traumatic memories of childhood sexual abuse (CSA). The surfacing of the repressed (dissociative) memories decades after the sexual abuse events was sudden and utterly surprising. No psychological intervention was involved. As the memories surfaced, the physical pain related to FMS subsided. In one patient who had brain single photon emission CT (SPECT) before and after HBOT, the prefrontal cortex appeared suppressed before and reactivated after. The 3 cases reported in this article are representative of a total of nine fibromyalgia patients who experienced a retrieval of repressed memory during HBOT. These cases provide insights on dissociative amnesia and suggested mechanism hypothesis that is further discussed in the article. Obviously, prospective studies cannot be planned since patients are not aware of their repressed memories. However, it is very important to keep in mind the possibility of surfacing memories when treating fibromyalgia patients with HBOT or other interventions capable of awakening dormant brain regions.

Hyperbaric Oxygen Therapy Can Induce Neuroplasticity and Significant Clinical Improvement in Patients Suffering From Fibromyalgia With a History of Childhood Sexual Abuse-Randomized Controlled Trial.

Background: Fibromyalgia syndrome (FMS), a condition considered to represent a prototype of central sensitization syndrome, can be induced by different triggers including childhood sexual abuse (CSA). Recent studies have demonstrated hyperbaric oxygen therapy (HBOT) can induce neuroplasticity and improve clinical outcome of FMS. The aim of the current study was to evaluate the effect of HBOT on patients suffering from FMS with a history of CSA. Materials and methods: A prospective randomized clinical trial conducted between July 2015 and November 2017 included women with a history of CSA who fulfilled fibromyalgia diagnosis criteria for at least 5 years prior to inclusion. Included participants (N = 30) were randomly assigned to treatment group, treated with 60 HBOT sessions and a control/crossover group received psychotherapy. After the control period, the control/crossover group was crossed to HBOT. Clinical outcomes were assessed using FMS questioners, post-traumatic stress disorder (PTSD) questioners and quality of life questioners. Objective outcome were assessed using brain function and structure imaging. Findings: Following HBOT, there was a significant improvement in all FMS questionnaires (widespread pain index, Fibromyalgia symptoms severity scale, Fibromyalgia functional impairment), most domains of quality of life, PTSD symptoms and psychological distress. The same significant improvements were demonstrated in the control following crossover to HBOT. Following HBOT, brain SPECT imaging demonstrated significant increase in brain activity in the prefrontal cortex, orbital frontal cortex, and subgenual area (p < 0.05). Brain microstructure improvement was seen by MRI-DTI in the anterior thalamic radiation (p = 0.0001), left Insula (p = 0.001), and the right Thalamus (p = 0.001). Conclusion: HBOT induced significant clinical improvement that correlates with improved brain functionality and brain microstructure in CSA related FMS patients. Trial Registration: www.Clinicaltrials.gov, identifier: NCT03376269. url: https://clinicaltrials.gov/show/NCT03376269.

Brain and Mind Integration: Childhood Sexual Abuse Survivors Experiencing Hyperbaric Oxygen Treatment and Psychotherapy Concurrently.

Due to evidence that traumatic experience impacts the brain, the body (concerning sensory sensitivity), and the mind, a recent study that attempted to answer the question of whether the effects of CSA can be reversed by using a multidisciplinary approach consisting of dual treatments: hyperbaric & psychotherapy, was conducted. Its results showed that in addition to improvement of brain functionality, symptoms of distress were significantly reduced. The current paper aims to present the process as experienced by the 40 female childhood sexual abuse survivor participants. Data included participants' daily journals and drawings, and participants' summaries presented verbally and written, 6-months after the study ended. A phenomenological analysis was used. Results showed three phases, the initial phase-remembering the trauma from both physical and cognitive aspects, the second phase-physiological relaxation as well as positive memories emerge; and, the third phase-bouncing back to life. The results are discussed in light of the study theoretical model and Lev-Wiesel (2015) childhood sexual abuse conceptualization.

Hyperbaric oxygen therapy can diminish fibromyalgia syndrome--prospective clinical trial.

BACKGROUND: Fibromyalgia Syndrome (FMS) is a persistent and debilitating disorder estimated to impair the quality of life of 2-4% of the population, with 9:1 female-to-male incidence ratio. FMS is an important representative example of central nervous system sensitization and is associated with abnormal brain activity. Key symptoms include chronic widespread pain, allodynia and diffuse tenderness, along with fatigue and sleep disturbance. The syndrome is still elusive and refractory. The goal of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on symptoms and brain activity in FMS. METHODS AND FINDINGS: A prospective, active control, crossover clinical trial. Patients were randomly assigned to treated and crossover groups: The treated group patients were evaluated at baseline and after HBOT. Patients in the crossover-control group were evaluated three times: baseline, after a control period of no treatment, and after HBOT. Evaluations consisted of physical examination, including tender point count and pain threshold, extensive evaluation of quality of life, and single photon emission computed tomography (SPECT) imaging for evaluation of brain activity. The HBOT protocol comprised 40 sessions, 5 days/week, 90 minutes, 100% oxygen at 2ATA. Sixty female patients were included, aged 21-67 years and diagnosed with FMS at least 2 years earlier. HBOT in both groups led to significant amelioration of all FMS symptoms, with significant improvement in life quality. Analysis of SPECT imaging revealed rectification of the abnormal brain activity: decrease of the hyperactivity mainly in the posterior region and elevation of the reduced activity mainly in frontal areas. No improvement in any of the parameters was observed following the control period. CONCLUSIONS: The study provides evidence that HBOT can improve the symptoms and life quality of FMS patients. Moreover, it shows that HBOT can induce neuroplasticity and significantly rectify abnormal brain activity in pain related areas of FMS patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT01827683.

Awareness of diagnostic and clinical features of fibromyalgia among orthopedic surgeons.

Fibromyalgia Syndrome (FMS) is a chronic pain syndrome characterized by widespread musculoskeletal pain and fatigue. The current study was designed to evaluate the awareness and skills of orthopedic surgeons (OS) regarding FMS diagnosis and treatment. For the examination of awareness and familiarity of OS in Israel to Fibromyalgia, a questionnaire-based survey was conducted. Two hundred and nineteen OS, residents and specialists, were asked anonymously about awareness, knowledge, and treatment of FM. Multivariable statistical analysis was performed. 91 % (199) of responders reported that they recognized the disease. Notwithstanding, the mean knowledge score was 7.6 out of 17. In addition, OS who were trained in the south of Israel were found to have a better degree of knowledge about FM (9.7 vs. 7.4; p < 0.03). The awareness and knowledge among OS regarding FM needs to be improved. OS who were trained in the south of Israel were found to have better degree of knowledge regarding FM.

The role of peripartum dissociation as a predictor of posttraumatic stress symptoms following childbirth in Israeli Jewish women.

OBJECTIVE: This study aimed to assess the role of peripartum dissociation in the development of childbirth-related posttraumatic stress (PTS) symptoms. Furthermore, it examined the relation between life-traumatizing events, in particular childhood sexual abuse (CSA), dissociation tendencies, prenatal PTS, prenatal depression, peripartum dissociation, and postnatal PTS symptoms. METHOD: A self-report questionnaire was administered to 1,003 Israeli Jewish women (sample after attrition) at mid-pregnancy (18-28 weeks) and at 2 months postnatally. RESULTS: Women with a history of CSA scored higher on all variables during pregnancy and postpartum. Prenatal PTS symptoms, depression, and dissociation tendencies coincided with higher levels of peripartum dissociation. CONCLUSION: Screening pregnant women, especially CSA victims, and implementing models of prevention and intervention can assist these women in acquiring better coping strategies during childbirth. Such practices are likely to decrease peripartum dissociation, which may in turn lessen postpartum PTS symptoms.

Childhood sexual abuse as a predictor of birth-related posttraumatic stress and postpartum posttraumatic stress.

OBJECTIVE: To investigate the extent to which childbirth may function as a retraumatization of childhood sexual abuse, and may exacerbate postpartum posttraumatic stress reactions. METHODS: Data was obtained from a convenience sample of 837 women in mid-pregnancy, at 2 and 6 months following childbirth. Three groups were drawn from this sample: women who experienced childhood sexual abuse (CSA), women survivors of trauma other than CSA, and women who reported no-trauma experiences. RESULTS: PTSD subcategories of intrusion and arousal were increased in the CSA group following childbirth, although the overall PTSD score did not increase following childbirth in any of the groups CSA survivors scored higher at all data collection time points. CONCLUSIONS: CSA is a traumatic event that has greater negative long-term effects than other traumas in the population of pregnant women. PRACTICE IMPLICATIONS: Identifying women who are survivors of CSA early in their pregnancy and establishing a risk assessment may significantly reduce delivery complications and consequently mitigate postpartum PTS outcomes.

Past traumatic events: are they a risk factor for high-risk pregnancy, delivery complications, and postpartum posttraumatic symptoms?

BACKGROUND: This study aimed to examine the association among past traumatic events, high-risk pregnancy, delivery complications, and postpartum posttraumatic stress (PTS) symptoms. METHODS: The final convenience sample consisted of 1071 Jewish women at midpregnancy. Data were gathered at three time points (during pregnancy and 1 month and 6 months after childbirth) through self-report questionnaires. RESULTS: There was a higher percentage of high-risk pregnancy among those who reported a history of traumatic events. Although the total score of PTS symptoms did not correspond with high-risk pregnancy, the intrusion and avoidance subscales did. Furthermore, a history of traumatic events as well as prenatal PTS symptoms, prenatal depression, and the subjective pain and distress during delivery accounted for postpartum PTS symptoms. Prenatal depression was found to account for delivery complications. CONCLUSIONS: Findings indicate that a history of trauma should be considered a risk factor for high-risk pregnancy and for postpartum PTS symptoms.