Underpinnings of the Halachic Approach to BRCA Screening and Intervention: Facilitating Provider Counseling for Observant Jewish Populations.

BACKGROUND: Halacha is the corpus of Jewish law which serves as a life blueprint for observant Jewish individuals. Health professionals counseling halachically observant populations at risk for breast cancer gene (BRCA) mutations should be well informed of the halachic approach to screening for BRCA mutations and subsequent interventions. AIM: To address the intersection of halacha with ethical norms and current medical evidence-based data as they relate to potential and identified BRCA mutation carriers at their various stages of decision-making. RESULTS: Halacha, ethics, and medicine have much in common, but there are specific principles which guide halacha; decision-making in light of halacha is complex and varies with respect to the multi-faceted aspects of screening and intervention. Halacha encourages the exercise of autonomy regarding situations in which beneficence is not clear-cut and dependent on subjective perceptions. CONCLUSIONS: Health professionals knowledgeable of halacha are better equipped to counsel the observant Jewish population at risk of BRCA mutations or identified as mutation carriers, enabling them to present targeted questions to halachic authorities and thus achieve optimal decision-making.

The role and function of the palliative care nurse practitioner in Israel.

BACKGROUND: Research studies emphasise the importance of the nurse practitioner (NP) role in the continuum of care, patient health outcomes, and the formation of a positive work environment. There are different reports about the extent of care delivered by the nurse practitioner in different fields of expertise and in different countries. AIM: To present the characteristics of nurse practitioners in Israel, the extent of the role and practice, activities, role responsibilities, and job satisfaction. METHODS: A descriptive computerised survey targeted palliative care nurse practitioners (PCNP). The study included nurses from all regions and districts in Israel, regardless of the nurses' health maintenance organisation or hospital affiliations. RESULTS: NPs reported performing fewer frequent physical assessments, medication prescriptions issued, and lab and imaging referrals. CONCLUSION: The complexity of the implementation of the NP role requires prior planning for role introduction, mentorship for the NP, and understanding of the interface between the NP and other professional staff.

Religion, Judaism, and the challenge of maintaining an adequately immunized population.

A slow but steady trend to decline routine immunization has evolved over the past few decades, despite its pivotal role in staving off life-threatening communicable diseases. Religious beliefs are among the reasons given for exemptions. In the context of an overview of various religious approaches to this issue, this article addresses the Jewish religious obligation to immunize. The latter is nested in the more general obligation to take responsibility for one's health as it is essential to living a morally productive life. Furthermore, the individual's responsibility extends to supporting communal health by contributing to herd immunity. Judaism embraces evidence-based information regarding immunization safety and efficacy and holds the resulting professional guidelines to be religiously binding. From a Jewish perspective, government bodies need to weigh respect for individual autonomy to refrain from immunization against preserving public safety, such that waiving autonomy should be reserved for immediately life-threatening situations. Nurses' knowledge and understanding of the Jewish legal approach as explicated in this article and those of other religions in which similar principles apply (such as Islam and Christianity) can enrich their awareness of how revering God can go hand in hand with an obligation to prevent illness for the self and the community by immunizing.

Distinctive gene expression profile in women with history of postpartum depression.

Postpartum depression (PPD) is a disease which incorporates a variety of depressive states differing in nature and severity. To assist in the understanding of the pathogenesis of the disease, we aimed to ascertain a molecular mechanism underlying PPD development. We applied microarray technology to characterize gene expression of euthymic women with a history of PPD and compared the results with healthy controls. Our study demonstrated that women who considered euthymic on a clinical level, in fact, had an altered molecular profile when compared to participants with no PPD history. We identified nine genes significantly distinguished expression in post- depressive women; they may serve as a diagnostic tool for the detection of a predisposition to PPD. Our findings contribute significantly to the understanding of PPD etiology and its pathogenesis, offer a plausible explanation for the risk of the PPD recurrence, and may also contribute to clinical treatment.

Improving Adherence in Hospitalized Patients Diagnosed With Schizophrenia: An Integrative One-on-One Intervention.

OBJECTIVE: This study examined an individualized integrative nursing intervention for improving attitude and adherence. METHODS: The sample included 60 patients, randomly assigned to an experimental or control group. Measures included The Visual Analog Scale for Assessing Treatment Compliance and the Drug Attitude Inventory (DAI- 10). RESULTS: Significant differences were found in attitude and reported adherence for the experimental group, before and after. Significant differences were found between the experimental and control group in the degree of change in attitude and reported adherence. CONCLUSIONS: This study indicates the benefit of integrative one-on-one tailor-made intervention versus routine care for improving attitude and adherence to drug therapy.

Should Sabbath Prohibitions Be Overridden to Provide Emotional Support to a Sick Relative?

BACKGROUND: There is a consensus among the halachic authorities that life-saving actions override Sabbath prohibitions. They are painstaking in securing that the sanctity of the Sabbath is maintained but that not a single life be lost. OBJECTIVE: This manuscript examines if and when a relative's presence at the bedside of a seriously ill individual is potentially life-saving against the backdrop of the scientific literature. It specifically addresses the permissibility of traveling in a motorized vehicle, generally prohibited on the Sabbath, to be with one's relative in hospital for the provision of emotional support. METHODS: Discourse of the halachic issues in the context of the scientific literature. RESULTS: Stress, mental or physical, has been determined as a potentially life-threatening condition in many disease entities. The literature attests to both the patient's and the professionals' perception of the curative potential of the presence of loved ones by advocating for the patient and relieving stress in the hospital experience. Emotional support from a loved one is perceived by some patients as vital to survival. There is halachic consensus that a patient's perception of the emotional need for a relative's presence is sufficient to permit overriding rabbinic prohibitions. Torah prohibitions, which may be overridden for medical needs, may be overridden for emotional support, providing a health professional or family member attests to the fulfilment of this specific need as diminishing the danger to the patient's life. In certain cases, the latter contingency is unnecessary. CONCLUSIONS: Emotional support has an impact on the patient's health status; the degree to which its impact is strong enough to save life is still being studied. As more data from scientific studies emerge, they may be relevant to sharpening the halachic rulings with respect to the issue at hand.

Israeli nurses' attitudes to the holistic approach to health and their use of complementary and alternative therapies.

PURPOSE: To examine nurses' attitudes to holistic and biomedical approaches to health care and the correlation between the two and to explore the extent of recommending and using complementary and alternative medicine (CAM) by nurses and its correlation with attitudes toward the holistic approach to care. DESIGN AND METHODS: In this cross-sectional correlational study, a structured questionnaire was completed anonymously by 213 Israeli hospital-based nurses from various departments. FINDINGS: Nurses perceived both approaches as critical to optimal health care: a positive correlation emerged of attitudes to the two approaches. Nurses recommended and used CAM extensively; most therapies were recommended and/or used by 70% or more of the respondents. Nurses with more positive attitudes toward holistic care tended to recommend and use CAM to a greater extent. CONCLUSIONS: Biomedical and holistic approaches are perceived by nurses to coexist within nursing professional boundaries and form a broad basis for optimal health care. Nurses' attitudes to the holistic approach appear to promote recommendation and/or use of CAM in practice. More training in CAM should be offered in nursing educational frameworks and research should continue to establish evidence for CAM's effectiveness.

Enteral nutrition in end of life care: the Jewish Halachic ethics.

Providing versus foregoing enteral nutrition is a central issue in end-of-life care, affecting patients, families, nurses, and other health professionals. The aim of this article is to examine Jewish ethical perspectives on nourishing the dying and to analyze their implications for nursing practice, education, and research. Jewish ethics is based on religious law, called Halacha. Many Halachic scholars perceive withholding nourishment in end of life, even enterally, as hastening death. This reflects the divide they perceive between allowing a fatal disease to naturally run its course until an individual's vitality (life force or viability) is lost versus withholding nourishment for the vitality that still remains. The latter they maintain introduces a new cause of death. Nevertheless, coercing an individual to accept enteral nourishment is generally considered undignified and counterproductive. A minority of Halachic scholars classify withholding enteral nutrition as refraining from prolonging life, permitted under certain circumstances, especially in situations where nutritional problems flow directly from a fatal pathology. In the very final stages of dying, moreover, there is a general consensus that enteral nourishment may be withheld, providing that this reflects the dying individuals' wishes. In the event of enteral nourishment becoming a source of overwhelming discomfort, two Halachic ethical mandates would come into conflict: sustaining life by providing nourishment and alleviating suffering. As in all moral conflicts, these would have to be resolved in practice. This article presents the issue of enteral nourishment as it unfolds in Halacha in comparison to secular and other religious perspectives. It is meant to serve as a foundation for nurses to reflect on their own practice and to explore the implications for nursing practice, education, and research. In a world that remains broadly religious, it is important to sensitize health practitioners to the similarities and differences among religions and between secular and religious approaches to ethical issues.

The Nursing Division of the Israeli Health Ministry Moves Nursing Into the Forefront of Health Care.

The Nursing Division of the Israeli Ministry of Health, with the Government Nursing Officer at its helm, plays a pivotal role in promoting the nursing profession and influencing national health policy. In terms of nursing, the division is authorized to set, upgrade, and audit professional standards; create new specialties; formulate, oversee, and accredit educational programs; and award license to practice. In terms of broad policy, it has a voice in shaping general health priorities and allocating resources. Through the strategic use of the Nursing Division's vested powers and in collaboration and consultation with stakeholders, current nursing roles are being expanded and new ones are being developed to meet the needs of the population. The aim of this article is to describe and analyze the contribution of the Nursing Division under leadership of the Government Nursing Officer in promoting nursing and health care in Israel over the last decade.

Gerotrancscendence through Jewish eyes.

The Swedish sociologist Tornstam perceives old age as the peak of human maturation whose favorable culmination is gerotranscendence. The latter is characterized by breaking out of one's finite existence and uniting with a greater world with respect to past, present, and future. Tornstam relates to gerotranscendent roots in Eastern cultures; this study will examine how gerotranscendence finds expression in Jewish sources. Varied Jewish texts speak to how the wisdom that accrues from life experience enables one to rise above physical decline and enrich relationships via self, fellow man, and cosmos. Three major biblical exemplars of gerotranscendors are depicted: Abraham, focusing on limitless giving to fellow man; Isaac, overcoming psychological barriers of past paternal disappointments; and Jacob uniting with his children and grandchildren through the blessing that becomes a legacy for perpetuating the future of the nation. Practical applications of the study for more meaningful aging are discussed.

The hierarchy of values in Jewish bioethics.

This article describes how ethical issues in health are approached and resolved within the framework of Jewish bioethics. Its main purpose is to explore the range of sources and methodologies used to determine the appropriate hierarchy of values for various ethical scenarios. Its major thrust is to illustrate how a divinely based but humanly negotiated ethical code stands firm upon 'red flag' principles, while at the same time, allowing for 'shades of gray' flexibility informed by given contexts. It provides significant insights and practical tools that can be instrumental in decision making for nurses and other health providers of all faiths. The following ethical domains are addressed: respect for patient autonomy, truth-telling and allocation of resources.

Profile, burden, and quality of life of Israeli stroke survivor caregivers: a longitudinal study.

The aims of this study were to (1) delineate the sociodemographic profile of Israeli primary caregivers of stroke survivors; (2) examine the changes in caregivers' burden, physical and emotional health, social support network, and quality of life (QOL) during the first 6 months after the stroke occurrence; and (3) identify the predictors of caregivers' QOL for that time period. Primary caregivers (N = 140) were assessed at three intervals during this period: within 2 weeks after the stroke occurrence, in the geriatric rehabilitation ward, and at 3 and 6 months poststroke in the community. Results of the study revealed that during the 6-month period, caregivers' physical health remained stable. After 3 months, depression levels decreased, as did the need for instrumental support in and outside the home. Nevertheless, satisfaction with informal support and family relationships decreased, as did QOL. Burden decreased consistently at 3- and 6-month intervals. After 6 months, perception of health and QOL improved, whereas the other variables remained stable. These results indicate that overall, this population of caregivers adapted to their role over the 6-month period. At each of the three intervals, QOL was explained by the same four variables, although with differential weights: number of diseases, confidence in the support system, burden, and sharing a household with the survivor. The results of this study contribute to nurses' ability to identify caregivers at risk and develop appropriately timed interventions for empowering caregivers in their role fulfillment.

Levels and predictors of knowledge and attitudes regarding pain among Israeli baccalaureate nursing students and nurses pursuing specialty certification.

This paper presents the research conducted in 2003 by the Nursing Division of the Israeli Ministry of Health regarding the level of and predictors of pain knowledge and attitudes of Israeli nursing students and certifying nurses, in the context of the Division's educational policy. Cross-sectional descriptive in design, the research included first and fourth year baccalaureate students and nurses beginning and completing certification programs (N = 1149). Knowledge and attitudes, educational level, experience and success in pain care were examined via a questionnaire based on the McCaffery and Ferrell and Riddell and Fitche tools. Student's t-test, Pearson correlations and ANOVA were used for data analysis. Educational level was the strongest predictor of knowledge and attitudes among nursing students and certifying nurses, contributing most of the 42.8% explained variance. Small significant contributions were made by other variables. This indicates that formal education is a good vehicle for enhancing knowledge and attitudes.

State involvement in professional nursing development in Israel: promotive or restrictive.

This article describes the role of the Israeli Ministry of Health's Nursing Division in regulating the development of the nursing profession and the nursing care provided. First, factors influencing professional nursing in Israel and the development of the Ministry of Health's Nursing Division are presented. Then, examples of the Nursing Division's influence on nursing practice, the process of statutory authorization used to facilitate this influence, and future Nursing Division initiatives are discussed. The article concludes by noting that, on balance, ministerial (governmental) involvement strengthens the nursing profession and the quality of nursing care provided, yet may also restrict nurses' private concerns.