Using Topic Modeling to Understand Patients' and Caregivers' Perspectives About Left Ventricular Assist Device: Thematic Analysis.

BACKGROUND: Heart failure (HF) is a significant global clinical and public health challenge, impacting 64.3 million individuals worldwide. To address the scarcity of donor organs, left ventricular assist device (LVAD) implantation has become a crucial intervention for managing end-stage HF, serving as a bridge to heart transplantation or as a destination therapy. Web-based health forums, such as MyLVAD.com, play a vital role as trusted sources of information for individuals with HF symptoms and their caregivers. OBJECTIVE: We aim to uncover the latent topics within the posts shared by users on the MyLVAD.com website. METHODS: Using the latent Dirichlet allocation algorithm and a visualization tool, our objective was to uncover latent topics within the posts shared on the MyLVAD.com website. Through the application of topic modeling techniques, we analyzed 459 posts authored by recipients of LVAD and their family members from 2015 to 2023. RESULTS: This study unveiled 5 prominent themes of concern among patients with LVAD and their family members. These themes included family support (39.5% weight value), encompassing subthemes such as family caregiving roles and emotional or practical support; clothing (23.9% weight value), with subthemes related to comfort, normalcy, and functionality; infection (18.2% weight value), covering driveline infections, prevention, and care; power (12% weight value), involving challenges associated with power dependency; and self-care maintenance, monitoring, and management (6.3% weight value), which included subthemes such as blood tests, monitoring, alarms, and device management. CONCLUSIONS: These findings contribute to a better understanding of the experiences and needs of patients implanted with LVAD, providing valuable insights for health care professionals to offer tailored support and care. By using latent Dirichlet allocation to analyze posts from the MyLVAD.com forum, this study sheds light on key topics discussed by users, facilitating improved patient care and enhanced patient-provider communication.

Factors that influence medication adherence in women with fibromyalgia: A path analysis.

AIMS: To investigate the relationships between depression symptoms, perceived stigma, disease severity, patient-provider communication and medication adherence in fibromyalgia patients. The objectives were to explore how these factors influence treatment adherence and to develop a comprehensive model illustrating their interconnections. BACKGROUND: Fibromyalgia is a chronic pain syndrome with fatigue, sleep issues and idiopathic pain. Medication adherence is limited by insufficient symptom relief, side effects and costs. Stigma further complicates fibromyalgia. Disease severity affects patient-provider communication. Associations between depression, stigma, severity, communication and adherence in fibromyalgia are unclear. DESIGN: A cross-sectional, correlational study. METHODS: The STROBE guidelines for cross-sectional studies were followed. Participants included Hebrew-speaking participants who were members of two Facebook groups: 'Shades of Purple' and 'Fibromyalgia- Get to Know!' Between February and April 2022. They undertook evaluations using The Patient Health Questionnaire-9 to gauge depression symptoms, assessed perceived stigma, utilised The Revised Fibromyalgia Impact Questionnaire to determine disease severity, employed The Patient Reaction Assessment questionnaire for patient-provider communication, and used the 8-item Morisky Medication Adherence Scale (MMAS-8). Associations between the variables were explored using Pearson's correlations and path analyses. RESULTS: The study included 141 women with fibromyalgia, aged 22 to 76 years. Most reported having a stable partner (69.5%) and 75.2% had children. The treatment adherence levels were as follows: 53.2% (N = 75)-low, 33.3% (N = 47)-medium and 13.5% (N = 19)-high. Depression positively correlated with stigma. Stigma negatively correlated with patient-provider communication. Patient-provider communication positively correlated with treatment adherence. A significant negative indirect effect of depression on treatment adherence through stigma and patient-provider communication was found. CONCLUSIONS: Perceived stigma and patient-provider communication played a mediating role in the relationships between depression and treatment adherence among women with fibromyalgia. RELEVANCE TO CLINICAL PRACTICE: Addressing stigma related to fibromyalgia and effective patient-provider communication can positively influence treatment adherence. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Factors affecting caregiver burden among parents of children with cancer: A path analysis.

AIMS: To investigate the relationships between parental resilience, illness perception and pain catastrophizing as factors affecting caregiver burden among parents of children with cancer, based on the Transactional Model of Stress and Coping. BACKGROUND: Parents, as the primary caregivers of children with cancer, often face universal challenges. These include adverse health impacts, work, financial disruptions, strained social and family relationships, and the need for specialised support and intervention. DESIGN: A cross-sectional design using path analysis. METHODS: The STROBE guidelines for cross-sectional studies were followed. An online questionnaire was distributed through Facebook pages operated by various organisations that support parents of children with cancer, such as 'The Israel Cancer Association', 'Giving Hope' and 'Hayim Association' from October 2021 to February 2022. The participants completed a questionnaire about demographic and child-related characteristics, resilience, illness perception, pain catastrophizing, social support and caregiver burden. Associations between the variables were explored using Pearson's correlations and path analyses. RESULTS: The study included 67 parents of children with cancer with an average age of 41.79 (SD = 6.31). The majority were mothers (n = 54, 80.6%) with a steady partner (n = 62, 92.5%). The level of caregiver burden was M (SD) = 25.00 (7.15) out of 48 possible, indicating a high burden level. Illness perception was directly positively associated with caregiver burden (ß = .280, p = .017) and pain catastrophizing (ß = .340, p < .01), and directly negatively with resilience (ß = -.318, p < .01). Illness perception and pain catastrophizing serially mediated the relationship between resilience and caregiver burden among parents of children with cancer (ß = -.190, p = .001). CONCLUSIONS: This study found that both illness perception and pain catastrophizing serially mediated the relationship between personal resilience and caregiver burden. RELEVANCE TO CLINICAL PRACTICE: To ease caregiver burden for parents of children with cancer, programmes should address their psychological and emotional needs, including managing perceptions of illness and coping with pain-related distress.

Development and validation of the novel nursing activities in the care of extracorporeal membrane oxygenation-supported patients scale.

BACKGROUND: Nurses are members of multidisciplinary teams providing care to extracorporeal membrane oxygenation-supported patients (ECMO-SP). There are no valid and reliable measurements available to assess nursing activities in the care of ECMO-SP. AIM: To develop and evaluate psychometric properties of a new 27-item nursing activities in the care of ECMO-SP scale. STUDY DESIGN: A convenience sample was recruited of 76 registered nurses (mean age 41.3 ± 8.7; 71% female) in Israel. The nurses participated in an online survey with software Qualtrics, between March and June 2022. Content and construct validity, as well as internal consistency of the scale were evaluated. The participants also completed the perceived knowledge and skills in the treatment of ECMO-SP scale. The correlations between nursing activities in the care of ECMO-SP and ECMO knowledge were examined using Pearson's correlation. RESULTS: Exploratory factor analysis extracted four factors, and seven items were excluded from the 27-item scale making it a 20-item scale in its final form. Internal consistency was acceptable for the total scale (α = 0.84) and the four subscales: Factor 1: Nursing care of ECMO-SP not related to the ECMO device (α = 0.90), Factor 2: Activities on ECMO device in emergency (α = 0.82), Factor 3: ECMO device calibrating and monitoring (α = 0.72), and Factor 4: Medication and blood administration through ECMO device (α = 0.73). When examined in confirmatory factor analysis, the 20-item scale yielded acceptable fit indices. A positive correlation was found between perceived ECMO knowledge and all four factors of the nursing activities in the Care of ECMO-SP scale. CONCLUSIONS: The 20-item scale examining nursing activities in the care of ECMO-SP is ready for use for clinical, educational, and research purposes. RELEVANCE TO CLINICAL PRACTICE: Because there are still no standards for nursing care of ECMO-SP and no agreed quality indicators, this novel scale may help in building such standards and quality indicators.

Factors affecting how parents cope with their preterm infant's pain: A cross-sectional study.

AIMS AND OBJECTIVES: This study examined the relationships between parents' catastrophising about their infants' pain, parental self-efficacy in the management of their infants' pain, perceived social support and the parental coping strategies for their infants' pain-related stress. BACKGROUND: Preterm infants hospitalised in the neonatal intensive care unit experience painful procedures causing stress to their parents. Coping with stress may be emotion- or problem-focused. Adults' coping with their own pain has been associated with pain catastrophising, pain management self-efficacy and social support. However, little is known about the associations between parents' catastrophising, their self-efficacy to manage, their perceived social support and their coping strategies when dealing with their infants' pain. DESIGN: This was a cross-sectional, correlational study design. METHODS: The STROBE guidelines for cross-sectional studies were followed. Participants included 149 parents of preterm infants hospitalised in a neonatal intensive care unit. They completed measures to assess infant pain catastrophising, self-efficacy regarding infant pain management, social support and emotion- and problem-focused coping. RESULTS: Positive associations were found between parental self-efficacy regarding infant pain management, social support, parental catastrophising about their infants' pain and problem-focused coping. Parental catastrophising was positively associated with emotion-focused coping. Gender moderated the relationships between parental self-efficacy regarding infant pain management and emotion-focused coping. Specifically, amongst mothers, the higher their level of self-efficacy, the lower their emotion-focused coping. Amongst fathers, the relations were reversed. CONCLUSIONS: Parents coping with their preterm infants' pain were associated with catastrophising about their infants' pain, self-efficacy regarding infant pain management and social support. Mothers had different ways to cope emotionally to that of fathers in relation to their self-efficacy in managing their infants' pain. RELEVANCE TO CLINICAL PRACTICE: Nursing interventions that provide support to parents and promote parental self-efficacy in managing their infants' pain may allow parents to more effectively cope with their infants' pain. PATIENT OR PUBLIC CONTRIBUTION: Patients or public were not involved in setting the research question, the outcome measures and the design or implementation of the study. Parents of preterm infants answered the research questionnaires.

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.

Factors affecting the professional functioning of health care workers during the COVID-19 pandemic: A cross-sectional study.

AIM: To examine personal and organisational factors related to professional functioning of nurses and physicians during the COVID-19 pandemic. BACKGROUND: Exposure to COVID-19-related stressors has been associated with lower self-reported professional functioning among health care workers. METHODS: A cross-sectional study among 115 hospital workers during the COVID-19 pandemic in Israel was designed to explore (a) personal professional functioning, (b) clarity of guidelines, (c) work organisation by the management, and (d) health care workers' feeling of contribution to a global effort. RESULTS: A feeling of contribution to a global effort while treating patients with COVID-19 mediated the relationships between work organisation by the management and professional functioning (ß = .05, p < .05). The clarity of guidelines for routine procedures (ß = .21, p < .05) and a feeling of ß contribution to a global effort (ß = .34, p < .01) positively predicted professional functioning of nurses and physicians during COVID-19 pandemic (R2 = .19, p < .01). CONCLUSIONS: In order to achieve optimal functioning of health care workers in an emergency, managers should provide clear guidelines and promote workers' feelings of contribution to a global effort. IMPLICATIONS FOR NURSING MANAGEMENT: The provision of clear guidelines and protocols is essential for efficient emergency management. Expressing appreciation for health care workers and providing positive feedback may improve professional functioning.

Nurses as 'second victims' to their patients' suicidal attempts: A mixed-method study.

AIMS AND OBJECTIVES: To understand the effects of patients' suicidal attempts and events on nurses' second victim symptoms and to explore the association between these experiences and nurse absenteeism and turnover. BACKGROUND: The term 'second victim' is when a healthcare professional expresses psychological symptom following adverse patient event. This has been previously shown to be associated with absenteeism and higher staff turnover. DESIGN: A mixed-methods study with a sequential exploratory approach. METHODS: A qualitative approach was used for nurses to relate their experiences of their patients' suicidal attempts. A cross-sectional quantitative study was conducted in 150 nurses who worked in internal departments. The Second Victim Experience and Support Tool was used to substantiate and measure second victim related distress of nurses who treated suicidal patients. The qualitative data were analysed by a constant comparative analysis method. The analytic analysis of the quantitative study included Pearson's correlations and hierarchical linear regression model to assess the explanatory variables to absenteeism and staff turnover. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies. RESULTS: The qualitative part identified three themes and nine sub-themes, including the new variable 'sense of being alone'. The quantitative part of the study found that nurses expressed a medium level of second victim related distress. After controlling for demographic variables, second victim distress and the sense of being alone following patients' suicidal events may explain nurse absenteeism and turnover. CONCLUSIONS: Nurses who experience suicidal attempts of their patients react as second victims. These symptoms lead to nurse absenteeism and turnover. RELEVANCE TO CLINICAL PRACTICE: Nurses who experience suicidal attempts of their patients need treatment and support as second victims, the same as in any other medical adverse event. The nursing leadership should emotionally support these nurses and prevent consequential staff organisational problems.

The effect of attitudes, subjective norms and stigma on health-care providers' intention to recommend medicinal cannabis to patients.

AIM: The aim of this study was to explore the effect of health-care providers' attitudes towards the medical use of cannabis, subjective norms and perceived stigma towards medicinal cannabis users on health-care providers' intention to recommend medicinal cannabis for patients with qualifying conditions. METHODS: A cross-sectional correlational study included 221 health-care providers (mean age, 42.2 ± 11.2; 74.2% women and 76.5% nurses) who completed a questionnaire examining theory-based variables and stigma towards medicinal cannabis users. RESULTS: More positive attitudes towards the medical use of cannabis were associated with lower stigma towards medicinal cannabis users, which, in turn, was associated with a higher intention of recommending medicinal cannabis for patients with qualifying conditions. The relationship between attitudes towards the medical use of cannabis and the intention to recommend medicinal cannabis varies according to subjective norms. CONCLUSIONS: Among nurses and physicians, stigma towards medicinal cannabis users mediated the relationship between attitudes towards the medical use of cannabis and the intention to recommend medicinal cannabis for patients with qualifying conditions, whereas subjective norms moderated this relationship. Effective treatment with medicinal cannabis might be compromised by health-care providers' negative attitudes, stigma and subjective norms.

Modern problems of youth extremism: Social and psychological components.

Nowadays, the global community is confronted by an acute problem of extremism associated with the growing intolerance, aggression and hostility of modern society. The ways extremism manifests among youth, who is perceptive and sensitive to extremism due to age peculiarities, are understudied. The purpose of the study is to identify psychological characteristics, which are preconditions and elements of extremism among young people. The research methods are theoretical and methodological analysis, survey methods, methods of mathematical and statistical data processing. Illegal behaviour, a propensity to take risks appeared to be the prerequisites for display of extremist elements among full-time young employees. The research results can be used for scientific and methodologically assurance of psychological and pedagogic support of students, tactics to prevent extremism among young people.

Depression and Anxiety Moderate the Relationship Between Body Image and Personal Well-being Among Patients With an Implanted Left Ventricular Assist Device.

BACKGROUND: Left ventricular assist devices (LVADs) support the diseased heart of patients with advanced heart failure and are used as a bridge to heart transplantation or as destination therapy for patients ineligible for heart transplantation. Body image changes, as well as anxiety and depression, are prevalent among patients with an implanted LVAD. OBJECTIVE: The aim of this study was to investigate whether a relationship exists between body image and personal well-being among patients with an implanted LVAD and, if it does, whether it is moderated by anxiety and depression. METHODS: In this cross-sectional correlational study, a convenience sample of 30 adult patients with an implanted LVAD (mean age, 63 ± 10; 90% male) from the outpatient facility of a tertiary medical center completed validated instruments including the Body Image Scale, Cosmetic Scale, Hospital Anxiety and Depression Scale, and Personal Well-being Index, from October 2017 to February 2018. Results were subjected to multivariate linear regression and bootstrap moderation analyses. RESULTS: Eleven patients (37%) had below-average personal well-being scores, and 14 patients (47%) had below-average body image scores. Seven (23%) had either anxiety or depression, and 11 (37%) had both anxiety and depression. Body image was found to be a significant predictor of personal well-being (t = 2.16, P = .04). When anxiety and depression were present, body image (t = 2.08, P = .049), depression (t = 2.53, P = .018), and the interaction between body image and depression (t = -2.1, P = .047) were significantly associated with personal well-being. CONCLUSIONS: Body image significantly predicted personal well-being among patients with an implanted LVAD. Depression alone, or depression combined with anxiety, moderated the relationships between body image and personal well-being. The current results may help to heighten healthcare providers' awareness of body image perception among patients with an implanted LVAD.

Nurses' perceptions of pain management adequacy in mechanically ventilated patients.

AIMS AND OBJECTIVES: To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. BACKGROUND: Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. DESIGN: The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. METHODS: A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February-May 2015. The "STROBE" EQUATOR checklist was used. RESULTS: Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. CONCLUSION: Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. RELEVANCE TO CLINICAL PRACTICE: Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.

Experiences, behaviors, and perceptions of registered nurses regarding research ethics and misconduct.

BACKGROUND: Nurses engaging in research are held to research ethics standards. RESEARCH AIM: Examine experiences, behaviors, and perceptions of nurses in Israel regarding research ethics and explore possible related factors. RESEARCH DESIGN: An original investigator-designed self-administered questionnaire measured five variables: (a) ethics in research, (b) encountered research misconduct during the course of one's studies, (c) the inclination to fabricate data, (d) the inclination to select or omit data, and (e) knowledge of research misconduct in the workplace. Additionally, demographic data were collected. PARTICIPANTS AND RESEARCH CONTEXT: The questionnaire was completed by 151 Israeli registered nurses. 10.2% hold a PhD, 34 % hold an MA, 42.2% hold a BA, and 13.6% with no academic degree. ETHICAL CONSIDERATIONS: The study was approved by the University's ethics committee; anonymity and consent of the respondents were respected. FINDINGS: Registered nurses' level of studies achieved was significantly associated with a lower inclination to fabricate data, with one exception-PhD nurses were more inclined to fabricate data than nurses with a Master's degree. A trend was found in which a higher level of studies is associated with higher knowledge of research misconduct in the workplace. DISCUSSION: Results indicate that nurses' perceptions of research ethics change throughout their academic studies, indicating a positive influence of level of studies, research experience, and work experience on ethics perceptions. Nevertheless, PhD nurses showed a greater inclination to actually select, omit, or even fabricate data than MA nurses. This may be related to pressure to publish. CONCLUSION: PhD nursing programs should include ethics training. Academic faculty members should serve as role models regarding research integrity. Research ethics deserves further emphasis on all levels of nurse education in Israel, as well as in the nurses' code of ethics and related documents. This may positively impact ethical research practices.

To command is to serve: Senior leadership and policy-making predict hospital ward functioning in emergency.

AIM: To examine personal, ward and organisational factors related to the functioning of general hospital staff under missile attack. BACKGROUND: The summer of 2014 is remembered in Israel for missile attacks from the Gaza Strip targeting the civilian population of southern Israel. METHODS: The study was carried out in two steps: (1) Qualitative-a focus group to identify the issues faced by the staff of a hospital under fire, (2) Quantitative-a cross-sectional study among 409 hospital workers to explore: (a) personal involvement in decision-making, (b) clarity of directives, (c) coping with emergency on the ward and on (d) the management level, (e) personal professional functioning. RESULTS: A statistically significant positive correlation was found between personal involvement in decision- and policy-making, the clarity of directives and hospital ward functioning. A regression analysis demonstrated that executive management and leadership, clarity of directives and workers' personal functioning statistically significantly explained 46.1% (R2  = 0.461) of the variance in ward functioning during emergency. CONCLUSION: Clarity of directives and executive management and leadership in emergency were positively associated with ward functioning and coping with emergency. IMPLICATIONS FOR NURSING MANAGEMENT: To ensure proper hospital functioning during emergency, managers must demonstrate personal involvement and leadership, providing clear directives.

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.

The effect of working in an infection isolation room on hospital nurses' job satisfaction.

AIMS: To examine how the nature of working in a carbapenemase-producing Klebsiella pneumoniae infection isolation room affects nurses' job performance and job satisfaction. BACKGROUND: Job satisfaction is under intensive research as a factor in the retention of nursing staff. METHODS: In a cross-sectional design study, a convenience sample of 87 registered nurses who had worked in carbapenemase-producing Klebsiella pneumoniae isolation rooms in a tertiary medical centre in Israel answered a self-administered questionnaire. Data were analysed by descriptive statistics, Pearson correlation coefficients, t tests, one-way ANOVA and multiple regression analysis. RESULTS: Job satisfaction was significantly correlated with perceived knowledge of carbapenemase-producing Klebsiella pneumoniae, with personal experience of working in an isolation room and the perceived level of professional functioning. Multiple regression analysis found that the quality of the nurses' personal experience of isolation room work and their perceived level of professional functioning there explained 33% of the variance in job satisfaction. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: Managers need to take into account that prolonged work in isolation can negatively impinge upon both performance and job satisfaction. Managers can consider refraining from lengthy nurse assignment to the isolation room. This would also apply to other areas of nursing practice where work is performed in isolation.

Feelings of indebtedness and guilt toward donor and immunosuppressive medication adherence among heart transplant (HTx) patients, as assessed in a cross-sectional study with the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS).

BACKGROUND: Nonadherence (NA) to immunosuppressive (IS) medications after organ transplant is a major risk factor for transplant failure, morbidity, and treatment costs. This study examined the association between feelings of indebtedness and guilt toward the donor, and IS medication adherence among HTx patients. METHODS: In this cross-sectional, descriptive, correlational study, a convenience sample of 102 HTx patients, from the outpatient facility of a tertiary medical center in Israel, completed the BAASIS, a validated instrument for assessing adherence, and reported their feelings of indebtedness and guilt toward the donor. RESULTS: Missing a dose or skipping two or more doses, taking medication >2 hours before or after the recommended dosing time, altering the prescribed amount, or completely stopping the IS treatment in the last 4 weeks, characterized 64 patients (64%). The highest score received the item "timing nonadherence," characterizing 58 patients (56.9%). Age, waiting time, and time since transplant, guilt feelings, and indebtedness to donor explained 17% (R2 =.17) of the variance in adherence (χ2(5) =13.22, P=.021), with age, time since transplant, and guilt feelings significantly explaining adherence. CONCLUSION: Physicians and nurses should inquire about the presence of guilt feelings, as they might be associated with NA to medications after HTx.

Transcendental Spirituality and Acquaintance With the Activities of the Domestic National Transplant Center as Factors Shaping Attitudes Toward Organ Donation.

CONTEXT: Organ donation has been shown to be perceived as inappropriate by religiously observant individuals. The impact of spirituality level on attitudes toward organ donation has not been broadly explored. OBJECTIVE: To explore the contribution of ethnicity, spirituality, level of religious observance, and acquaintance with the activities of the Israel National Transplant Center (INTC) to forming attitudes toward organ donation among Jews and Muslim Arabs in Israel. DESIGN: A descriptive cross-sectional survey. PARTICIPANTS: Three hundred five (65.2%) Jewish and 163 (34.8%) Muslim Arab respondents living in Israel. RESULTS: Jewish respondents had more positive attitudes toward organ donation than Muslim Arabs. Muslim Arabs had a higher mean spirituality score than Jews. Gender, age, ethnicity, level of religious observance, education, 4 spirituality dimensions, and acquaintance with the activities of the INTC explained 41.5% of the variance in attitudes to organ donation. Transcendental spirituality, acquaintance with the activities of the INTC, and level of religious observance had the highest contribution to explaining attitudes to organ donation, while gender and age had a low contribution. Ethnicity, education, and the 3 other spirituality dimensions were not found to have a significant contribution. CONCLUSION: A multifaceted approach to improving attitudes toward organ donation among Jews and Muslim Arabs in Israel is important.

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.