Family adaptation in families of individuals with Down syndrome from 12 countries.

Our current understanding of adaptation in families of individuals with Down syndrome (DS) is based primarily on findings from studies focused on participants from a single country. Guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, the purpose of this cross-country investigation, which is part of a larger, mixed methods study, was twofold: (1) to compare family adaptation in 12 countries, and (2) to examine the relationships between family variables and family adaptation. The focus of this study is data collected in the 12 countries where at least 30 parents completed the survey. Descriptive statistics were generated, and mean family adaptation was modeled in terms of each predictor independently, controlling for an effect on covariates. A parsimonious composite model for mean family adaptation was adaptively generated. While there were cross-country differences, standardized family adaptation mean scores fell within the average range for all 12 countries. Key components of the guiding framework (i.e., family demands, family appraisal, family resources, and family problem-solving communication) were important predictors of family adaptation. More cross-country studies, as well as longitudinal studies, are needed to fully understand how culture and social determinants of health influence family adaptation in families of individuals with DS.

"God gave you a special child because you are special": difficulties, coping strategies, and parental burnout of Jewish mothers - a qualitative study.

Background: "Parental Burnout" is a specific syndrome resulting from an imbalance between continuous exposure to chronic parenting stress and available protective resources. Mothers of children with special needs have an increased risk of Parental Burnout due to dealing with various difficulties from carrying out long-term childcare. Purpose: To examine difficulties, coping strategies, and PB (risk factors and protective resources), among ultra-Orthodox and non-Orthodox Jewish mothers of children with special needs with high or low levels of Parental Burnout. Methods: A qualitative study. Twelve mothers of children with special needs identified with high or low Parental Burnout via a quantitative study were interviewed. The constant-comparative analysis method was used to analyze the findings. Findings: Three themes and twelve categories emerged: 1. Difficulties involved in motherhood with six categories: (a) caregiver burden, (b) task overload, (c) physical and mental self-neglect, (d) environmental, couple-hood, family and social neglect, (e) recognizing the gap between their child with special needs and other children of the same age, (f) the environment's contradictory expectations from the mother; 2. Coping strategies with four categories: (a) practical, (b) spiritual, (c) social and (d) emotional; and 3. Parental Burnout, consequences and coping with two categories: (a) personal and environmental risk factors (e.g., fear of the future, difficulty in trusting others in taking care of their child), and (b) personal and environmental protective resources (e.g., sharing similar circumstances with other mothers, a belief in God). Conclusions and implications: The findings contribute to understanding the unique difficulties, coping strategies and differences in risk factors and protective resources of Parental Burnout among ultra-Orthodox and non-Orthodox Jewish mothers of children with special needs. In order to alleviate the difficulties experienced by mothers and thus also reduce Parental Burnout risk factors and provide effective protective resources, it is recommended to develop empirically based professional guidance for policymakers, child development specialists, nurses, physiotherapists, and informal caregivers.

Nursing students' experiences of unprofessional behaviours and associations with guideline compliance: A multicenter survey.

AIMS: To assess the reported prevalence of unprofessional behaviours, including incivility and bullying, experienced by nursing students during their clinical practice. To assess the prevalence of students' abilities to speak up about unprofessional behaviours encountered and infection control concerns; their compliance with standard precautions and COVID-19 guidelines; and their perceived responsibility for infection prevention. Lastly, to describe the potential impact of unprofessional behaviour on compliance with these guidelines. BACKGROUND: Unprofessional behaviours in healthcare settings are associated with a wide range of individual and organisational negative outcomes for nurses and nursing students, which may affect patient safety. The COVID-19 pandemic created new challenges for clinical education and for infection control. DESIGN: A descriptive cross-sectional design. METHODS: A multi-centre survey was carried out in six academic universities and colleges in Israel. The research study involved 369 undergraduate nursing students during 2022. Their clinical experiences were assessed using an online questionnaire. The STROBE guideline was used for accurate reporting. RESULTS: 301 (81.6%) students reported experience of unprofessional behaviour while undertaking clinical practice. Students with reported skills to speak up about unprofessional behaviour were less likely to report having experienced these behaviours (p = 0.003). Students who did not experience unprofessional behaviours were more likely to report higher compliance with standard and COVID-19 precaution guidelines (OR 3.624, 95% CI 1.790-7.335, p < 0.001). These students also had a higher perception of personal responsibility toward patient safety (OR 1.757, 95% CI 1.215-2.541, p = 0.003). CONCLUSIONS: Nursing students experiencing unprofessional behaviours in the clinical setting reported lower compliance with standard and COVID-19 precautions. In addition, cultivating personal responsibility towards patients' safety may have a positive impact on guidelines compliance. Nursing educators and leaders should develop strategies to enable students to better cope with unprofessional behaviours. Closer cooperation between all stakeholders may promote civility among nurses and nursing students in the clinical setting.

Privacy and utility of genetic testing in families with hereditary cancer syndromes living in three countries: the international cascade genetic screening experience.

Background: Hereditary breast and ovarian cancer and Lynch syndrome are associated with increased lifetime risk for common cancers. Offering cascade genetic testing to cancer-free relatives of individuals with HBOC or LS is a public health intervention for cancer prevention. Yet, little is known about the utility and value of information gained from cascade testing. This paper discusses ELSI encountered during the implementation of cascade testing in three countries with national healthcare systems: Switzerland, Korea, and Israel. Methods: A workshop presented at the 5th International ELSI Congress discussed implementation of cascade testing in the three countries based on exchange of data and experiences from the international CASCADE cohort. Results: Analyses focused on models of accessing genetic services (clinic-based versus population-based screening), and models of initiating cascade testing (patient-mediated dissemination versus provider-mediated dissemination of testing results to relatives). The legal framework of each country, organization of the healthcare system, and socio-cultural norms determined the utility and value of genetic information gained from cascade testing. Conclusion: The juxtaposition of individual versus public health interests generates significant ELSI controversies associated with cascade testing, which compromise access to genetic services and the utility and value of genetic information, despite national healthcare/universal coverage.

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

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

The role of motivation in the intention of nurse clinical instructors to persevere in their role: A cross-sectional study.

AIM: To examine factors related to clinical instructors' motivation to persevere in their role, such as motivation, benefits and support. BACKGROUND: Clinical nursing education is mainly based on acquiring hands-on training provided by clinical instructors in various health environments. In recent years the number of nursing students in Israel has increased, resulting in a shortage of clinical instructors. One of the reasons is that many clinical instructors do not persevere in their role for long. DESIGN: A quantitative cross-sectional study. METHODS: Participants included 176 licensed clinical instructors. Data were collected between January 2020 and March 2020 using an online questionnaire. The questionnaire included five parts: personal details, job benefits, perceived support, motivation for serving as a clinical instructor (autonomous motivation, controlled motivation and amotivation) and the intention to persevere as a clinical instructor. RESULTS: Findings showed clinical instructors' intention to persevere in their role was positively associated with the overall score for motivation, perceived support and job benefits and negatively associated with amotivation (defined as a state where people do not intend to perform a particular behavior or do not know why they are performing it). Two mediation models analyses indicated that autonomous motivation fully mediates the relationship between support and the intention to persevere as a clinical instructor and that amotivation partially mediates the relationship between job benefits and the intention to persevere as a clinical instructor. The findings also demonstrated a correlation between the nature of the benefits preferred by clinical instructors and their motivation to persevere in their role. CONCLUSIONS: Motivation plays an important role in the intentions of clinical instructors to persevere in their role. Providing clinical instructors with support from various resources and adjusting the benefits offered according to their needs may also raise their motivation to persevere in their role. Moreover, health managers and educators should pay attention to and follow the professional training and guidance processes of new and existing clinical instructors to establish and strengthen their internal motivation so that they continue willingly in their positions.

ACCESS: an empirically-based framework developed by the International Nursing CASCADE Consortium to address genomic disparities through the nursing workforce.

Introduction: Efforts are needed across disciplines to close disparities in genomic healthcare. Nurses are the most numerous trained healthcare professionals worldwide and can play a key role in addressing disparities across the continuum of care. ACCESS is an empirically-based theoretical framework to guide clinical practice in order to ameliorate genomic disparities. Methods: The framework was developed by the International Nursing CASCADE Consortium based on evidence collected between 2005 and 2023 from individuals and families of various ethnic backgrounds, with diverse hereditary conditions, and in different healthcare systems, i.e., Israel, Korea, Switzerland, and several U.S. States. The components of the framework were validated against published scientific literature. Results: ACCESS stands for Advocating, Coping, Communication, cascadE Screening, and Surveillance. Each component is demonstrated in concrete examples of clinical practice within the scope of the nursing profession related to genomic healthcare. Key outcomes include advocacy, active coping, intrafamilial communication, cascade screening, and lifelong surveillance. Advocacy entails timely identification of at-risk individuals, facilitating referrals to specialized services, and informed decision-making for testing. Active coping enhances lifelong adaptation and management of disease risk. Effective intrafamilial communication of predisposition to hereditary disease supports cascade testing of unaffected at-risk relatives. Lifelong surveillance is essential for identifying recurrence, changes in health status, and disease trajectory for life-threatening and for life-altering conditions. Discussion: ACCESS provides a standardized, systematic, situational, and unifying guide to practice and is applicable for nursing and for other healthcare professions. When appropriately enacted it will contribute towards equitable access to genomic resources and services.

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

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

Nursing students' emotional work and its consequences following encounters with e-patients who present reliable or unreliable information; a scenario based cross sectional survey.

BACKGROUND: Hochschild's theory of emotional work explains how people evoke or suppress emotions in order to adhere to social norms. An encounter with an e-patient who presents potentially unreliable medical information from the internet can lead to caregivers undergoing emotional work. This may have a negative impact on caregivers, such as mental exhaustion or professional dissatisfaction. OBJECTIVES: To examine nursing students' emotional work and its consequences following an encounter with e-patients who present new information from reliable or unreliable internet websites. DESIGN: A cross sectional study. SETTINGS: A large university in the center of Israel. PARTICIPANTS: 376 nursing students (230 Jewish, 146 Arab) of a 4-year BA program. METHODS: The study was scenario based describing an e-patient that presents information from a reliable/unreliable website. The students were asked about the emotions the situation evokes in them based on the Emotional Work Questionnaire. In addition, the questionnaire examined the emotional work techniques (surface versus deep acting) and the impact of emotional work on the students. RESULTS: Deep acting emotional work was the most used emotional work technique. Arab students performed more deep acting emotional work compared to Jewish students (F(1,360) = 12.57, p < 0.001). Deep acting emotion work mediated the relationship between ethnicity and the impact of emotion work ((LLCI (-0.1018), ULCI (-0.0199)). CONCLUSIONS: The training of nursing students should allow and encourage students' legitimacy to feel and express various emotions, even when they are contrary to expectations. Sharing others' (students', clinical instructors') feelings that arise in clinical situations is an essential aspect of clinical training. This training may lead to effective emotional management in different situations and allow students to receive help and support that will enable them to develop good coping skills during their studies which will benefit them later in their professional career.

Integrating Genomic Professional Skills Into Nursing Practice: Results From a Large Cohort of Israeli Nurses.

PURPOSE: To explore the association of genomic knowledge, self-epistemic authority (SEA; i.e., subjective perception of knowledge expertise), perceived importance of genomics in nursing, and the integration of genomic skills into nursing practice. DESIGN: A cross-sectional study of nurses working in pediatric, obstetric, and internal wards of two medical centers in Israel between February and October 2018. METHODS: Participants completed anonymous questionnaires about genomic knowledge, SEA, perceived importance of genomics, and the performance of genomic skills in nursing practice. Associations between variables were analyzed using Pearson correlations, and a hierarchical regression model was used to determine which variables explained the performance of genomic practices among participants. FINDINGS: Altogether 423 nurses participated in the study. The mean genomic knowledge was low (55.05 ± 14.82%). Nurses reported a low integration of genomic skills in their practice (M = 1.90, SD = 0.71), although their overall perceived importance of genomics was positive (M = 2.88, SD = 0.68). Positive correlations were found between SEA and the integration of genomic skills in nursing practice. Obstetric nurses had more genomic knowledge, more positive perceptions about genomics, and performed more genomic skills in their nursing practice. CONCLUSIONS: Although nurses realized the importance of genomics to their practice, and genomics is part of the Israeli nursing core curriculum, we found disappointingly low levels of knowledge and performance of genomic skills in nursing practice. CLINICAL RELEVANCE: The results call for action to establish ongoing education programs in genomics for nurses, which would lead to the inclusion of genomic skills into routine nursing practice, and prepare nurses for providing personalized medicine.

Assessment of the Intention to Use Mobile Health Applications Using a Technology Acceptance Model in an Israeli Adult Population.

Background: Mobile health applications (mHealth apps) have now gained global popularity. However, evaluating the level of their use over time still remains a pertinent challenge. According to the Technology Acceptance Model (TAM), perceived ease of use and usefulness predict attitudes toward technology utilization. Together, these factors serve as determinants of behavioral intention to use the technology, which in turn predicts actual use. Purpose: We sought to elucidate factors affecting behavioral intention to use mHealth apps in an Israeli adult population sample. Methods: A modified TAM Likert Scale questionnaire-based survey was offered to 200 participants, with 168 respondents. Results: Sixty one percent of participants reported using mHealth apps on their smartphones, 81% of whom used mHealth apps from health maintenance organization providers. Generation Y participants displayed more confidence with the use of mHealth apps, and were less concerned about compromising the confidentiality of their health records. Furthermore, answers to TAM-related questions among mHealth apps users were significantly more positive, compared with nonuser TAM components that accounted for 51% of the total variance in the intention to use mHealth apps. Discussion: TAM constructs were related to the behavioral intention to continue to use mHealth apps. Health organizations as providers of mHealth apps were strong determinants of their acceptance and utilization. Generational differences in user competence were observed; however, whether user experience or interface design represents the underlying differentials remains to be elucidated, and developers of health care-related mobile technologies will need to address this question.

Family Health Clinics as a Source of Social Capital.

PURPOSE: To examine the extent to which Family Health Clinics (FHCs) contribute to the formation of social capital among mothers, and determine whether it is influenced by socioeconomic factors. In FHCs, social capital can be gained by relationships between mothers (bonding social capital), by relationships between mothers and FHCs team, or between mothers of different origins/culture (bridging social capital) and health services institutional bodies (linking social capital). DESIGN: This is a mixed method study. For the quantitative part, data were collected from 673 mothers using a questionnaire. The qualitative part was conducted with six focus groups. RESULTS: The FHC constitutes a source of social capital in all dimensions. Bridging social capital was most prominent and is formed by interactions between mothers and FHC nurses. The factors that explain the formation of social capital were: mothers' spoken language being Arabic, participation in group training, and lower level of education. The focus groups revealed that participation in group training increased the social capital. Mothers noted that FHC nurses supplied updated information about their children's care. Regarding linking social capital, mothers perceive FHC nurses as mediators between them and the local and national health services. CONCLUSIONS: FHC clinics are a source for gaining social capital. The FHC services should be adapted to mother's needs. IMPLICATIONS: FHC nurses should try to create conditions for mothers to meet to create bonding social capital, relate to mother's needs for the creation of bridging social capital, and provide culturally adapted care for the formation of linking social capital.

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.

Role of Academic Self-efficacy and Social Support on Nursing Students' Test Anxiety.

Associations between test anxiety, academic self-efficacy (ASE), and social support through social media have not been fully explored. The purposes were to explore associations between test anxiety, ASE, and social support from social media and to examine differences in test anxiety by students' year of studies and cultural background. This study used a cross-sectional, descriptive design. The sample comprised first- and fourth-year nursing students (n = 240) attending a baccalaureate nursing program in Israel. Higher ASE and support through social media were related to lower test anxiety. Fourth-year students and Jewish students had higher ASE than first-year and Arab students, who received more support on social media than Jewish students. Developing learning strategies designed to increase students' ASE and reduce test anxiety is warranted. Social media as an educational tool can be adopted for this purpose.

The quality and safety culture in general hospitals: patients', physicians' and nurses' evaluation of its effect on patient satisfaction.

OBJECTIVE: To explore the disparities between patients' and health care workers' perception of the quality and safety culture and to explore the relationship between patient perceptions, and engagement in, and satisfaction with their care and treatment. DESIGN: A cross-sectional study was conducted in medical-surgical wards of four Israeli general hospitals. Data were collected using a self-administered questionnaire. SETTING: Fourteen medical-surgical wards of the four hospitals where data were collected. PARTICIPANTS: The sample comprised of 390 physicians and nurses and 726 inpatients admitted for at least 3 days. MAIN OUTCOME MEASURES: A self-administered questionnaire that covered the following topics: (i) quality and safety culture, (ii) patient engagement, (iii) patient satisfaction, (iv) an assessment of the care quality and safety in the ward and (v) sociodemographic data. The questionnaire was translated into Arabic and Russian. Sixty nine items were directed to the staff and 71 to patients. RESULTS: Patients evaluated the quality and safety culture significantly higher than did the health care workers. Significant correlations were found between patients' engagement in and satisfaction with their care and their quality and safety assessments. Their evaluation of this culture was the only predictor of their satisfaction and engagement. Arabic-speaking patients rated four variables, including patients' satisfaction with their care, lower than did Hebrew and Russian speakers. CONCLUSIONS: Patients have sufficient experience and understanding to form an opinion of the quality and safety of their care. The lower evaluation of the quality and safety culture expressed by health care workers might stem from their more realistic expectations.

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

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

Israeli E-patients' Informational Needs.

BACKGROUND: Online medical information has transformed the way patients obtain information. PURPOSE: The present study examined patients' informational needs and the patient- Healthcare Provider (HCP) relationship from the perceptions of both patients and HCP. METHODS: The study was a cross-sectional study; data were collected in Israel from100 HCPs (nurses and physicians) and 184 e-patients. FINDINGS: E-patients were comfortable sharing e-information with their HCP and expected them to consider the e-information in treatment decision-making. Physicians thought they provided more information than the patients considered that they received from them, while both nurses and patients were in agreement about their interactions. Patients thought that there was a higher concordance between the e-information and the information they received from the physician/nurse as compared to what physicians and nurses reported. DISCUSSION AND CONCLUSIONS: E-health information does not disrupt the patient-nurse/physician relationship. To promote compliance to treatment, it is important that HCPs consider information presented by patients when preparing the treatment plan.

Companions or patients? The impact of family presence in genetic consultations for inherited breast cancer: Relational autonomy in practice.

As in other areas of medical practice, relatives accompany patients to genetic consultations. However, unlike in other areas, the consultations may be relevant to the relatives' health because they may be at risk of developing the same genetic condition as the patient. The presence of relatives in genetic consultation may affect the decision-making process and it raises questions about the perception of patient autonomy and the way it is practiced in genetics. However, these issues have not been examined in previous empirical studies. This article aims to fill this gap by reporting findings from a qualitative study with clinicians working in the area of inherited breast cancer. The findings indicate that family presence has an impact on the patient's decisions to undergo genetic testing and preventative operations when she is diagnosed as a carrier. The findings further indicate that, unlike in other areas of medical practice, blood relatives who are present in consultations are perceived by clinicians as patients or potential patients, and this in turn increases their involvement in discussions in the consultation room. Finally, the findings indicate that in genetics, a relational approach to autonomy is applied. Decisions are made in a social context, where the relatives' views are heard and taken into account. The findings suggest that the conventional bioethical approach to autonomy, which perceives the decision-making unit as comprising a clinician and an individual patient, is challenged in genetics. The findings thus suggest that bioethicists, lawyers and policy-makers should consider whether this individualistic approach is still valid and applicable.

The associations between peer caring behaviors and social support to nurse students' caring perceptions.

Caring is seen as an essential part of nursing and as a desirable competency expected of nursing students. Yet, students have difficulties in understanding the meaning and practice of caring relationships. The aim of this study was to explore the relationship between perceived social support and peer caring behaviors to nurse students' caring perceptions. A cross-sectional study was conducted among first and fourth-year nursing students (n = 246) attending a Baccalaureate nursing education program at a major university in Israel. The findings revealed first-year students significantly received more social support from family and friends than fourth-year students. Moreover, first-year students reported an increase in the use of social support through social media platforms during their first semester of studies. Social support from family, peers and social media platforms was associated to caring perception. Fourth-year students scored higher than first-year students in their caring perceptions and peer caring behaviors. Educators should consider the growing potential role of social media technologies as an accessible source of social support and as a learning tool. Moreover, nurse educators should encourage the use and practice of peer caring behaviors among students as professional means of facilitating future caring relationships with patients and their families.