Nursing perceptions of patient safety climate in the Gaza Strip, Palestine.

AIMS: This study was undertaken to assess the perception of nurses about patient safety culture and to test whether it is significantly affected by the nurses' position, age, experience and working hours. BACKGROUND: Patient safety has sparked the interest of healthcare mangers, yet there is limited knowledge about the current patient safety culture among nurses in the Gaza Strip. METHODS: This was a descriptive cross-sectional study, administering the Arabic Safety Attitude Questionnaire (Short Form 2006) to 210 nurses in four public general hospitals. RESULTS: Job Satisfaction was the most highly perceived factor affecting patient safety, followed by Perception of Management. Safety culture varied across nursing position, age, work experience and working hours. Nurse Managers had more positive attitudes towards patients than frontline clinicians did. The more experience nurses had, the better their attitudes towards patient safety. Nurses who worked the minimum weekly required hours and who were 35 years and older had better attitudes towards all patient safety dimensions except for Stress Recognition. Nurses with a positive attitude had better collaboration with healthcare professionals than those without a positive attitude. LIMITATION: Generalization is limited, as nurses who worked in private and specialized hospitals were excluded. CONCLUSION: Evaluation of the safety culture is the essential starting point to identify hindrances or drivers for safe patient care. Job Satisfaction, Perception of Management and Teamwork necessitate reinforcement, while Working Conditions, Stress Recognition and Safety Climate require improvement. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Ensuring job satisfaction through adequate staffing levels, providing incentives and maintaining a collegial environment require both strategic planning and institutional policies at the higher administrative level. Creation of a non-punitive and learning environment, promoting open communication and fostering continuous education should be fundamental aspects of hospital management. A policy of mixing experienced nurses with inexperienced nurses should be considered.

Risk factors of gestational diabetes mellitus in the refugee population in Gaza Strip: a case-control study.

To determine the risk factors of gestational diabetes mellitus in refugee populations in the Gaza Strip, a retrospective case-control study was performed between March and June 2011 in the United Nations Relief and Works Agency (UNRWA) primary health care clinics. Data were collected on maternal sociodemographics and the prevalence of diagnosed GDM according to World Health Organization criteria from clinics where postnatal Palestinian refugee women had been diagnosed with GDM during previous pregnancies, and non-GDM women were used as controls. Sociodemographic characteristics, pre-pregnancy body-mass index (BMI), obstetrics history and family history of diabetes were used as study variables. In total, 189 incident cases of GDM were identified. The most significant risk factors for GDM were: history of miscarriage more than once; overweight before pregnancy; history of stillbirth; history of caesarean birth; and positive family history of diabetes mellitus.

The association of psychological stress and health related quality of life among patients with stroke and hypertension in Gaza Strip.

BACKGROUND: The study was performed to investigate the association of psychological stress and quality of life (QOL) among patients with the cardiovascular disease (CVD) of hypertension plus stroke or hypertension only. METHODS: The WHOQOL-BREF questionnaire was applied to 112 hypertensive patients with hypertension plus stroke and 224 hypertensive patients without stroke. Psychological stress was assessed with SCL-90. Means scale scores were compared using student-t-test and predictors of QOL were calculated with covariance analysis. RESULTS: Patients with stroke had a significant lower QOL than patients without stroke and a significantly higher level of stress (p < 0.01). In analyses of covariance psychological stress was significantly correlated to all domains of QOL among non-stroke patients. The same psychological and sociodemographic factors showed little impact on the stroke patients in these multivariable analyses. In these models psychological stress had a significant impact on the global domain of QOL among stroke patients. Income and gender were the only sociodemographic factors being significantly associated with the physical (education) and social (gender) domains of QOL in stroke patients. CONCLUSION: Psychological stress was strongly correlated with all domains of QOL in patients without stroke and was only partly associated with QOL among patients with stroke. Future studies should investigate if psychological stress is a factor suitable for educational and psychological interventions aiming at stress reduction in CVD patients which might substantially contribute to better health related quality of life in these patients.

Factors of non-compliance with the therapeutic regimen among hypertensive men and women: a case-control study to investigate risk factors of stroke.

To identify potential risk factors among the therapeutic regimen and life style which may increase the risk for stroke, a pair matched case-control study was conducted in Gaza Strip among 112 patients, who had been hospitalized for acute stroke and history of hypertension, and 224 controls with history of hypertension. Conditional logistic regression models show significant associations between stroke and medication not taking as prescribed (OR = 6.07; 95% CI: 1.53, 24.07), using excessive salt at meals (OR = 4.51; 95% CI: 2.05, 9.90), eating diet high in fat (OR = 4.67; 95% CI: 2.09, 10.40), and high level of stress (OR = 2.77; 95% CI: 1.43, 5.38). No significant association between smoking and the development of stroke (OR = 2.12; 95% CI: 0.82, 5.51) was found. Regular physical exercise was a protective factor (OR=0.26; 95% CI: 0.12, 0.57). Using excessive salt at meals was a significant risk factor (OR = 16.61; 95% CI: 4.40, 62.80) in people having low level of stress, whereas it was not significant in people having high level of stress. (OR = 1.76; 95% CI: 0.58, 5.33). Smoking in combination with low level of stress was a significant risk factor for stroke (OR = 9.88; 95% CI: 2.52, 38.78), but a non-significant protective factor in combination with high level of stress (OR=0.52; 95% CI: 0.14, 1.99). An increase in compliance with the pharmacological and non-pharmacological therapeutic regimen might be a key to a reduction of stroke incidence and prevalence among hypertensive patients.

[Is pain a clinically relevant problem in general adult psychiatry? A clinical epidemiological cross-sectional study in patients with psychiatric disorders]. / Sind Schmerzen ein klinisch relevantes Problem in der Allgemeinpsychiatrie? Eine klinisch-epidemiologische Querschnittstudie bei Patienten mit psychischen Störungen.

OBJECTIVE: To study the prevalence of pain and risk factors for pain in psychiatric patients in a psychiatric hospital. METHODS: Using a questionnaire we investigated in a cross-sectional study the prevalence of pain, duration of pain, impairment and unfitness for work due to pain in 106 patients primarily diagnosed with a psychiatric disorder in the field of general adult psychiatry. Potential risk factors were explored. RESULTS: The point prevalence of pain was about 50%, the 6-month prevalence 75.5% and the 12-month prevalence 76.5%. The patients' most frequent complaints were low back pain, headache and shoulder and neck pain. Patients with affective disorders most frequently had pain complaints, followed by those with neurotic, stress-related and somatoform disorders and those with psychotic disorders such as schizophrenia, schizotypic and delusional disorders. Almost 10% of all patients reported pain continuing at least 3 months in the past year. Impairment and unfitness for work were related to specific psychiatric diagnosis. Statistically significant risk factors for pain were depression (OR=6.05) and the number of past admissions to psychiatric hospitals (OR=3.609). CONCLUSION: We found evidence that pain can be a significant clinical problem in psychiatric patients which seems to be underestimated in psychiatry. The investigated patients in general adult psychiatry are characterized by specific risk factors different from clinical subpopulations of other disciplines.