The psychosocial impact of quarantine due to exposure to COVID-19 among healthcare workers in Israel.

Quarantine is an essential practice during pandemics but it could have negative effects. There are currently no studies on the experiences of health care workers (HCWs) in quarantine during the coronavirus disease pandemic. The aim of this study was to assess the psychosocial effects of quarantine on tertiary hospital HCWs who were exposed to coronavirus. A cross-sectional study on the psychological wellbeing, needs and resources of HCWs during quarantine was conducted using an online survey in a large tertiary hospital. In total, 148 quarantined HCWs participated in this study. Overall self-reported psychological wellbeing scores were high (5.22 ± 1.11). Physicians had higher psychological wellbeing compared to nurses (5.58 ± 1.05 and 4.83 ± 1.21, respectively). Being a nurse, separation from family during quarantine, experiencing public shaming and longer quarantine period were associated with lower psychological wellbeing and higher needs. Working from home and confidence in safety at work was associated with fewer needs during quarantine. Nurses might be a risk group for the negative influences of quarantine. The ability to remain connected to work by working from home could have a protective effect on HCWs' psychological wellbeing. More efforts should be implemented in order to support HCWs in quarantine and after their return to work.

During the COVID-19 crisis, health care workers (HCWs) were at the frontline of this pandemic and therefore were exposed to its risks and negative impact. One of the challenges during this time was the frequent quarantines of HCWs as a result of their exposure to patients. Although quarantine is important to stop the infection, it may effect mental and physical health. This study examined HCWs' experience during quarantine, their well-being and ways of coping. We sent HCWs who are working in a tertiary hospital an online questionnaire and 148 replied. We found that the average well-being of HCWs in quarantine was high, with physicians having the highest reported well-being and nurses having the lowest. HCWs who reported low sense of well-being also reported on having more difficulties coping with the quarantine and reported more public shaming due to being in quarantine. We also found that HCWs who were working from home during quarantine and those who reported they felt safe in their place of work reported less difficulties coping with the quarantine. Our study suggests that nurses are more vulnerable to the negative impact of quarantine. It also suggests that being connected to work during quarantine can improve well-being. It is important to address stigma toward quarantined individuals and to provide more resources to support HCWs in quarantine and after their return to work.

Adapting a palliative care-focused cancer self- and family management intervention for use in Israel.

BACKGROUND: In Israel, there is a need to improve quality of life and health outcomes among patients and families facing cancer. Increasing awareness of, literacy about, and availability of palliative care may further this goal. AIMS: This study aimed to adapt a palliative care-focused cancer self- and family management intervention developed in the US for use in Israel. METHODS: The Managing Cancer Care (MCC) psycho-educational intervention is comprised of Managing Cancer Care: A Personal Guide (MCC-PT©) for patients and Managing Cancer Care: A Caregiver's Guide (MCC-CG©) for family caregivers. Following translation into Hebrew, an expert panel of Israeli nurses edited the MCC tool for cultural relevance. The authors then conducted qualitative interviews with patients with breast cancer and their family caregivers to obtain feedback. Data were analysed using qualitative content analysis. FINDINGS: Following recommendations from Israeli experts in oncology and/or palliative care (n=3), the authors revised intervention content specific to the US healthcare system and culture. Patients' (n=13) and family caregivers' (n=10) reported MCC as attractive (70%, 80%), topically relevant (80%, 70%), and culturally appropriate, but felt that palliative care resources should be more Israel-specific. CONCLUSION: The MCC tool is acceptable to potential users, warranting further pilot-testing.

Medical personnel knowledge and stigmatic attitude toward HIV patients in a high-income country.

Negative attitudes of health care workers (HCW) toward people living with HIV (PLWH) impact patients' care, quality-of-life, therapy adherence, and retention in care. Few publications address stigma and discrimination among HCWs in high income countries. This study aims to provide a better understanding of HCW knowledge and attitudes toward caring for PLWH, how this relates to discriminatory tendencies and professional contacts, and proposes effective strategies to reduce negative attitudes and stigmas among health care providers in a tertiary hospital in Israel. Of 321 health care personnel who responded to an electronic questionnaire, HCWs had a good level of general knowledge regarding HIV. A lack of knowledge was noted regarding antiretroviral therapy influences, HIV transmission from mother to child, and HIV risks and transmission. Cultural diversity was also noted. This study supports the need to implement a training program for HCWs on HIV-related stigma-reduction.

Nursing students' stress and satisfaction in clinical practice along different stages: A cross-sectional study.

BACKGROUND: Research in the field of nursing students' stress shifted internationally in recent decades from Western to Eastern countries with an emphasis on Middle East and Far East countries. The clinical experience has always been at the heart of nursing education cross-culturally and is a major source of stress and attrition. OBJECTIVES: To investigate the perceptions of stress and satisfaction of undergraduate nursing students during three stages of clinical learning experiences: preclinical, clinical and advanced clinical. DESIGN: A cross-sectional study. SETTINGS: Three Bachelor's in Nursing programs in three higher educational institutions in Israel. PARTICIPANTS: Nursing undergraduate students in their second, third and fourth year of study (n = 892). METHODS: The Nursing Students Stress Scale and the Nursing Students Professional Satisfaction questionnaires were used for data collection. Descriptive statistics used to analyze the data included: Pearson correlation, Cronbach's alpha, one way ANOVA, t-test, Kruskal Wallis and Mann Whitney U tests. RESULTS: Overall mean level of stress was mild-moderate (2.67) and overall satisfaction moderate-high (3.57). Year of study and gender were the most significant predictors of nursing students' stress. The level of stress and satisfaction of second year students in the preclinical stage was significantly higher compared to peers in their third and fourth year. Female students experienced significantly higher levels of stress and satisfaction. The top most stressful situations for second year students were related to inadequate preparation to cope with knowledge and skill demands, whereas for third and fourth year students they were conflicts between professional beliefs and the reality in hospital practice. CONCLUSIONS: Nurse Educators are challenged to tailor stress reduction interventions according to the students' perceptions of stress. It is not only critical for their wellbeing and attrition, but also important in developing nursing professionals who will provide better care and caring for patients.

Attitudes Among Nurses Toward the Integration of Complementary Medicine Into Supportive Cancer Care.

PURPOSE/OBJECTIVES: To explore the attitudes of nurses treating patients with cancer regarding the use of complementary and integrative medicine (CIM) therapies to reduce symptoms and improve quality of life (QOL). 
. DESIGN: Prospective and descriptive.
 
. SETTING: 12 hospital and community care settings in Israel. 
. SAMPLE: 973 nurses working in oncology and non-oncology departments.
. METHODS: A 26-item questionnaire was administered to a convenience sample of nurses treating patients with cancer. 
. MAIN RESEARCH VARIABLES: Interest in CIM integration and training in supportive cancer care.
. FINDINGS: Of the 973 nurses who completed the questionnaire, 934 expressed interest in integrating CIM into supportive cancer care. A logistic regression model indicated that nurses with a greater interest in integration tended to be older, believed that CIM improved patients' QOL, and had no structured postgraduate oncology training. Nurses who believed CIM to be beneficial for QOL-related outcomes were more likely to express interest in related training. The goals of such training include improving QOL-related outcomes, such as anxiety, insomnia, gastrointestinal symptoms, and pain. 
. CONCLUSIONS: Most nurses working with patients with cancer are interested in the integration of CIM into supportive cancer care. 
. IMPLICATIONS FOR NURSING: Most nurses would like to undergo training in CIM to supplement conventional care. CIM-trained integrative nurses can help promote the integration of patient-centered CIM therapies in supportive cancer care settings.

Improving work conditions through strike: Examination of nurses' attitudes through perceptions of two physician strikes in Israel.

BACKGROUND: Strikes are means to influence policies related to working conditions, yet raise ethical dilemmas for healthcare workers. Nurse strikes have become more prominent around the world. OBJECTIVE: To assess the change in Israeli nurses' attitudes towards strikes in light of two physician strikes that have preceded a nursing strike. METHODS: An anonymous survey was administered once in 2000 (N = 106) and again in 2011 (n = 175) following 110 days of a physician strike, to assess nurses' attitudes towards the strike and resulting ethical issues. RESULTS: A statistically significant change (p < 0.05) between administrations revealed that in 2011 more nurses identified striking as a legitimate mechanism, would strike under the same circumstances, and felt that collaboration with physicians persisted despite the strike. Additionally, an increasing number of nurses said that the suffering of patients due to the strike is somewhat or entirely justified, although they were faced with a difficult dilemma of loyalty to physician colleagues vs. PATIENTS: Nurses reported finding ways to mitigate the suffering of patients resulting from the strike. CONCLUSIONS: While patient-centered care remains nurses' first and foremost priority, findings indicate an increasing support of collective bargaining and strike to promote working conditions related to professional and public health agendas.

Stress measurement among charge nurses: developing a cross-cultural tool.

AIM: The aim of this study was to develop a cross-cultural tool for the measurement of stress among charge nurses in general hospitals. BACKGROUND: Studies of the specific stressors unique to different nursing roles are few, particularly those related to hospital charge nurses. The Charge Nurse Stress Questionnaire is a well-validated Israeli-developed scale. However, it has not been tested cross-culturally. DESIGN: A descriptive methodological study was conducted in Israel, Ohio and Thailand. METHOD: A total of 2616 nurses from 23 hospitals (small to large size) completed the questionnaire between 2011-2013. The questionnaire was translated into English and Thai. To establish tool validity and reliability, content validity, internal consistency reliability, exploratory and confirmatory factor analysis were performed. RESULTS: Analyses resulted in a final abbreviated version of the questionnaire with 25 items and four stress subscales. Internal consistency for the subscales indicated very good internal consistency. CONCLUSIONS: We developed a self-reported, cross-cultural, valid and reliable tool for evaluating the specific stressors of the role of charge nurses. A rigorous assessment of charge nurse stress provides a good basis for planning tailored stress reduction interventions. It is recommended to further use the tool in different settings across different countries.

Falls in young children with minor head injury: A prospective analysis of injury mechanisms.

BACKGROUND: Fall is a common mechanism of injury (MOI) in young children and an important risk factor for traumatic brain injury (TBI). Most children who fall have a minor head injury (MHI), defined as a blunt head trauma that occurred in a patient who is conscious and responsive. OBJECTIVE: To seek a possible association between MOI and injury severity. METHODS: A single centre cohort study was conducted. Data were collected on patients aged 0-2 years with MHI. Clinically-significant TBI (csTBI), defined as head injury resulting in death, intubation or neurosurgery, was the primary outcome measure. Traumatic finding on CT scan (TFCT) was the secondary outcome measure. RESULTS: Five hundred and ninety-five patients were analysed. Eight types of falls were identified: from ground-level, down stairs, from a bed, from a changing table, from furniture, from adult-hold, from a playground-device and from a stroller/baby-carriage. One patient (0.16%) had csTBI. Thirty-one (5.2%) underwent CT scans, TFCT was diagnosed in 17 (2.8%) patients; 10 (1.7%) linear skull-fractures, two (0.3%) depressed skull-fractures and five (0.8%) intracranial haemorrhages. Regression analysis did not reveal a statistically significant association between any of the MOI and the presence of TFCT. CONCLUSIONS: The risk for csTBI was low and no association was found between MOI and injury severity.

Management of mass casualty events: the Israeli experience.

PURPOSE: Among all the emergency scenarios, the most common medical emergency event in Israel is the conventional mass casualty event (MCE). This article describes the Israeli model of emergency preparedness and management at the national level, step-by-step emergency management at the hospital level, and nursing roles in emergency events. SETTING: Israel has a unique national and local model of organizing and managing an emergency event, characterized by a central national organization that is responsible for emergency policy, management, coordination, quality control, and ongoing improvement. CONCLUSIONS: Well-planned emergency preparedness training for a multidisciplinary staff is crucial. Nurses play significant roles both clinically and managerially in leading and organizing emergency events on all levels. CLINICAL RELEVANCE: Lessons gained from the special model of management of MCEs in Israel, particularly regarding unique nursing roles, may be considered for applicability in other countries.

Stress among charge nurses: tool development and stress measurement.

The aim of this study was to develop and implement a tool for measuring the role stress of charge nurses. Tools are lacking regarding measurement of nursing role stressors, particularly for charge nurses. Based on focus groups and in-depth interviews with charge nurses within a large tertiary hospital, a charge nurse stress questionnaire was developed which measures six factors of stress: authority-responsibility conflict, patient-nurse interaction, deficient resources, managerial decision making, role conflict, and overload. The prominent stressors on charge nurses were specific to the role. Mean levels of stress were significantly higher for nurses who attended post-graduate clinical courses than for those who did not. The mean level of stress was higher for department nurse managers than for nurses without a managerial position. This tool was designed to measure charge nurse stress demonstrates reliability, and highlights the specific stressors demanded by the role. Preparation and ongoing support for fulfilling this position are recommended.

Parents, spouses, and children of hospitalized patients: evaluation of nursing care.

AIM: This paper is a report of a study of the effect of kinship type and gender on family members' evaluation of nursing care for patients and their families in hospital units. BACKGROUND: With increasing competition in the healthcare system, hospitals attribute great importance to client satisfaction, which is strongly related to the quality of nursing care. However, to date there has been little research into family members' evaluation of nursing care. METHODS: Questionnaires were administered to spouses, parents and children (n = 441) of hospitalized patients in three Israeli hospitals during 2007-2008. RESULTS: Kinship type interacted with gender in affecting family members' evaluation of the quality of nursing care. Among men, husbands were the most satisfied with nursing behaviour, treatment of the patients, and the information they receive. Fathers were the least satisfied. Overall family evaluation of the service was predicted by their evaluation of caring, treatment, and the patient's environment; departmental reputation was predicted by evaluation of treatment. CONCLUSION: Nurses should be trained to develop sensitivity to the diverse expectations and needs of relatives, as well as awareness of how their own preconceptions affect their behaviour toward patients' families. Nurses should develop self-awareness of possible stereotypes and prejudices that may bias their behaviour towards family members. Reactions of family members should also be included in surveys of client satisfaction with nursing care.

New approach for teaching health promotion in the community: integration of three nursing courses.

The complexity of the health care system and its interdisciplinary nature require that each component of the system redefine its professional framework, relative advantage, and unique contribution as an independent discipline. In choosing the most efficient and cost-effective work-force, each profession in the health care system must clarify its importance and contribution, otherwise functions will overlap and financial resources will be wasted. As rapid and wide-ranging changes occur in the health care system, the nursing profession must display a new and comprehensive vision that projects its values, beliefs, and relationships with and commitment to both patients and coworkers. The plans to fulfill this vision must be described clearly. This article presents part of a new professional paradigm developed by the nursing department of the University of Haifa, Israel. Three main topics are addressed: The building blocks of the new vision (i.e., community and health promotion, managerial skills, academic research). Integration of the building blocks into the 4-year baccalaureate degree program (i.e., how to practice health promotion with students in the community setting; managerial nursing skills at the baccalaureate level, including which to choose and to what depth and how to teach them; and academic nursing research, including the best way to teach basic research skills and implement them via a community project). Two senior student projects, demonstrating practical linking of the building blocks.