Informal caregivers' negative affect: The interplay of caregivers' resilience, aging anxiety and burden.

OBJECTIVES: This study focused on the negative affect of informal caregivers of older adults. In a novel investigation, the interplay of aging anxiety, caregiving burden, and resilience as a protective factor was examined, suggesting that aging anxiety and caregiving burden are mediators for the link between resilience and negative affect. METHODS: In a cross-sectional design, 191 Israeli informal caregivers of older adults (65+) participated in the study. They completed questionnaires that assessed demographic and caregiving characteristics, resilience, aging anxiety, caregiving burden, and negative affect. RESULTS: The findings showed a serial mediation process in which higher resilience predicted lower caregiving burden, which subsequently predicted lower aging anxiety, which subsequently predicted lower negative affect. However, the indirect path from resilience to aging anxiety and negative affect was non-significant. CONCLUSION: Based on this study's findings, the aging anxiety of informal caregivers of older adults should be professionally addressed in the early stages of caregiving because it contributes to the caregiving burden and negative affect. Additionally, resilience should be enhanced by psycho-social interventions tailored to address informal caregiver challenges that often induce caregiving burden and negative affect.

Dental anxiety and ageing anxiety: Moderated mediation roles of Oral Health-Related Quality of Life and subjective accelerated ageing.

BACKGROUND: Oral health and its relation to ageing is an important topic often neglected among geriatric populations. Proper oral rehabilitation may aid in alleviating mental health burdens in such populations. OBJECTIVES: The present study aimed to explore the association between dental anxiety and ageing anxiety, with regard to the interplay of Oral Health-Related Quality of Life (OHRQoL) as mediator and subjective accelerated ageing as a moderator. METHODS: A total of 577 participants with mean age 72.78 years (SD = 3.832, range = 68-87) were recruited via a survey company in Israel. They completed a self-report battery of questionnaires about dental anxiety, OHRQoL, subjective accelerated ageing and ageing anxiety, along with their informed consent. RESULTS: The findings revealed that dental anxiety was positively associated with ageing anxiety (direct effect), and that OHRQoL mediated the link between dental anxiety and ageing anxiety (indirect effect). Additionally, subjective accelerated ageing moderated the positive link between dental anxiety and OHRQoL, as well as the positive link between OHRQoL and ageing anxiety. CONCLUSIONS: The results provide insight for the roles of OHRQoL and subjective accelerated ageing among older adults between dental anxiety and ageing anxiety. Tailoring oral rehabilitation interventions that focus on these factors are warranted to improve older adults' dental health.

The intrapersonal and interpersonal processes of fear of recurrence among cervical cancer survivors: a qualitative study.

OBJECTIVE: Cervical cancer's emotional and mental toll often extends beyond the disease's duration. Fear of cancer recurrence has been identified as prominent in patients and survivors, yet there is a paucity of studies regarding this population. The present study sought to explore and expand the understanding of the meaning of fear of cancer recurrence among cervical cancer survivors. METHODS: In this qualitative study, semi-structured interviews were conducted with 15 cervical cancer survivors. The interviewees' mean age was 41.33 years (range 34-47 years), and the mean time since diagnosis was 3.1 years (ranged from 0.5 to 7 years). RESULTS: Three central themes emerged that represent intrapersonal and interpersonal processes: The first, "No longer resilient" refers to feelings of uncertainty in the face of the illness experienced on the intrapersonal level, where the interviewee mostly engaged with efforts to return to the "normal" state that existed before the cancer diagnosis. The second, "To be afraid in a dyad," relates to the interpersonal level that included mutual fears shared by the interviewee and her partner. The third "And what if the disease comes back and I die?" represents a combination of intrapersonal and interpersonal processes manifested by the greatest fear - death - expressed by both the interviewee and her partner. CONCLUSIONS: The present findings revealed that the fear of cancer recurrence represents intrapersonal and interpersonal processes encompassing three factors - uncertainty, social-cognitive processing, and death anxiety. Accordingly, potential psycho-social treatment options could be tailored to specifically address the prominence of these factors for cervical cancer survivors.

Secondary Traumatic Stress and Vigor Among Neonatal Intensive Care Unit Personnel: The Moderator Role of Coping Flexibility.

BACKGROUND: The demanding and highly stressful work environment of the neonatal intensive care unit (NICU) has led to the identification of a possible psychological stress reaction among NICU nurses and physicians, termed secondary traumatic stress (STS). PURPOSE: The current study aimed to explore the association between vigor at work (as an energy resource) and STS, while considering their association with the professional role (nurses/physicians-as a condition resource) as well as with coping flexibility (as a personal resource). METHODS: In this cross-sectional study physicians and nurses working in NICUs across Israel completed a questionnaire comprising sections on demographics and professional characteristics, self-rated health, STS, coping flexibility, and vigor. RESULTS: Of 280 physicians and nurses approached, 70% (195) completed the questionnaire. No significant differences between nurses and physicians were found in STS adjusted for gender, being in a committed relationship, and seniority in the NICU. Vigor was negatively correlated with STS-both in the entire sample and for each professional role alone. Coping flexibility was a statistically significant moderator between vigor and STS, whereas the interaction between vigor and professional role was not significant. Specifically, the negative relationship between vigor and STS was significant when coping flexibility was more than 10.10 (61% of the participants) but not significant at lower values. IMPLICATIONS FOR PRACTICE AND RESEARCH: The understanding of the relationship between vigor and STS, with coping flexibility as its moderator, encourages an intervention aimed at reducing stress by increasing these resources.

Psychological distress and perceived job stressors among hospital nurses and physicians during the COVID-19 outbreak.

AIMS: The study examined self-reported job-related stressors induced by the COVID-19 pandemic and psychological distress among hospital nurses and physicians. In addition, we explored the role of negative affect (NA) and background variables in relation to COVID-19-related job stressors and psychological distress. BACKGROUND: During COVID-19 pandemic, hospital nurses and physicians were exposed to highly enduring occupational stress, that stem from subjective appraisal of inadequate job resources (i.e., personal protection equipment, information on how to manage safely in the ongoing work and organizational attention to the needs arising from the ongoing work). DESIGN: Cross-sectional design. METHODS: Between May and July 2020, 172 nurses and physicians working at a medical centre in Israel filled in self-report questionnaires about sociodemographic data, COVID-19-related job stressors, psychological distress and NA. RESULTS: Our results confirmed the positive direct link between perceived COVID-19-related job stressors and psychological distress among hospital nurses and physicians. NA was found to serve as a mediator in this association (indirect link). Furthermore, nurses and physicians' seniority was related positively to psychological distress and also played a moderator role in the indirect link. CONCLUSION: We recommend to monitor the mental health of hospital nurses and physicians and to provide a platform to address their job stressor concerns related to COVID-19, and share helpful coping strategies. IMPACT STATEMENT: During the abrupt COVID-19 outbreak, hospital nurses and physicians face challenges that might raise NA and psychological distress. Our study revealed that among hospital nurses and physicians, COVID-19-related perceived job stressors and psychological distress were positively linked, and NA plays a mediating role in this association. Among nurses and physicians with moderate or high years of seniority (>11 years), higher COVID-19-related perceived job stressors associated with higher NA, which in turn was associated with greater psychological distress. Policymakers would be wise to provide a platform to address hospital nurses and physicians' mental health.

Vigor among health-care professionals at the workplace: the role of intra- and inter-personal resources.

Feeling vigorous throughout the workday in a medical facility despite exposure to daily job-related stress is essential for productive work-related behavior and for the subjective well-being of health-care professionals. The current study explored the contribution of an intra-personal resource (i.e. coping flexibility) and an inter-personal resource (i.e. social support) to the explained variance of vigor among nurses and physicians. Two hundred two hospital personnel completed self-report questionnaires regarding personal and professional data, vigor, coping flexibility and social support. The results revealed that the intra-personal resource coping flexibility, was positively associated with vigor while the inter-personal resource social support was not found to be associated with vigor. In addition, older age and higher self-rated health positively associated with feeling vigor. The current study shed light on the role of intra-personal resources in feeling vigorous throughout stressful workdays that characterize the workplace of hospital personnel. Tailoring interventions that may enhance coping flexibility among hospital personnel can increase their vigor which in turn may beneficially contribute to their job performance.

"You did not desert me my brothers in arms": The continuing bond experience of men who have lost a brother in arms.

This qualitative study provides an in-depth account of the continuing bond experience of bereaved Israeli men who have lost a comrade with whom they served in mandatory military service (a brother in arms). Our study findings indicate that bereaved men experienced continuing bond relationships with their deceased brothers in arms on two axes-an internal axis and an external axis. Together, the two axes connected the bereaved to the deceased. Furthermore, the bereaved constantly (re)negotiated these connecting axes vis-a-vis Israeli social norms and expectations. Implications for practice are outlined.

"It's like we're at war": Nurses' resilience and coping strategies during the COVID-19 pandemic.

The sudden outbreak of the COVID-19 epidemic forced healthcare workers to use all their professional and personal skills to battle it. The unexpected onset of the disease has led to extraordinary pressure on healthcare workers and has challenged their resilience. The study aimed to explore the subjective experiences of 18 Israeli nurses who are directly treating COVID-19 patients, and to identify the sources of resilience used by nurses to address national health crises. The data were gathered via semi-structured interviews and thematically analyzed. The analysis yielded three central analytic themes that described the nurses' experiences during the pandemic: maneuvering between professional demands and personal-family life; the nurses' coping strategies and resilience; and nurses' use of metaphorical military language as a way of coping with the difficulties. The findings show that in a time of severe health crisis, and despite the fear of infection, nurses adhere to the values of the profession and are willing to fight the virus to save lives. The nurses' extensive use of military metaphorical language reflected their experiences, strengthened them, and provided them with a source of empowerment in the face of a common enemy that needed to be overcome.

Preferences for end-of-life care settings among the healthy population in Israel-Related socio-demographic variables.

OBJECTIVE: Preferences for end-of-life (EoL) care settings is of considerable interest for developing public health policy and EoL care strategies. Culture, the cause of illness, and background characteristics may impact preferences. The present study aimed to explore preferences for EoL care settings: homes, hospitals, and inpatient hospice units among the general healthy population in Israel. Possible associations between the setting preferences and socio-demographic characteristics were also examined. METHOD: A cross-sectional survey was conducted among 311 healthy adults who were recruited through a representative internet panel of the Israeli population using the Israeli census sampling method. The sex ratio was almost 1:1 with 158 women (50.8%) and 153 men (49.2%). All participants completed self-report measures using an online survey system. The questionnaires assessed sociodemographics and preferences for EoL care settings. RESULTS: This survey revealed that 52.1% of the participants expressed preference for being cared for at home rather than in an inpatient hospice unit, 40.8% expressed being cared for at home rather than in a hospital, while 36.7% had no preference regarding being cared for in hospital or in a hospice unit. Among the socio-demographic variables, only age and gender were found to be significantly associated with preferences for EoL care settings. SIGNIFICANCE OF RESULTS: The present study highlights the need to be cautious when regarding home as the preferred EoL care setting, as some individuals declared that they would prefer EoL hospice/hospital care. Age and gender should be considered when discussing and tailoring strategies regarding EoL preferences.

"A kaleidoscope of relationships" - cervical cancer survivors' perspectives on their intimate relationships: A qualitative study.

OBJECTIVE: Cervical cancer is known to affect survivors' intimate relationships, as well as their communication and coping. Yet little is known about the perspectives of these survivors on their intimate relationships in the context of their needs during and after medical treatment. Additionally, only a few studies have focused on survivors' perceived needs or on existing psychosexual support. Understanding these perceptions can help provide a tailored response and improve dyadic interventions. The aim of this study was to examine cervical cancer survivors' perspectives on their intimate relationships during and after their treatment. METHOD: The present study adopted a qualitative-phenomenological approach. In-depth, semi-structured interviews were conducted with 15 survivors of cervical cancer between the ages of 38 and 44 who were diagnosed at stages I-II and were treated with radiotherapy or chemo-radiotherapy and surgery. Data collection continued until saturation of concepts was reached. The results underwent thematic analysis. RESULTS: Analysis of the findings revealed two key themes: (1) Together and apart in the shadow of cervical cancer. This theme focuses on the recovery period as a potential opportunity for changing and improving the couple relationship, such that men no longer withdraw but rather provide their partners with needed support and encouragement. (2) Changes in sexual life and couple intimacy. This theme focuses on changes in sexual relations, which have become a burden, painful, and something to avoid. SIGNIFICANCE OF RESULTS: The study provides a comprehensive picture of intimate relationships during and after cervical cancer treatment and highlights the women's needs and desires for support from their intimate partners. The discussion notes that oncology providers can better facilitate supportiveness on the part of cervical cancer partners by offering better couple-oriented education and interventions to promote couple communication.

Cervical cancer survivors: The experiences of the journey.

OBJECTIVE: Cervical cancer affects survivors' overall coping. Yet, specifically emotional and behavioral expression patterns among cervical cancer survivors have barely been examined. In addition, no study has focused on survivors' experiences of sequences related to coping. Understanding these perceptions can help provide a tailored response and improve psycho-social interventions. The aim of this study was to gain a better understanding of the emotional and behavioral motives involved in coping with cervical cancer recovery. METHODS: Qualitative interviews were conducted with 15 survivors of cervical cancer (stages I and II), using a semi-structured in-depth questionnaire. The interviews were recorded, transcribed, and analyzed by three researchers using thematic analysis. RESULTS: Six main themes emerged: (i) Reasons and benefits for keeping the disease a secret or sharing it with others; (ii) "When you get used to despair, there's also room for hope": Despair alongside hope; (iii) Self-guilt following the disease, but also knowing how to forgive yourself; (iv) Deep loneliness alongside a significant need for support; (v) Finding the way from passivity to activity; and (vi) When meaning in life is missing, and the importance of meaning when it is present. There was a balance between negative emotions and behaviors (despair, confidentiality, guilt, loneliness, passivity, lack of meaning) and positive emotions and behaviors (hope, openness, forgiveness, significant support, activity, meaning). SIGNIFICANCE OF THE RESULTS: The study revealed that in some cases cervical cancer coping during the recovery period moves across sequences. The women's narratives portray past difficulties as the reason for present psychological health, and their experience of a healthy present is intensified by their past difficulties. Implications for practice are discussed.

Meanings attributed by bereaved unmarried intimate partners of fallen soldiers to their loss.

The death of a partner may be stressful for unmarried intimate partners as they lack legal status vis-à-vis the partner, and, thus, lack sufficient cultural support. This qualitative study examined the meaning attributed to the loss by 12 Israeli bereaved intimate partners of fallen soldiers. Through applying a constructivist-narrative methodology, we derived three clusters from interviews with the intimate partners: (a) The relationships never ended - "an unfinished business," (b) The need to conceal the relationships - "a hidden wound," and (c) The relationship guides their lives - "a compass." Practical implications were discussed.

The double sides of hope: The meaning of hope among amyotrophic lateral sclerosis (ALS) patients.

Hope is an important factor in coping and adjusting to life-threatening disease. In this study, we examined the meaning of hope among people with amyotrophic lateral sclerosis (ALS). Semi-structured interviews with 12 people revealed that hope had two contradictory meanings. For some, hope was considered an obstacle to achieving control and to actively cope with the disease. Alternatively, other people with ALS regarded hope as a crucial resource, which empowered their coping and control. These findings are discussed in the context of research and theoretical literature about hope and coping processes.

Death anxiety and psychological distress post-donation in non-directed living kidney donors.

The current study sought to assess death anxiety and psychological distress among kidney donors, in comparison to a control population. Seventy-eight non-directed living kidney donors were recruited through the Israeli voluntary kidney donation association. This sample was compared to 396 participants from a control population. The results revealed that non-directed living kidney donors had higher levels of death anxiety in comparison to the control population while their psychological distress was lower in comparison to the control population. The results of this study highlight the importance of relating to non-directed living kidney donors' death anxiety.

Can posttraumatic growth after breast cancer promote positive coping?-A cross-lagged study.

OBJECTIVES: The diagnosis of breast cancer can be associated with significant emotional distress, yet, over time, cancer survivors also may experience positive psychological changes labeled posttraumatic growth (PTG). Two alternative paths between coping strategies and PTG were tested among breast cancer patients, employing longitudinal design: Would PTG after medical treatment of breast cancer lead to an increase in reporting positive coping strategies; alternatively, would positive coping strategies after medical treatment of breast cancer lead to increased PTG. METHODS: A longitudinal study was conducted among 198 breast cancer patients who completed validated self-report scales, at five time points: at 3 months after completing active medical treatment (T1); after 6 months (T2); after 1 year (T3); after 2 years (T4); and after 7 years (T5). The current study analyzes three time points: T1, T3, and T5 using structural equation modeling. RESULTS: Our results support the path that describes the first alternative, that higher report of PTG after medical treatment of breast cancer patients would lead to increased report of positive coping strategies. In addition, positive coping strategies were found to be positively linked to PTG after 6 months, and the link was slightly stronger after 2 years. Nevertheless, 7 years after diagnosis, no association was found between positive coping strategies and PTG measurements. CONCLUSIONS: Finding positive meaning after coping with breast cancer, as reflected in PTG, may be a significant resource in coping with cancer, and it may lead to increase of positive coping strategies.

Coping strategies in secondary traumatization and post-traumatic growth among nurses working in a medical rehabilitation hospital: a pilot study.

PURPOSE: Secondary traumatization and post-traumatic growth have been recognized as psychological reactions that might occur among the medical staff in general, and among nurses in particular. Nurses in the field of medical rehabilitative care might reveal such reactions as their work involves stress and traumatic situations. Coping strategies might either alleviate or exacerbate work-related stress experienced by nurses. The aims of the current study were to explore the link between secondary traumatization and post-traumatic growth exhibited by nurses in the field of medical rehabilitative care, and to examine the link between problem-focused coping strategies and emotion-focused coping strategies to secondary traumatization and post-traumatic growth. MATERIAL AND METHOD: One hundred and fifty-three rehabilitative nurses completed self-report questionnaires regarding personal data, post-traumatic growth, secondary traumatization, ways of coping strategies and personal negative life events. RESULTS: Correlation matrix for the path analysis model revealed positive significant correlation between secondary traumatization and post-traumatic growth. Both, problem-focused coping and emotion-focused coping strategies were linked to secondary traumatization and post-traumatic growth. CONCLUSIONS: Nurses employed in a medical rehabilitation hospital who cope via problem-focused strategies as well as emotion-focused strategies in their work, might reveal secondary traumatization but might simultaneously benefit from post-traumatic growth.

Burnout and perceived social support: The mediating role of secondary traumatization in nurses vs. physicians.

AIMS: The study aimed to examine differences between paediatric nurses and physicians regarding burnout syndrome, secondary traumatic stress (STS) and perceived social support (PSS). BACKGROUND: Paediatric nurses and physicians encounter cumulative effects of treating sick and injured children and helping their families, in situations that might promote burnout and STS. DESIGN: Cross-sectional design. METHOD: Nurses (n = 158) and physicians (N = 76) completed self-report questionnaires on STS, PSS and burnout. RESULTS: Nurses and physicians had similar rates of STS and burnout but showed significant differences in PSS. Furthermore, STS mediated the association between PSS and burnout for both groups; however, the effect was stronger for nurses in comparison to physicians. CONCLUSION: Paediatric nurses and physicians would benefit from participating in interventions geared towards reducing STS, thus minimizing burnout. Moreover, advocating social support within the organization is needed to bolster the ability for coping with sources of stress. IMPACT STATEMENT: Nurses' and physicians' involvement in the physical, physiological and mental needs of their paediatric patients might lead to burnout and secondary traumatic stress (STS). However, research on social support in the context of burnout and STS among nurses and physicians is scant. Secondary traumatic stress and burnout were similar for nurses and physicians, though perceived social support (PSS) was higher for nurses. Secondary traumatic stress plays a mediating role in the association between PSS and burnout among nurses and physicians. However, the mediation effect was stronger for nurses. Policy makers would be wise to advocate institutional stress management interventions to reduce secondary traumatic and to reinforce organizational support for nurses and physicians.

Body Perception and Organ Donation: Bereaved Parents' Perspectives.

The view of the body in sociological, psychological, and gender studies may be broadly summarized to three metaphors: (a) the body as a machine, (b) the body as Self, and (c) the body as sacred and sanctified entity. Each of these philosophical views has an impact on organ donation. The current study aimed at revealing body perception of bereaved Israeli parents who agreed to donate organs of their deceased child. A deductive and inductive thematic analysis captured an ongoing perceptual change that bereaved donor parents experienced in their view of the child's body. Parents' ability to move between two positions (the body as Self, the body as a machine) allowed them to agree with and protect their decision to donate as well as to maintain an ongoing bond with their deceased child. The view of the body as scared entity was not evident in the bereaved parents' narratives.