Israeli Nurses Research Articles

Social Support Moderates the Relationship Between Death Anxiety and Psychological Distress Among Israeli Nurses.

Based on the stress-buffering model, the current study sought to examine the moderating role of perceived social support in the association between death anxiety and psychological distress among nurses. Select variables found in previous studies to correlate with psychological distress served in the current study as covariates to control for their relationship with psychological distress among nurses. These include gender, years of professional experience, self-rated health, self-efficacy, and self-defined burnout. Structured questionnaires were administered to a sample of 795 professionally active nurses in Israel. Psychological distress was assessed by the 6-item Kessler Psychological Distress Scale (K6), death anxiety was assessed by a single item scale designed by Abdel-Khalek, and perceived social support was assessed by the Multidimensional Scale of Perceived Social Support (MSPSS). The research findings show that higher levels of death anxiety were associated with higher levels of psychological distress only among nurses with lower levels of perceived social support. The study indicates that in order to reduce the level of distress experienced by nurses it is important to take action to reduce their death anxiety and enhance their social support mechanisms.

Israeli Nurses' Palliative Care Knowledge, Attitudes, Behaviors, and Practices.

To describe and compare self-perceived end-of-life (EOL) knowledge, attitudes, behaviors, and practices of intensive care unit (ICU) nurses compared to oncology nurses. 126 Israeli nurses (79 oncology nurses and 47 ICU nurses) who were members of the Israel Association of Cardiology and Critical Care Nurses and the Israeli Oncology Nurses Organization. This cross-sectional study used an online survey to gather demographic information, clinical setting, and study measures (EOL knowledge, attitudes, behaviors, and practices). Oncology nurses and ICU nurses showed moderate levels of self-perceived knowledge and attitudes toward palliative care; however, their self-reported behaviors were low. Oncology nurses scored slightly higher than ICU nurses on knowledge and attitudes but not behaviors, although the difference was not statistically significant. Contrary to the current authors' expectations, oncology nurses and ICU nurses have similar levels of knowledge, attitudes, and behaviors regarding palliative care. Nurses in both settings need to be better trained and empowered to provide such care.

How skilled do Israeli nurses perceive themselves to be in providing palliative care? Results of a national survey.

In Israel, palliative care (PC) services are limited. This study assessed Israeli nurses' perceived competencies and educational needs in providing PC. Online administration of the End-of-Life Professional Caregiver Survey (EPCS). Oncology and PC nurses were identified through the Israel Ministry of Health and Oncology Nurses' Society. Demographic and practice data were analysed using analysis of variance tests to determine differences between nurse characteristics by EPCS domains. The sample (n=105) was 94% female, had a mean age of 48 years (SD=10.5) and 83% were Jewish Israeli. Thirty-nine percent reported PC training in nursing school and 42% felt their workplace provided little to no PC education and resources to nurses. Those with advanced degrees and those who received post-graduate PC training had higher mean scores across EPCS domains (p<0.05 for all). Nursing education and workplace support in PC for Israeli nurses are limited. It is hoped that these findings may inform future PC nursing education and policy in Israel.

Professional, generational, and gender differences in perception of organisational values among Israeli physicians and nurses: Implications for retention

ABSTRACTThe global health workforce today is more age diverse than ever before and spans three generations: baby boomers, X and Y generations. Each generation has a distinct set of characteristics, values, and beliefs. This diversity can lead to increased creativity and a greater richness of values and skills, but at the same time it can also lead to value clashes, disrespect, and conflicts. This study aimed to examine professional, generational, and gender differences in the perception of the importance of organisational values among nurses and physicians working in both hospitals and outpatient clinics in Israel. Data were collected from a large sample of nurses and physicians (N = 603) from 11 hospitals and community services across Israel. The participants completed a self-administered questionnaire rating the perceived importance of 20 organisational values, such as leadership, risk-taking, competition, power, and collaboration. The five values ranked most important were performance quality, cooperation, commitment, effectiveness, and efficiency. The five values ranked least important were competition, marketing, power, risk-taking, and assertiveness. Significant value differences were found by profession, generation, and gender. Nurses scored efficiency, assertiveness, risk-taking, power, and marketing higher than physicians did. The Y generation scored power higher and marketing lower than the two older generations. Women ranked the values of cooperation, commitment, innovativeness, vision, and marketing significantly higher than men did. Understanding differences between professions, generations, and gender is a useful first step in improving employees’ job satisfaction, productivity, and retention.

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

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. To assess the change in Israeli nurses' attitudes towards strikes in light of two physician strikes that have preceded a nursing strike. 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. 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. Nurses reported finding ways to mitigate the suffering of patients resulting from the strike. 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.

Multi-faceted identities and interactions in mixed health teams.

The literature in the area of the health workforce and societies in conflict encompasses a wide range of studies and potential directions. Lately, Keshet and Popper-Giveon reported on a study based on interviews with 13 Arab Israeli nurses who work in Israeli hospitals. This preliminary study describes how being an Arab nurse in Israel is experienced and perceived by those nurses. The results indicate the need for further studies on the complexity of health workers’ experiences in their changing and multi-faceted professional, cultural, gender and national identities. In order to manage health systems, in particular in divided societies that are characterized by inter-group conflicts, special attention should be given to studying the everyday processes in mixed teams.

Knowledge, perceptions, attitudes and willingness to report to work in an earthquake: A pilot study comparing Canadian versus Israeli hospital nursing staff

BackgroundHealth practitioners are expected to respond effectively to an earthquake event and provide lifesaving treatment to an influx of casualties. Understanding the factors that may influence nurses' willingness to report (WTR) in different social contexts and preparedness approaches is crucial for improving preparedness of medical facilities. MethodsA questionnaire based on a previously validated methodology was used to assess demographic characteristics, knowledge, perceptions, attitudes and WTR of nurses after an earthquake. The questionnaire was disseminated among a sample of 56 Israeli and 127 Canadian nurses, from two tertiary care hospitals, located in risk regions. ResultsWTR was generally higher among Canadian versus Israeli nurses (74% vs. 64%). Knowledge and perceptions of organizational-efficacy were generally higher among Israeli nurses. ‘Concern for family's well-being’ and ‘professional commitment to care’ were reported by the largest proportion of nurses as factors that might influence WTR. A common significant predictor of WTR among both samples was the belief that ‘colleagues will also report to work’. ConclusionAlthough different preparedness approaches or emergency experience in Canada and Israel may cause differences in nurses' preparedness, some factors seem to be cross-cultural and may play a key role in increasing nurses' willingness to report after an earthquake.

Israeli Nurses’ Attitudes to the Holistic Approach to Health and Their Use of Complementary and Alternative Therapies

To examine nurses' attitudes to holistic and biomedical approaches to health care and the correlation between the two and to explore the extent of recommending and using complementary and alternative medicine (CAM) by nurses and its correlation with attitudes toward the holistic approach to care. In this cross-sectional correlational study, a structured questionnaire was completed anonymously by 213 Israeli hospital-based nurses from various departments. Nurses perceived both approaches as critical to optimal health care: a positive correlation emerged of attitudes to the two approaches. Nurses recommended and used CAM extensively; most therapies were recommended and/or used by 70% or more of the respondents. Nurses with more positive attitudes toward holistic care tended to recommend and use CAM to a greater extent. Biomedical and holistic approaches are perceived by nurses to coexist within nursing professional boundaries and form a broad basis for optimal health care. Nurses' attitudes to the holistic approach appear to promote recommendation and/or use of CAM in practice. More training in CAM should be offered in nursing educational frameworks and research should continue to establish evidence for CAM's effectiveness.

Disciplinary Procedures Against Israeli Nurses

In Israel, the Ministry of Health's Nursing Division, the regulating authority for the nursing profession, is responsible for every nurse's professional competence and fitness to practice. Disciplinary proceedings in the Israeli nursing profession are similar to those in other health care professions.The primary aim of the proceedings is to maintain levels of professional competence and ethics. However, to date, no Israeli publication has reported the findings on formal complaints against nurses, physicians, or other health care staff members in Israel. This article reviews the disciplinary decisions of the last decade and examines the sentencing policies of the Ministry of Health regarding the nursing profession.

Israeli Nurses’ Intention to Report for Work in an Emergency or Disaster

This study investigates the effect of personal characteristics and organizational factors on nurses' intention to report for work in a national emergency. A convenience sample was drawn of 243 Israeli registered nurses. A structured self-administered questionnaire collected data on (a) intention to report for work, (b) barriers preventing nurses from reporting for work, (c) perceived self-efficacy in emergency conditions, (d) risk appraisal of health hazards, (e) knowledge of nurses' roles in emergency work, (f) access to institutional support services, and (g) reporting to work in a past emergency. Data were analyzed by descriptive statistics, Pearson correlation coefficients, t tests, and multiple regression analysis. Less than half of the nurses who said they had been asked to report for work in a past emergency had actually done so. The major barrier to reporting for work was childcare demands. There was a significant correlation between perceived knowledge, risk appraisal, self-efficacy, and intention to report. Self-efficacy, risk appraisal, working through an earlier emergency, perceived knowledge, and full or part-time working altogether. Personal factors, such as perceived knowledge, risk appraisal, and self-efficacy, are more important to Israeli nurses than objective barriers in preventing them from reporting for emergency work. The level of perceived knowledge as to the demands on and duties of nurses in a large-scale emergency is low. Self-efficacy enhancing activities need to be introduced into nurse training for emergency preparedness. This study makes an important contribution to research on the importance of perceived self-efficacy in the context of disaster planning.

Organizational Safety Culture and Medical Error Reporting by Israeli Nurses

To investigate the association between patient safety culture (PSC) and the incidence and reporting rate of medical errors by Israeli nurses. Self-administered structured questionnaires were distributed to a convenience sample of 247 registered nurses enrolled in training programs at Tel Aviv University (response rate = 91%). The questionnaire's three sections examined the incidence of medication mistakes in clinical practice, the reporting rate for these errors, and the participants' views and perceptions of the safety culture in their workplace at three levels (organizational, departmental, and individual performance). Pearson correlation coefficients, t tests, and multiple regression analysis were used to analyze the data. Most nurses encountered medical errors from a daily to a weekly basis. Six percent of the sample never reported their own errors, while half reported their own errors "rarely or sometimes." The level of PSC was positively and significantly correlated with the error reporting rate. PSC, place of birth, error incidence, and not having an academic nursing degree were significant predictors of error reporting, together explaining 28% of variance. This study confirms the influence of an organizational safety climate on readiness to report errors. Senior healthcare executives and managers can make a major impact on safety culture development by creating and promoting a vision and strategy for quality and safety and fostering their employees' motivation to implement improvement programs at the departmental and individual level. A positive, carefully designed organizational safety culture can encourage error reporting by staff and so improve patient safety.

Organisational values and organisational commitment: do nurses’ ethno-cultural differences matter?

To examine the association between perceived organisational values and organisational commitment among Israeli nurses in relation to their ethno-cultural background. Differences and the discrepancy between individuals' organisational values and those of their organisational culture are a potential source of adjustment difficulties. Organisational values are considered to be the bond of the individual to their organisation. In multicultural societies, such as Israel, the differences in perception of organisational values and organisational commitment may be reflected within workgroups. Data were collected using a questionnaire among 106 hospital nurses. About 59.8% of the sample were Israeli-born. A positive correlation was found between organisational values and organisational commitment. Significant differences were found in organisational values and organisational commitment between Israeli-born-, USSR-born- and Ethiopian-born nurses. The socio-demographic profile modified the effect of organisational values on organisational commitment: when the nurse was male, Muslim, religiously orthodox and without academic education, the effect of organisational values on organisational commitment was higher. Findings confirm the role of culture and ethnicity in the perception of organisational values and the level of organisational commitment among nurses. Assessing ethno-cultural differences in organisational values and organisational commitment provides a fuller understanding of nurses' ability to adjust to their work environment and helps nurse managers devise means to increase nurses' commitment.

Factors affecting Israeli nurses' reports of violence perpetrated against them in the workplace: A test of the theory of planned behaviour

Ben Natan M, Hanukayev A, Fares S. International Journal of Nursing Practice 2011; 17: 141–150 Factors affecting Israeli nurses' reports of violence perpetrated against them in the workplace: A test of the theory of planned behaviour Violence against nurses in the workplace is universal. Violence has negative implications for nurses, their patients and the medical facility. Nonetheless, violent incidents are only infrequently reported (20–25%). A correlational design was used to examine whether the guiding conceptual model, constructed of the variables: assailant traits, victim traits and type of violence, succeeds in predicting a nurse's decision to report violence perpetrated against them in the workplace. Data were gathered with a structured questionnaire, constructed specifically for the current research and based on the literature review and research model. The research population was sampled by convenience sampling and consisted of nurses from general hospitals in northern and central Israel of 220 nurses, of whom nearly 72% (n = 158) had experienced violent incidents over the past year, mainly verbal abuse by patients' relatives. Only 26.6% (n = 42) reported violent incidents in written form. Most reports were submitted to the nurse in charge of the department. Correlations were found between assailant traits (identity and mental state) and victim traits (sociodemographic characteristics and attitudes on and perceptions of reporting) and intention and actual report. Nurses' normative beliefs regarding reporting violence had the greatest effect on intention to report.

Professional image and intention to emigrate among Israeli nurses and nursing students

Under globalization, nurse migration has become an increasingly widespread phenomenon. One factor motivating it might be nurses' perception of the profession's image. The purpose of this study was to examine the connection between Israeli working nurses' and student nurses' perceptions of nursing's professional image and their intention to emigrate. One hundred thirty-two nurses and students participated in this cross-sectional study, the data collected by means of a structured questionnaire. Fifty-five percent of the sample were considering emigration or definitely intended to emigrate. Significantly more participants under the age of 35 were considering or had decided to emigrate than older participants. No statistically significant correlation was found between intention to migrate and perception of the profession's image. However, perceived professional image, as a component of professional reasons for emigrating (to get a better salary, working conditions, etc.), did contribute to the intention to emigrate.

Implicit as Compared With Explicit Safety Procedures: The Experiences of Israeli Nurses

Approaches to nurses' safety in health care organizations, including modifying individual behavior through enforced compliance with safety rules and mandatory participation in safety training, have been of only modest benefit in reducing injuries. Apparently, what matters is not the existence of guidelines, but their implementation. The aim of the present study was to explore nurses' implicit safety theories concerning when to comply with safety rules. Using a multimethod approach, including semistructured interviews (perceptions), observations (real-time behavior), and documentary evidence from 15 nursing units (90 nurses), we found that nurses developed implicit rules for when and how to protect themselves. These included: (a) continue providing care for the patient even at the price of protecting yourself, (b) do not disturb other nurses' work, (c) it cannot happen to me!, (d) be aware of recently occurring accidents, and (e) protect yourself when significant others are present. These implicit rules seemed to be reinforced by personal, social, and contextual factors at the unit, limiting the likelihood that the decision makers (nurses) would discover their fallacy.

Associations Between Oncology Nurses' Attitudes Toward Death and Caring for Dying Patients

To examine relationships between oncology nurses' attitudes toward death and caring for dying patients. Cross-sectional, descriptive, and correlational. Israeli Oncology Nurses Society annual conference in June 2006. A convenience sample of 147 Israeli nurses who were exposed to death in their daily work. Most worked in oncology departments and were of Jewish faith. Completion of the Frommelt Attitude Toward Care of the Dying Scale, Death Attitude Profile-Revised Scale, and a demographic questionnaire. Attitudes toward caring for dying patients, attitudes toward death (fear of death, death avoidance, and types of death acceptance), and demographic variables (e.g., religiosity). Nurses demonstrated positive attitudes toward care of dying patients. The attitudes were significantly negatively correlated with death avoidance, fear of death, and approach acceptance of death. A mediating role of death avoidance was found between fear of death and attitudes toward caring for dying patients. Nurses' personal attitudes toward death were associated with their attitudes toward the care of dying patients. The mediating model suggests that some nurses may use avoidance to cope with their own personal fears of death. Inconsistency between the current results and previous studies of associations between acceptance of death and attitudes toward care for dying patients imply that culture and religion might play important roles in the development of these attitudes. Training and support programs for oncology nurses should take into consideration nurses' personal attitudes toward death as well as their religious and cultural backgrounds.

Spiritual Beliefs among Israeli Nurses and Social Workers: A Comparison Based on Their Involvement with the Dying

The purpose of the study was to compare spiritual beliefs and practices between nurses and health care social workers based on their involvement with dying patients. Exposure to the dying was identified by two indicators: the percentage of terminally ill patients in the provider's care and the work environment. On the basis of the literature, differences were expected between the two types of professionals and the three degrees of involvement with the dying. Nurses were expected to have a higher spiritual perspective than social workers; and health care providers with high involvement in care for the dying were expected to hold the highest levels of spiritual beliefs. Contrary to expectations, no differences in spirituality were found between nurses and social workers; both groups exhibited medium levels of spirituality. Furthermore, health care providers who were highly involved with dying patients had the lowest spiritual perspectives. Tentative explanations of these unexpected results are presented and discussed.

Ethical Dilemmas: The Experiences of Israeli Nurses

In this study I explored ethical dilemmas in nursing to gain a better understanding of nurses' work and their professional status. Qualitative data on ethical dilemmas were collected by interviewing 52 nurses in 18 hospitals and health maintenance organizations. The transcribed interviews were analyzed using a stepwise method. Results indicate a large number of dilemmas that can be divided into five main categories: caring vs. following formal codes; fair process vs. fair outcome; organizational standards vs. family agenda; autonomy vs. deference to higher authority, and guarding secrecy vs. duty to report. The study findings might enhance nurses' ability to cope with ethical dilemmas and bring about change in their professional status. In addition, the results might guide nurses and their supervisors toward developing practitioner programs for nurses that deal with ethical aspects. All these might reduce the expected shortage of nurses and improve the ability of the system to provide quality health care.

Caring for abused women: impact on nurses’ professional and personal life experiences

This article is a report of a study of the impact of caring for abused women on nurses' professional and personal life experiences. Encountering abused women can have emotional, cognitive and behavioural influences on nurses, known as vicarious traumatization. They may feel incompetent to deal with such an overwhelming problem and may avoid screening survivors of abuse. Thus, nurses treating these survivors need to be aware of their attitudes, emotions and differential responses during these interactions. A phenomenological study was carried out in 2005 in Israel. The data were collected using in-depth, interviews with 22 female Israeli nurses in hospitals and community healthcare clinics. Data analysis revealed one main theme, 'Struggling on work and home fronts', based on two subthemes: 'Encounter with domestic violence: a challenge to nurses' professional role perception' and 'Between work and home'. Nurses experience perplexity regarding abused women and their professional care. Encounters with these women challenge nurses' personal and professional attitudes, as well as influencing their personal lives (intimate relationships, parenthood and gender attitudes). These encounters induce empathy and compassion, but also anger and criticism towards abused women, creating emotional labour for the nurses. The dissonance between personal values, attitudes and emotions and the desirable professional intervention procedures might impede nurses' performance in caring for abused women. Implementing training programmes for screening and intervening with abused women might reduce the emotional labour required, enhance nurses' responses to domestic violence, and enable personal growth.

Factors Associated With Reporting of Medication Errors by Israeli Nurses

This study investigated medication error reporting among Israeli nurses, the relationship between nurses' personal views about error reporting, and the impact of the safety culture of the ward and hospital on this reporting. Nurses (n = 201) completed a questionnaire related to different aspects of error reporting (frequency, organizational norms of dealing with errors, and personal views on reporting). The higher the error frequency, the more errors went unreported. If the ward nurse manager corrected errors on the ward, error self-reporting decreased significantly. Ward nurse managers have to provide good role models.