Hanna Admi

National Strategy for Mass Casualty Situations and its Effects on the Hospital

A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized. The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each sites readiness level and the continuity of the flow of care are tested. In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs). A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent.

Nothing to Hide and Nothing to Advertise Managing Disease-Related Information

The purpose of this study was to explore the process of managing disease-related information through various developmental stages from the inside perspective of those who live with a long-term health condition. The retrospective, longitudinal, life history method was used to generate a descriptive theoryfrom accounts constructed with 21 informants: 10 adolescents and young adults with cystic fibrosis (CF) aged 16 to 25 years, and 11 of their significant family members. People chose a specific telling strategy according to the perceived ability of the audience to deal with the information and the situational context. Four strategies of managing disease-related information emerged: visibility, direct telling, silent telling, and concealment. The informants frequently chose information management strategies that enabled an ordinary style of living. These strategies neither reflect feelings of shame nor of pride, as it is suggested in the existing literature. Implications for theory, health care practice, and further research are discussed.

From Research to Reality: Minimizing the Effects of Hospitalization on Older Adults

This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient’s acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.

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.

Human Factors–Focused Reporting System for Improving Care Quality and Safety in Hospital Wards

Objective: The aim was to develop a reporting system for collecting human factors problem reports to establish a database to guide activities for improving health care quality and patient safety. Background: The current error and incident report systems do not provide sufficient and adequate coverage of the factors contributing to impaired safety and care quality. They fail to examine the range of difficulties that clinical staff encounters in the conduct of daily work. Method: A voluntary problem-reporting system was developed to be used by hospital wards’ clinicians and was tested in four wards of two hospitals in Israel. The system is based on human factors–formatted problem reports submitted by physicians and nurses on difficulties and hazards they confront in their daily work. Reports are grouped and evaluated by a team of human factor professionals. Results: A total of 359 reports were collected in the wards during 12 weeks, as compared with a total of 200 incidents reports that were collected during a period of 5 years with the existing obligatory incident reporting system. In-depth observational studies conducted on the wards confirmed the ability of the new system to highlight major human factors problems, differentially identifying specific problems in each of the wards studied. Problems reported were directly related to general factors affecting care quality and patient safety. Conclusion: Validation studies confirmed the reliability of the reporting system in pinpointing major problems per investigated unit according to its specific characteristics. Application: This type of reporting system could fill an important information gap with the potential to be a cost-effective initial database source to guide human factors efforts to improve care quality, reduce errors, and increase patient safety.

“Lighthouse in the dark”: A qualitative study of the role of breast care nurse specialists in Israel

This study gains insight into the role of the breast care nurse specialist through an analysis of thank you letters written by women with breast cancer in a tertiary hospital in Israel. Descriptive content analysis was used to analyze 125 thank you letters. The findings revealed three aspects of the role of the breast care nurse specialist: instrumental, cognitive, and emotional. The women described these aspects as “paving the way through bureaucracy” (instrumental), being a “traffic light at a crossroad in life” (cognitive), and treating each one of them “as if I am your only patient” (emotional). This analysis highlighted the significance of the breast care nurse specialist in a holistic and integrative role that fills a gap within the biomedical healthcare system. Transferability of the findings to other nurse specialist roles in different clinical settings should be investigated.

Transitions from hospital to community care: the role of patient-provider language concordance.

BackgroundCultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care.MethodsThis was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit.ResultsOverall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01).ConclusionLanguage-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

Stress Intervention: A Model of Stress Inoculation Training

1. The initial clinical experience in a hospital setting has been identified as a major area of threat for beginning nursing students. 2. A stress inoculation program, in which students were exposed to situation similar to future clinical experience, was used to help students develop confidence and coping skills. 3. The program was found to be an effective preparation for clinical experience, mainly in terms of the students clinical performance.

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.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.

Characteristics and behaviours of formal versus informal nurse champions and their relationship to innovation success

AIMS To identify the sociodemographic attributes, project characteristics and champion strategies that differentiate formal from informal nursing champions, and to test their success in terms of project spread and novelty. BACKGROUND Champions spread innovation in healthcare organizations. Empirical research has not explored the differences between formal and informal champions in terms of their antecedents and success. DESIGN A quantitative cross-sectional design. METHOD Data were collected on 93 nursing champions in three hospitals from 2015 - 2016. Champions were identified according to a validated approach; data on their sociodemographic attributes, project characteristics and strategies were assembled through interviews and validated questionnaires. Their success in terms of novelty and spread was assessed via expert ratings and validated questionnaire. FINDINGS Informal champions had longer tenure and were involved mainly in bottom-up projects aimed mostly at improving human resources and services; formal champions were mostly involved in top-down projects aimed at quality control. Informal champions expressed more enthusiasm and confidence about the innovation; formal champions tended to use more online resources and peer-monitoring strategies. Projects of informal champions were more novel than those of formal champions. Project spread did not differ between the two groups. CONCLUSION Formal and informal champions differ in their characteristics and implementation strategies. To encourage projects innovation, the organizational climate should encourage the emergence of informal champions; formal and informal champions should be chosen wisely, assuring that they possess enough organizational resources; and coaching programmes for junior champions should be planned to equip them with championing behaviours.