The Suitability of Measuring Patient-Reported Outcomes in Older Adults Following a Hip Fracture Using the Short-Form 36 Questionnaire: A Qualitative Description Approach.

Hip-fractures (HF) in older adults are associated with poor outcomes and high costs. Measuring quality-of-care of HF patients has focused on clinical definitions rather than on measuring outcomes that are meaningful to the patient. Healthcare systems worldwide are increasingly interested in patient-reported outcome measures (PROs). The Short-form (SF36) questionnaire is a recommended measure among older adults however it's comprehensiveness and uniqueness for specific patients after a HF is not clear. The aims of this study were to: understand the perspective of the older adults experience following HF, to assess the suitability of the SF36 as a PRO for HF and to determine the best timing for questioning. A qualitative description approach was used. This took place in 2 large academic medical-centers in Israel. The inquiry was done in 2 parts by semi-structured interview. A total 15 HF patients were interviewed. Categories and themes emerging from their responses were similar to the 8 domains of the SF36 questionnaire, but the participants added clarity regarding their own needs for setting goals. In the second part, participants agreed that the SF36 reflected common issues and served as an adequate measure for personal-goal setting. The study encourages patient-centered care in older adults recovering from HF, providing evidence that the SF36 is a suitable tool for measuring PROs in HF patients. Healthcare systems focus on clinical-outcome indicators and do not reflect how the patient views his outcomes. This study provides evidence that care should be customized for each person.

Development of collaborative family nurse practitioner education using physician preceptors: A focused critical ethnographic study.

BACKGROUND: Global oppressive power structures in healthcare systems and between professions hinder care delivery. The family nurse practitioner is a new role in Israel. Through an innovative international collaborative education partnership, 19 Israeli nurses were trained as family nurse practitioners. Israeli physician preceptors integrated them into a national health maintenance organization despite national and organizational resistance. OBJECTIVES: Explore Israeli physicians' experiences while providing clinical mentorship to family nurse practitioners and develop strategies for the implementation of the new community role. DESIGN: Qualitative focused critical ethnographic approach. PARTICIPANTS: Eleven Israeli physician preceptors were recruited from a larger pool of 50. METHODS: Physicians were interviewed via recorded phone calls and asked open-ended questions about precepting family nurse practitioners. Observations of the program were included from the year prior to the interviews. Data were analyzed using Carspecken's five steps for critical ethnographic approach. RESULTS: Three categories for transforming the current status were identified: role clarification, logistics, and collaborative education. Exemplar cases described collaborative practice regarding measurable outcomes. Learning happened through "shadowing" and "coaching" techniques. Findings led to the Collaborative Team Development Illustration which mirrors current recommendations from the World Health Organization and Institute of Medicine. CONCLUSIONS: The Collaborative Team Development Illustration offers a structured strategy for advocacy and transformation in other oppressive health systems considering introducing nurse practitioners. This paper provides evidence that physician participants believed partnerships with nurse practitioners could improve patient care delivery. We hope this research will contribute to changing power relations in healthcare and improve outcomes. This may offer hope for integration of family nurse practitioners in countries that currently do not support advanced practice nursing roles.

Integration of advanced practice providers into the Israeli healthcare system.

Many countries around the world have integrated various types of Advanced Practice Providers (APPs) into their healthcare systems. The main motivating factors for recognizing and developing APPs worldwide include physician shortages and the need for improved access or delivery (US, France, Belgium, Scotland, Switzerland), reduced residency hours (US, UK), shortages in underserved regions (US, Canada, Finland, Australia), and cost containment (Germany, Netherlands, UK, US). Israel is experiencing a shortage of physicians in peripheral geographic regions and in critical medical specialties. Recent by-laws approved by the Knesset (Parliament), combined with Israel Ministry of Health (MOH) policies, have thus far been unable to fully address the shortages. To understand the potential contribution of APPs in Israel, we evaluated the international historical foundations and development of APP roles. We assessed how APPs have impacted healthcare in other countries by analyzing public data and published international research about APP education, safety, quality of care, motivators, barriers, and impact. We found that APPs are recognized in dozens of countries, and have similar scopes of practice, graduate level education requirements (in developed countries), and clinical training. At the same time, there is wide variability among countries in the actual function and independence of the advanced practice nurse (APN), particularly the nurse practitioner (NP). APPs have been established as cost effective, safe healthcare providers who improve healthcare access. Israel has begun to introduce APPs, specifically NPs, in a variety of fields, including geriatrics, palliative care and diabetic care. We recommend a rapid expansion of existing and new APP roles into the Israeli healthcare system based on evidence and the recommendations of international evaluations by non-government organizations. By shifting the education to a university setting, mirroring successful, evidence-based, and established APP models found internationally, Israel could lessen the projected Israeli physician shortage, improve healthcare access in specific areas, and bolster existing resources towards a larger and richer pool of healthcare providers in Israel.

Developing a measure of cultural-, maturity-, or esteem-driven modesty among Jewish women.

Understanding modesty and how it relates to religiosity among Jewish women was relatively unexplained, and as part of a larger study, a measure was needed. The purpose of this article is to report on three studies which represent the three stages of instrument development of a measure of modesty among Jewish women, "Your Views of Modesty": (a) content/concept definition; (b) instrument development; and (c) evaluation of the psychometric properties of the instrument: reliability and validity. In Study I, Q methodology was used to define the domain and results suggesting that modesty has multidimensions. In Study II, an instrument was developed based on distinctive perspectives from each group or what was important and not so important. This formed a 25-item Likert scale. In Study III, a survey of 300 Jewish women revealed internal consistency estimates with Cronbach's alpha 0.92, indicating high degree of internal consistency reliability for "Your Views of Modesty." For construct validity, four factors were found explaining 55% of the variance of modesty: (a) religion-driven, (b) maturity-driven, (c) esteem-driven, and (d) public-based modesty was identified. "Your Views of Modesty" shows good evidence for reliability and validity in this Jewish population.

Defining and exploring modesty in Jewish American women.

Whether culture-based modesty may be a barrier to women's health care has been a longstanding question. Numerous studies have noted that, in certain cultures, modesty is considered a barrier to mammography screening and breast feeding. Though modesty has been noted as an inherent aspect of the lived experience of many cultures, no extant measures or clear definitions were found. Jewish women, some having strict rules regarding modesty, were sampled to understand their definition of modesty. These perspectives were objectively analyzed using Q methodology. We found that although some perspectives on modesty may be accounted for by culture, there are others that are not.