Who do you Prefer to Take Care of you: A Jewish or an Arab Nurse? Nationality and Religion Preferences in Israeli Hospitals.

Studies show that there are patients who refuse treatment or demand that treatment be provided by a professional belonging to their ethnic group. We investigated whether patients have preferences for nationality and religion of nurses (PFNR), and which factors impact these preferences. The study included 1012 Jews and Arabs. Results show that Arabs and Jews prefer that a nurse of their own nationality and religion treat them. Trust is the most important factor that influences this preference. In the Israeli healthcare system, the patient-nurse encounter is affected by the strong bias that Jews and Arab Muslims hold against each other.

Nursing Cultural Competence in Israel: Does Practice Make It Better?

Because of globalization, immigration, and mass exodus from countries due to political conflicts, there is an ever-changing mix of people with diverse cultural backgrounds who require institutions to provide continuing education to ensure that effective services are provided to everyone. Part of the transcultural challenges involves religion, socioeconomic differences and languages, and ethnic backgrounds that differ. The objective of this study was to examine whether a transcultural training program for undergraduate nursing students in Israel could enhance students' cultural competence. In this study, 319 senior undergraduate nursing students were asked to complete the Transcultural Health Care Screening Questionnaire as a measure of their cultural competence. The students' cultural competence was satisfactory but less than it had been in previous years. The authors suggest that cultural competence needs to be considered as a contextual, developmental, and experiential process that requires ongoing attention and curricular revisions.

Differential Willingness to Pay for Kidney Transplantation From Living and Deceased Donors: Empirical Study Among End-Stage Kidney Disease (ESKD) Patients.

Kidney transplantation has developed to the stage where it is currently the most cost-effective treatment for patients suffering from end-stage kidney disease (ESKD) and, when available, offers them the highest quality of life. Yet, kidney transplantation is challenged by cultural and traditional beliefs; thus, this study sought to evaluate the willingness to pay for a kidney transplant in a culturally sensitive population. A self-administered survey was completed by 734 end-stage kidney disease (ESKD) patients. A quantitative method and survey design were chosen and employed descriptive, correlational, nonparametric, and multivariate statistical tests. Participants were willing to pay a mean amount of $40 751.36 for a living donor kidney transplant, whereas the mean is considerably lower, $18 350.51, for a deceased donor kidney. Significant predictors of the willingness to pay (WTP) for a kidney transplant from a living donor and a deceased donor were found, among them: religiosity and ethnicity. The participants' willingness to pay for a kidney transplant could attest to significant benefits in enhancing patient well-being. The willingness to pay differentially for a donation from a deceased or a living donor stems from the higher chances of success with a living-donor organ as well as from moral and religious motives. In Israel kidney transplantation is not tradable in the free market and is fully funded by the state. The average cost of kidney transplantation in Israel is $61 714.50. Since the cost exceeds the utility and since the economic literature suggests that the funding of healthcare interventions should be provided up to the point where the costs of that funding equal the benefits that society derives from it, crucial revisions in public health policy should be made. Education may have a significant impact on the approach to kidney donation and organ donation in general.

Religious Worldviews Affecting Organ Donation in Israel.

BACKGROUND: The supply of donor organs available for transplantation far exceeds demand in Israel. Organ donation is perceived by many believers as contravening the tenets of their religion. This study investigates the different attitudes toward organ donation of members of the 3 major religions by subgroups and level of religiosity. METHOD: A large convenience sample of Muslims, Jews, and Christians of all subgroups completed questionnaires on organ donation. RESULTS: Notwithstanding the sanctioning by the 3 religions of organ donation, both live and postmortem, the general public demonstrates different levels of disinclination to donate, which is characterized by affiliation to religious subgroups or non-affiliation and the decisions of religious authorities. The secular constitutes an exception within all 3 religions for all research variables. Religious belief as well as its absence are central factors in making personal decisions about organ donation. CONCLUSIONS: To increase organ donation, campaigns aimed at educating the public must consider the religious rulings of each religion and its subgroups and work with their spiritual leaders. Hospital nurses, in particular, who are often closest to the family of a candidate for organ donation, should be familiar with official religious stances on organ donation issues.

Standing on Both Sides: Analysis of a Transplant Coordinator's Ethical Position Between the Recipient and the Donor's Family.

BACKGROUND: When an organ is harvested from a deceased donor, how should transplant coordinators handle the issue of contact between the donor's family and the organ recipient? METHODS: The authors-qualified both by their own considerable practical experience and theoretical investigation-discussed various aspects of the problem, relating to the bioethical issues as well as the practical dilemmas that must be clarified and decided. RESULTS: They proposed a strategy whereby transplant coordinators can analyze their own philosophical attitude toward the issue and respond accordingly in their work to the needs and preferences of both parties. CONCLUSIONS: The professionals handling the transplant process need training tailored to the bioethical issues relevant to the challenges they are likely to confront. This training must consist not only of theoretical and ethical guidance but also simulations designed to clarify the clinician's own personal belief system and raise awareness and self-reflection of their own biases.

The View of the Three Monotheistic Religions Toward Cadaveric Organ Donation.

Religious concerns regarding the legitimacy of cadaveric organ donation have been found to be major inhibiting factors for people to consent to donate organs post-mortem for transplantation; this constitutes a major cause for the grave shortfall of available organs for transplantation. The purpose of this review is to explore the view of the three monotheistic religions, namely Christianity, Islam, and Judaism, toward cadaveric organ donation. The literature review reveals that all three monotheistic religions support cadaveric organ donation but within certain restrictions. We provide a detailed description of the approach of each religion and the inhibiting considerations as interpreted by religious authorities. Health professionals need to collaborate with faith leaders in order to optimize the education of the public of believers with regard to the benefits stemming from organ donation. Developing transplantation medicine does not depend solely on technical capabilities and expertise; rather, this development should go hand in hand with religious, traditional and cultural beliefs and rituals. Providing a believer with a religious authority about cadaveric organ donation is very effective in helping families and individuals cope with difficult and critical decisions.

Christianity, Islam, Judaism, and unwillingness to donate organs post-mortem.

Willingness to donate organs is contingent upon knowledge about and attitude toward organ donation. In order to explore differences between members of the three monotheistic religions: Christianity, Islam, and Judaism, a nation-wide survey was conducted in Israel. Members of all three religions expressed a very low willingness to donate organs postmortem. They had similar levels of knowledge regarding organ donation and similar negative attitudes toward organ donation. The public feels negative regarding the issue, therefore education campaigns should be designed and implemented in order to refute potential misconceptions and hence increase the number of people who sign donor cards.

Evaluating health-related quality of life and emotions in Muslim and Jewish kidney transplant patients.

BACKGROUND: The scholarship on the impact of the source of the donated kidney (living donor (LD) or deceased donor) and the ethnoreligious background on the quality of life post-transplantation have received little scientific attention. The purpose of the present research is to evaluate health-related quality of life and psychological feelings among kidney transplant (KT) recipients. OBJECTIVE: To compare the health related quality of life and psychological feelings between kidney transplant (KT) recipients who received a graft from a living versus a deceased donor, and between Muslim and Jewish patients. METHODS: Two hundred and sixty-two renal recipients completed the health-related quality of life (HRQOL; World Health Organization Quality of Life Brief Version (WHOQOL-BREF)) questionnaire and answered the Transplant Effects Questionnaire assessing their post-transplantation emotional and psychological responses. RESULTS: KT recipients reported medium levels of physical, psychological, social and environmental dimensions of HRQOL. Muslim recipients reported significantly higher levels of physical, psychological and social dimensions of HRQOL than Jews. Recipients of kidneys from LD reported higher levels of HRQOL and reported significantly higher levels of guilt and responsibility to be healthy. CONCLUSIONS: Our findings indicate that receiving a graft from an LD contributes to the HRQOL in the physical, psychological and environmental dimensions. Hence, donations from LD should be encouraged, by investing efforts in promoting public awareness of the importance of donating kidneys by LDs. Muslim KT recipients enjoy better physical, social and psychological HRQOL; this difference can be explained by the supportive and embracing familial and social networks characterizing traditional Arab communities. Post-transplantation support programs should be designed in order to provide further support and improve emotional and psychological responses to postoperative reality.

Religious observance and perceptions of end-of-life care.

This study examines the impact of the level of religious observance on the attitudes toward end-of-life (EOL) decisions and euthanasia of Jews in Israel-where euthanasia is illegal-as compared to Jews living in the USA, in the states where euthanasia is legal. A self-reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations.

Health-related quality of life of transplant recipients: a comparison between lung, kidney, heart, and liver recipients.

BACKGROUND: Quality of life and psychological responses to transplantation are constructs used to assess various psychosocial aspects after organ transplantation. The purpose of this study is to compare physical, psychological, social, and environmental quality of life between recipients of four organs: liver, lung, heart, and kidney. METHODS: In order to compare the four types of quality of life and emotional responses post-transplant, HRQOL and TxEQ questionnaires were administered to 427 transplant recipients. RESULTS: Heart and liver recipients report significantly higher health-related quality of life than lung and kidney recipients. Heart and lung patients report significantly fewer concerns and worries than liver and kidney patients. New additional variables were explored in our study: psychological connection to the living donor/deceased donor's family and commitment to them. We also found that heart recipients feel their personality traits changed, postoperative. CONCLUSIONS: The contribution of our study was the finding that ethno-religious and psychosocial variables have a positive effect on four dimensions of HRQOL. It may be useful to design psychological support interventions specifically adapted to patients after organ transplantation that aim at enhancing patients' HRQOL and alleviating negative emotional responses.

Integrating Ultra-Orthodox Jewish Men in Academic Nursing Training.

As part of the national plan for integrating the ultra-Orthodox Jewish population in academic studies and in order to promote its labor force participation, the Tel Aviv-Yaffo Academic College School for Nursing Sciences created a BSN program specifically for ultra-Orthodox men, for the first time in Israel. Ultra-Orthodox students' entry into the academic world requires the program to be culturally sensitive without compromising on quality standards. The structure and context may be ultra-Orthodox, but the contents and learning experience expose the students to a different worldview than that of their religious studies. The ultra-Orthodox way of life requires adjustments also in the area of learning aids. Most important, the students are exposed to the Internet for the first time, and some of them are even unable to use a computer. The students in the first class of male ultra-Orthodox nursing students are the pioneers of this community. Their academic success in the first stage-and integration in the labor market in the second-is a test of the national labor force integration project.

Israeli emergency department nurses' attitudes to an extension of their role and powers.

AIMS AND OBJECTIVES: To investigate the opinions of Israeli ED nurses as to (1) an expansion of their powers and autonomy in treating commonly presenting ED conditions, (2) whether nurses or physicians should be responsible for giving ED patients necessary information and (3) whether ED nurses should perform triage. BACKGROUND: The development of the new emergency nurse practitioner role has relieved the pressure on emergency departments, reduced patient waiting times and raised patient satisfaction. Israel has yet to introduce either this role or the triage approach into its emergency departments. DESIGN: This investigation was designed as a cross-sectional study by self-administered questionnaire. METHODS: The researchers distributed a questionnaire they had developed and validated to 270 registered nurses working in 18 general hospital emergency departments. The responses were analysed by chi-square and t-tests and anova. RESULTS: Of respondents 60-90% agreed that they should be granted 10 out of a list of 12 new powers, and a large majority thought nurses should be responsible for performing triage. They wanted to increase the information they gave to patients, both on general ED functioning and on specific medically related matters. CONCLUSIONS: The contribution of this study is the positive response of a large representative sample of ED nurses to extending their powers. It will be necessary to establish postregistration training courses and draw up new regulations reshaping the delivery of emergency medicine. RELEVANCE TO CLINICAL PRACTICE: The study demonstrates that ED nurses are convinced that they need the authority to diagnose and treat commonly presenting ED conditions and perform triage and discharge in order for their department to optimally exploit the resources available to it. The study should promote the development of the emergency nurse practitioner role in Israel and so reduce patient waiting times.

Contact between deceased donors' families and organ recipients.

The benefits and disadvantages of posttransplant contact between a donor family and the organ recipient are disputed. In this study far more contacters reported benefits rather than disadvantages and noncontacters reported the opposite. The dissatisfaction of noncontacters with no contact was high: no less than 60% wanted some form of contact in the future. The authors conclude that contact has more benefits for the donor family than disadvantages, evidenced by families' desire to maintain contact with the organ recipient. Both donor families and organ recipients need the transplant coordinator's initiative and guidance on this issue.

The transplant team's role with regard to establishing contact between an organ recipient and the family of a cadaver organ donor.

AIMS AND OBJECTIVES: To understand how the recipients of cadaver-harvested organs and donor families perceive the role of the transplant team and transplant coordinator in bringing them into contact. BACKGROUND: Studies dispute the benefits and disbenefits of contact and their differential weights with the two parties. For the donor family, contact with the recipient after a successful transplant renders positive meaning to the tragedy of the family's loss, but expectations of the recipient can also be disappointed. For recipients, contact with the donor family lets them express gratitude and shake off the guilt of having their life saved by a death but can also draw them into the family's mourning and into feeling the family are owed a 'return' for their life-saving gift. The transplant team have to weigh these potential benefits and disbenefits. If the answer is positive, what should they do to bring the contact about? DESIGN: A sample of 135 donor family members and organ recipients (representing all successful transplants in Israel from 1998-2007) were interviewed by structured questionnaire. Some had made contact, some not. METHOD: Data were analysed by means, frequencies and correlation coefficients. RESULTS: Far more 'contacters' than 'non-contacters' wanted the transplant coordinator to take an active role in establishing contact. No less than 60% of non-contacters wanted contact in the future, and 50% were dissatisfied with the absence of contact. CONCLUSIONS: This is the first study to investigate the benefits and disbenefits of not making contact. Both donor families and organ recipients would respond positively to the coordinator taking the initiative in establishing mutual contact. RELEVANCE TO CLINICAL PRACTICE: Transplant coordinators are given convincing backing for taking the initiative in promoting contact between donor families and organ recipients. The coordinator's intervention, information and guidance are needed to make a success of such contact.