The protective role of sense of coherence in resident physicians facing secondary trauma due to patient death in intensive care-A qualitative inquiry.

The salutogenic paradigm is increasingly used in research and practice but remains to be investigated in secondary trauma of health professionals. This qualitative study explored the main anchor of salutogenics, the sense-of-coherence, as a coping mechanism among resident physicians facing secondary trauma due to continuous exposure to patient suffering and deaths. Participants were sixteen resident physicians from intensive care units at emergency departments of two Israeli public tertiary hospitals. Data analysis employed reflexive thematic analysis. Findings suggest that while all residents described having comprehensibility, manageability and meaningfulness differed among residents. Some residents thrived, coped well with secondary trauma, centered on patient emotional needs, and drew meaningfulness from the challenges. Other residents suffered while providing care, reported poor well-being, were too overwhelmed to center patients, and doubted their career choices. Salutogenic-based interventions to cultivate the resilience of resident physicians experiencing secondary trauma are proposed.

Association of quality of nursing care with violence load, burnout, and listening climate.

BACKGROUND: Violence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept. METHODS: We sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected. RESULTS: There were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care. CONCLUSIONS: The results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.

Professional burnout among expert physicians, patient-focused care, and trust in top management: Moving forward.

INTRODUCTION: Professional burnout in physicians is perceived as an inevitable occupational hazard inhibiting patient-focused care, the preferred approach of care, which enhances satisfaction of physicians with their work and improves clinical outcomes. Burnout jeopardizes the physical, mental, and emotional health of physicians, inhibiting high-quality care. Most individual-driven interventions and job-level interventions to reduce burnout proved inefficient or reduced burnout for only a short term. The potential of organizational processes to reduce burnout was acknowledged but is yet to be empirically tested. Drawing on social exchange theory, this study investigates the role of an organizational phenomenon, organizational trust among physicians in top management, on burnout. METHODS: Data were collected across specialties in 10 out of 20 Israeli public general hospitals. The sample comprised 798 senior expert physicians. Measures were all previously published. Structural equation modeling was performed. RESULTS: Response rates ranged from 17% to 77% across the 10 hospitals. Mean burnout was 4.7 (SD = 0.68), mean patient-focused care was 3.9 (SD = 0.79), and mean organizational trust was 3.7 (SD = 0.84). Mean burnout for women was 5.6 and for physicians from internal medicine was 5.5. The structural equation modeling supported the proposed study model, which explained 45% of burnout. Organizational trust reduced burnout by 14%. DISCUSSION: Efforts to reduce burnout should integrate effective individual-level and job-level interventions with building trust among physicians in top management through implementing the paramount professional value of patient-focused care. CONCLUSIONS: Perceiving management, among physicians, as facilitating the value of patient-focused care led to organizational trust in top management, which was negatively associated with burnout.

Personalizing Communication of Clinicians with Chronically Ill Elders in Digital Encounters-A Patient-Centered View.

BACKGROUND: Chronically ill elderly patients are concerned about losing the personal connection with clinicians in digital encounters and clinicians are concerned about missing nonverbal cues that are important for the diagnosis, thus jeopardizing quality of care. AIMS: This study validated the expectations and preferences of chronically ill elderly patients regarding specific communication messages for communication with clinicians in telemedicine. METHODS: The sample comprised 600 elderly chronically ill patients who use telehealth. We used a conjoint-based experimental design to test numerous messages. The outcome variable is elder patient expectations from communication with clinicians in telemedicine. The independent variables were known categories of patient-clinician communication. Respondents rated each of the 24 vignettes of messages. RESULTS: Mathematical clustering yielded three mindsets, with statistically significant differences among them. Members of mindset 1 were most concerned with non-verbal communication, members of mindset 2 prefer communication that enhances the internal locus of control, and members of mindset 3 have an external locus of control and strongly oppose any dialogue about their expectations from communication. CONCLUSIONS: The use of the predictive algorithm that we developed enables clinicians to identify the belonging of each chronically ill elderly patient in the clinic to a sample mindset, and to accordingly personalize the communication in the digital encounters while structuring the encounter with greater specificity, therefore enhancing patient-centered care.

Experiencing and witnessing disruptive behaviors toward nurses in COVID-19 teams, patient safety, and errors in care.

BACKGROUND: Nurse managers and team co-workers' disruptive behaviors (DBs) are negatively associated with a perceived safe climate. Moreover, DBs are a risk factor for patients' safety. Yet, it remains unknown whether and to what extent these effects were prevalent in COVID-19 wards and among witnesses of DBs. DESIGN: A cross-sectional study. METHODS: A questionnaire was distributed on social networks and completed by nurses in various Israeli healthcare organizations using snowball sampling between October and December 2021. The questionnaire included seven previously published measures and a question checking whether the participants had worked in a COVID-19 ward. The minimal sample size for any analysis was 236. Hypotheses were tested with correlations and structural equation modeling. RESULTS: DBs of nurse managers and team co-workers toward nurses were higher in COVID-19 teams. As hypothesized, DBs were negatively correlated with a safe climate and positively with patient safety (fewer errors). The data were consistent with a model suggesting that a safe climate is related to fewer DBs and DBs largely mediate the effects of safe climate on errors. Surprisingly and importantly, the strongest predictor of errors, including preventable mortality, is witnessing DBs and not being a victim of DBs. CONCLUSIONS: DBs may impede open communication and collaboration among co-workers, particularly in COVID-19 teams. This study shows the links between nurse shaping of a safe climate, DBs toward nurses, and patient safety. CLINICAL RELEVANCE: Nurse managers who create a safe climate and show zero tolerance for DBs could reduce the risk of errors in care.

An Adlerian-Based Narrative Inquiry of Temporal Awareness, Resilience, and Patient-Centeredness Among Emergency Physicians-The Gyroscope Model.

INTRODUCTION: Although extensive research examined time perceptions among patients in the emergency department (ED), studies on temporal awareness among emergency physicians is scant. Salutogenics is the theoretical anchor. METHODS: The sample comprised ten emergency resident physicians from an Israeli public tertiary hospital. Narrative interviews were conducted. To determine the theme of the study, Adlerian narrative analysis was performed. To identify categories, semantic and content analyses were performed. RESULTS: Adlerian narrative analysis highlighted temporal awareness as a strong theme across interviews. Semantic and content analyses identified categories within temporal awareness. Analyses revealed a movement among three subcategories: A clinical task in which physicians rapidly shift along seven distinct times, temporal awareness shaping their work experience, and temporal awareness as inhibiting or enabling relationships with patients. Data-analyses identified two groups of physicians, one group driven by the need to control the time to avoid errors, experiencing anxiety and poor wellbeing, and the other, shifting from clinical tasks to patient-centeredness while removing the time factor from their considerations and experiencing resilience through manageability and meaningfulness. We introduce the "gyroscope model" for physicians to illustrate these findings and propose recommendations for practice. DISCUSSION: Understanding the complexity of the temporal continuum and the influence of shifting from the clinical task to relationships with patients may contribute to resilience of resident physician in the ED and to their self-efficacy, enriching their professional skills and capacity to cope and grow while facing the complexity of the ED.

Invalidating the Leadership of Muslim Spiritual Leaders in Death From COVID-And Shaping the Grief Journey - A Narrative Inquiry.

This narrative study voices the perspectives of a hidden population, spiritual leaders of the Muslim minority in Israel whose leadership in attending to deaths throughout COVID-19 was invalidated. Findings elucidate their dilemmas as being responsible for protecting the community from infection on one hand, and for guiding religious death rituals and preventing disenfranchised grief of families and the community on the other hand. Denying religious minorities their right to conduct traditions in a safe manner and leaving spiritual leaders outside of decision making on shaping COVID-19 guidelines creates distrust and deepens aggravation of enfranchised grief. As the global society is becoming religiously fragmented, distrust of religious minorities in health authorities due to denial of burial of death rituals, funerals, and burials, may have societal consequences and must be considered. Recommendations of this study may assist authorities in creating guidelines that accord with the laws, traditions, and values of religions minorities, empowering their spiritual leaders.

Personalized Communication with Patients at the Emergency Department-An Experimental Design Study.

Communication of clinicians at the emergency department is a barrier to patient satisfaction due to lack of human connection, lack of control over the situation, low health literacy, deficient information, poor support at a time of uncertainty all affecting perceived quality of care. This explorative study tests drivers of patient satisfaction with communication of clinicians at the emergency department. The sample comprises 112 Americans from the New York greater area, who visited an emergency department in the past year. A conjoint-based experimental design was performed testing six messages in six categories. The categories encompass acknowledged aspects of communication with health providers enabling to compare among them when exploring communication at the ED by patient preferences. Respondents rated messages by the extent to which it drives their satisfaction with communication of clinicians at the emergency department. Based on the similarity of patients' response patterns to each message, three significantly distinct mindsets of patient preferences regarding communication exchanges with clinicians at the emergency department emerged. Different conduct and communication messages drive the satisfaction of members of each mindset with the communication of clinicians at the emergency department. The strong performing messages for one mindset are irrelevant for members of other mindsets. Clinicians may identify the patient-belonging to a mindset and communicate using mindset-tailored messages. This novel strategy may enable clinicians to implement patient-centered communication, by mindset, promoting patient satisfaction and enabling clinicians to better cope with patients in the chaotic emergency department environment.

An Inverted Container in Containing and Not Containing Hospitalized Patients-A Multidisciplinary Narrative Inquiry.

Objective: Patient-centered care calls to contain patients in their time of crisis. This study extends the knowledge of provider patient interactions in the hectic environment of acute care applying Bion's container-contained framework from psychoanalysis. Methods: Following ethical approval, we performed a narrative inquiry of the experiences of ten patients upon discharge from lengthy hospitalizations in acute care. Interviews were conducted upon discharge and about one-month post-discharge. Findings: Data analysis suggests four modes of containing of patients by providers. In nurturing interactions, typical of an active container-contained mode, patients experienced humanized care, symptom control, hope, and internal locus of control. This mode yielded patient gratitude toward providers, wellbeing, and post-discharge self-management of diseases. In rigid and wall-free modes of containing, patients experienced a sense of powerlessness and discomfort. A new mode of container-contained was identified, the "Inverted Container", which extends Bion's theory and contradicts patient-centered care. In inverted containers, patients contained the providers yet reported feeling gratitude toward providers. The gratitude constitutes a defense mechanism and reflects a traumatic experience during hospitalization, which led to post-discharge distrust in providers and hospitals and poor self-management of illness. Conclusions: To effectively provide patient-centered care, provider-patient interaction in lengthy hospitalizations must move along a clinical axis and a relationship axis. This shifting may facilitate containing patients in their time of crisis so essential processes of reflection, projection, and transference are facilitated in-hospital care.

Metaphors of War in Effective and Ineffective Coping of Medical Directors of COVID-19 Wards in Public Hospitals.

The COVID-19 pandemic has challenged medical professionals worldwide with an unprecedented need to provide care under conditions of complexity, uncertainty, and danger. These conditions, coupled with the unrelenting stress of overwhelming workloads, exhaustion, and decision-making fatigue, have forced clinicians to generate coping mechanisms. This qualitative study explored the use of metaphors as a coping mechanism by clinical directors of COVID-19 wards in Israeli public general hospitals while they were exposed to death and trauma throughout the pandemic's first wave in Israel (March to June 2020). The study employs discourse methodology and metaphor mapping analysis to capture the personal, organizational, and social dimensions of effective and ineffective processes of coping with an extreme health crisis. Analysis revealed that the metaphors that clinical directors used reflect a dual process of mediating and generating the social construction of meaning and facilitating effective and ineffective coping. Effective coping was facilitated by war metaphors that created a sense of mission and meaningfulness at both the organizational and the individual levels. War metaphors that generated a sense of isolation and sacrifice intensified helplessness and fear, which undermined coping. We propose actionable recommendations to enhance effective coping for individuals and organizations in this ongoing pandemic.

Corrigendum: From a View of the Hospital as a System to a View of the Suffering Patient.

[This corrects the article DOI: 10.3389/fpubh.2021.800603.].

Death From COVID-19, Muslim Death Rituals and Disenfranchised Grief - A Patient-Centered Care Perspective.

In Islam, religious directives regarding death are derived from the Quran and Islamic tradition, but there is a variety of death rituals and practices, lived by Muslims across contexts and geographies. This narrative study explored the dynamics of death and bereavement resulting from COVID-19 death among religious Muslims in Israel. Narrative interviews were conducted with 32 religious Muslims ages 73-85. Findings suggest several absent death rituals in COVID-19 deaths (i.e., the physical and spiritual purification of the body, the shrouding of the body, the funeral, and the will). Theoretically, this study linked death from COVID-19 with patient-centered care, highlighting disenfranchised grief due to the clash of health authority guidelines with religious death practices. Methodologically, this narrative study voices the perspectives of elder religious Muslims in Israel. Practically, this study suggests ways to implement the cultural perspective in COVID-19 deaths and enable a healthy bereavement process.

Shared trust of resident physicians in top-management and professional burnout: A cross-sectional study towards capacity for patient-focussed care, peer support and job expectations.

RATIONAL: Hospitals desire to achieve the strategy of patient-centred care but burnout inhibits its implementation. Management has a role in responding to needs of patients, junior professional staff, and the hospital, in the present and future. AIM: To test the association between shared organisational trust (OT) of resident physicians in top-management, a systemic organisational process, and professional burnout among residents. METHODS: Participants in this cross-sectional study, are 316 residents assigned to 31 internal medicine departments at eight out of 15 academic Israeli general public hospitals in various locations and sizes. All measures were published: Burnout, patient-focussed care, shared trust in top-management, and antecedents of organisational trust, which are: peer support, clinical autonomy, meeting expectations, and value congruence. Structural Equation Modelling was performed. RESULTS: The structural equation modelling model was recursive, explaining 14% of the variance in burnout. Shared trust in top-management was the strongest antecedent of burnout. The facilitation of patient-focussed care created shared trust in top-management which reduced burnout. DISCUSSION: To achieve patient-centred care, management is called upon to reduce burnout by aligning organisational processes with patient-focussed care. Shared trust in top-management may reduce burnout and enhance residents' sense of meaningfulness, engagement, and well-being.

Science and behavioral intentions among Israeli Jewish ultra-Orthodox males: Death from COVID-19 or from the COVID-19 vaccine? A thematic study.

The COVID-19 vaccine is a scientific breakthrough to end the pandemic. We explore perceptions underlying behavioral intentions toward the COVID-19 vaccine among ultra-Orthodox Jewish males in Israel upon rollout of the vaccine. Forty-two men aged 36-56 years participated in in-depth interviews. The theoretical anchor is Miller's theory of scientific literacy. The research questions are "What perceptions shape rejection of the COVID-19 vaccine?" "What perceptions shape hesitancy and deterrence toward the COVID-19 vaccine?" and "What social forces shape behavioral intentions toward the COVID-19 vaccine?" Thematic data analysis demonstrated six themes of vaccine rejection and four themes of hesitation toward vaccination. The social forces shaping behavioral intentions are the local community's leader and the national religious authority. We highlight the need to enhance scientific literacy and reduce suspicion through collaborative community-based work among health professionals from the community, religious leaders, and lay leaders to increase acceptance of the COVID-19 vaccine.

Sexual harassment of religious Jewish nurses by patients and its relation to the ward's listening climate, care avoidance and quality of nursing care.

AIM: This study aimed to examine the associations between religious Jewish nurses' exposure to sexual harassment by patients, the ward's listening climate, the quality of nursing care and nurses' avoidance of therapeutic contact with harassing patients. BACKGROUND: A few studies have examined nurses' exposure to sexual harassment by patients, but this phenomenon has not been studied among religious Jewish nurses. METHODS: This is a cross-sectional study of 85 nurses who study at a religious Jewish nursing school. Respondents completed self-administered structured questionnaires. Multiple regression analysis was performed to reveal antecedents of the quality of nursing care provided to sexually harassing patients. RESULTS: The more religious the nurses, the more they avoided therapeutic contact with harassing patients. The strongest predictor of reported quality of care for harassing patients was the avoidance of therapeutic contact. Forty-two per cent of the variance in reported quality of nursing care was explained by the employment type and by the avoidance of therapeutic contact, which was related to the nurses' level of religiosity. CONCLUSIONS: Nurses' level of religiosity is related to the quality of care provided to sexually harassing patients. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leadership must raise awareness of sexual harassment by patients and develop policy and implementation programmes with sensitivity to religious nurses.

Rapid discovery of optimal messages for behavioral intervention: the case of Hungary and Covid-19.

The right messaging plays an important role in the fight against the spread of COVID-19. The present study aims at uncovering the way people think about governmental measures against COVID-19. Two hundred and sixteen Hungarians participated in this on-line study. A conjoint-based experimental design was used to reveal the power of messages as drivers of voluntary social distancing based on the perceived risk of COVID-19, the ways to practice social distancing and to assure it, and preferences regarding the communicator of the social distancing policy. Results revealed three major mindsets: Pandemic observers, Order-followers, and Health-conscious. Members of each mindset respond differently to messages. To enhance compliance with social distancing and contain the virus, we suggest using the prediction tool we developed to identify the belonging of people or groups in the population to mindsets in the sample and address people using effective mindset-tailored messaging.