Barriers to Adopting Healthy Lifestyle and Health Promotion among Ethnic Minority Bedouin Women in Southern Israel: A Qualitative Study.

BACKGROUND: A healthy lifestyle is a crucial step in disease prevention and management, as well as a significant predictor of health promotion. Yet, despite an increase in chronic morbidity among Bedouin women in southern Israel, little research has been conducted on their health behaviors. Therefore, the aim of this study is to examine barriers to adopting a healthy lifestyle and health promotion among ethnic minority Bedouin women in southern Israel. METHODS: This qualitative study was based on data collected through focus groups during June and July 2021. Participants included 44 Bedouin women aged 18-55. Focus groups were recorded and transcribed. Transcriptions were thematically analyzed and coded using the ecological model. RESULTS: We found multiple barriers at various levels that prevent Bedouin women from adopting a healthy lifestyle and health promotion. At the individual level, such factors included the impact of financial limitations on healthful nutrition, as well as a lack of awareness or knowledge regarding healthy lifestyle and health promotion. At the organizational level, barriers include a lack of clinics, accessibility, and availability of health services and cultural incompatibility of the health services. At the community level, impediments to a healthy lifestyle include inaccessibility to sports facilities and suppression of physical activity. At the public policy level, participants, especially those living in unrecognized villages, described difficult living conditions related to environmental and social neglect as affecting their health status and ability to maintain a healthy lifestyle. CONCLUSION: Study findings emphasize the need for policymaking and a systemic approach to address health disparities and ensure equal health promotion for the Bedouin population.

Components of professional satisfaction among novice nurses.

BACKGROUND: In Israel there are only 6.53 nurses per 1000 citizens, compared to 8.8 nurses per 1000 citizens in the OECD countries. The nursing shortage is even more severe in peripheral areas, especially in southern Israel. Nurses` professional satisfaction is crucial for preserving the nursing workforce. This study aimed to assess job satisfaction among novice nurses and identify components of professional satisfaction. METHODS: Cross-sectional study of 216 novice nurses who graduated in 2018-2022 and were approached ten months after graduation. Job satisfaction components were constructed using factor analysis. RESULTS: Professional satisfaction was based mainly on the intrinsic characteristics of the occupation related to personal accomplishment and organizational culture. In a multivariable model, a one-point increase in mean satisfaction with the training period during studies in the nursing department was associated with a more than a three-fold elevation in the odds for high and very high professional satisfaction (OR 3.0, 95% CI 1.7-5.1). Odds for high and very high professional satisfaction were more than four-fold and two-fold higher among graduates who rated their level of control over work schedule as high and medium vs. low (OR 4.2, 95% CI 1.0-16.7 and OR 2.8, 95% CI 1.2-6.3, respectively). Work-life balance without disturbance to daily life by work was found significantly associated with higher odds for high and very high satisfaction. Nurses who plan to continue professional development, i.e., an advanced professional course or Master's degree, had significantly higher mean professional satisfaction scales than others (4.2 vs. 3.7, p = .009 and 4.2 vs. 3.9, p < .001, respectively). CONCLUSION: The most important components of professional satisfaction among novice nurses are self-accomplishment, which was built from work-related challenges, interest and variety of tasks, personal growth and development, and the possibility of contributing to patients` care and organizational culture, which was built from relationships with co-workers. Persons who manage nurses should cultivate an atmosphere of support and guidance, provide new nurses with interesting work tasks, and increase their ability to control their work schedule. Young nurses should be encouraged to continue their professional and academic education.

Family Income and Low Birth Weight in Term Infants: a Nationwide Study in Israel.

OBJECTIVES: To explore the influence of income on Low Birth Weight (LBW), taking into account other socio-economic measurements. METHODS: This retrospective cohort study is based on the Israel National Insurance Institute (NII) database. The study population included 58,454 women who gave birth between 2008 and 2013 to 85,605 infants. Only singleton births at term (gestational age in weeks = 37 and later) were included. Logistic regression models with a Generalized Estimating Equation approach were used in order to assess the independent effect of income and Socio-Economic Regional Index (SERI), maternal age, family status, population group and occupational status on LBW. In addition, sibling analysis was conducted to assess the influence of a change in income on birth weight (BW) among 21,998 women. RESULTS: Lower income was associated with higher odds of LBW (odds ratio (OR) = 1.266; 95% CI:1.115-1.437. Immigrants from Ethiopia, Bedouins from the Negev, the youngest, the oldest, and single mothers had higher odds for LBW newborns. Compared to women whose income quartile had not changed between the most recent and the first births, for women who experienced a deterioration of three and two quartiles in family income, significantly lower birth weight was observed at the time point with lower income: 103 g (p = .049) and 71 g (p = .008), respectively. Improvement in income revealed an almost linear increase in birth weight. CONCLUSIONS FOR PRACTICE: In an effort to prevent LBW associated mortality and diseases, interventions should be focused first of all on women from population groups who are disadvantaged.

Personal initiative and work environment as predictors of job satisfaction among nurses: cross-sectional study.

BACKGROUND: Job satisfaction contributes to better work outcomes and productivity, and reduces nurses' absenteeism and turnover. The contribution of personal initiative to the interaction between these variables needs additional examination. This study aimed to examine the relationships between personal initiative, work environment, and job satisfaction among nurses. METHODS: This was a cross-sectional study. The convenience sample consisted of 1040 nurses working in hospitals across the country. Data were collected by a structured self-administered questionnaire measuring: (a) personal initiative, (b) nursing work environment, (c) job satisfaction. RESULTS: Personal initiative and work environment scores, together with demographic and occupational characteristics that univariate analysis showed to be significantly associated with job satisfaction, were included in a logistic regression model to predict job satisfaction. The results of multivariable analysis indicated that female gender, working in emergency room (ER) and pediatric wards, a higher personal initiative, and positive perception of work environment, were significantly associated with higher job satisfaction. Work in the ER and pediatric area of practice was significantly associated with five-fold (OR = 4.97; 95% CI 1.52-16.25) and three-fold higher odds (OR = 2.85; 95% CI 1.17-6.91) for high and very high job satisfaction in comparison with work in oncology. The model explained 32% of the variance in job satisfaction. CONCLUSIONS: The findings demonstrate that high personal initiative together with positive perceptions of the nursing work environment, contributed significantly to the explanation of job satisfaction. There is a need to invest more efforts in strengthening the organizational climate stimulating initiative behavior and encouraging nurses to be active, share knowledge, and promote innovation.

Nurses' occupational satisfaction during Covid-19 pandemic.

BACKGROUND: Covid-19 has brought healthcare workers in general and nurses in particular into the limelight as never before. It is important to study the intensity of the impact of this pandemic on the profession. OBJECTIVE: This study aims to assess the occupational satisfaction during the pandemic of Covid-19 among the nurses in Israel, to shed light on conditions of work and to identify factors associated with low occupational satisfaction. METHODS: Cross-sectional study of 130 Israeli nurses. Minnesota Satisfaction and Measure of Job Satisfaction questionnaire with 28 items was used to assess occupational satisfaction. RESULTS: In the multivariable model, nurses working in the community had higher occupational satisfaction than those working in hospitals (ß = 0.24, p = .032); nurses who took care of patients who tested positive for Covid-19 had significantly lower occupational satisfaction than others (ß = -0.48, p = .009). Most of the sample reported lack of personal protective equipment (PPE). Nurses who experienced lack of PPE reported lower occupational satisfaction than those who did not (3.4 vs. 3.8, p = .039). Occupational satisfaction was mainly based on the component, built by the intrinsic characteristics of the occupation related to the personal accomplishment. Most of nurses had to increase their workload as a result of staff shortages, but the elevation of the workload was not associated with lower occupational satisfaction. CONCLUSION: Even under the circumstances of the pandemic, the most important nurses` occupational values are worthwhile accomplishments, importance of professional challenge, diversity and interest in the job, personal growth and development and independence in their practice.

Views of Bedouin physicians and nurses on nursing as a profession in Israel: There is more to strive for.

Bedouin society poses challenges to attempts at modernization. Great efforts are being made to expand the number of nurses coming from the Bedouin population. This cross-sectional study among 201 Bedouin nurses and physicians from southern Israel examined differences in their views on nursing as a profession and its relationship to the working environment, using a self-administered questionnaire. Bedouin physicians demonstrated less positive attitudes towards the nursing profession than did nurses, but perceived the nursing work environment more positively. Compared to nurses, physicians ranked both nurses' involvement in policy practice and their clinical contribution to quality care lower, but scored nurses' dependence on physicians' orders higher. They also ranked teamwork and professional nursing development higher, and the autonomy of nurses lower. In conclusion, the perception of nursing as a profession in Bedouin society is linked to cultural fundamentals, gender, and the social status of women. Managers of multicultural teams, especially those including Bedouin-origin healthcare workers, should be aware of the effect of cultural background and should take care to address social disparities and eliminate differences in perspectives.

Nursing Students in Crisis Mode: Fluctuations in Anxiety During the COVID-19-Related Lockdown.

BACKGROUND: The COVID-19 pandemic initiated a period of new and difficult challenges for nursing students. PURPOSE: The aim of this study was to assess the change in levels of anxiety and ways of coping when the lockdown was being lifted compared with the period of the most severe lockdown restrictions. METHODS: First- to fourth-year nursing students in Israel (N = 244) completed 2 surveys conducted during the initial lockdown and 5 weeks later. RESULTS: When the restrictions were lightened, the mean anxiety score decreased from 9.3 to 7.5 (P < .0001). Among Muslims students, the trend was the opposite, and anxiety levels increased. Stronger resilience was associated with lower odds for anxiety. Mental disengagement and information seeking were associated with higher anxiety levels. CONCLUSIONS: The pandemic created unparalleled stressful situations for nursing students. Faculty should have heightened awareness of these stressors and act to implement innovative resolutions for the problems that arise.

Ethnic disparities in receiving benefits for disability following postpartum mental illness during first two years after delivery: an Israeli nationwide study.

BACKGROUND: Despite relatively high rates of Postpartum Depression (PPD), little is known about the granting of social security benefits to women who are disabled as a result of PPD or of other postpartum mood and anxiety disorders (PMAD). This study aims to identify populations at risk for underutilization of social security benefits due to PMAD among Israeli women, with a focus on ethnic minorities. METHODS: This retrospective cohort study is based on the National Insurance Institute (NII) database. The study population included a simple 10% random sample of 79,391 female Israeli citizens who gave birth during 2008-2016 (these women delivered a total of 143,871 infants during the study period), and who had not been eligible for NII mental health disability benefits before 2008. The dependent variable was receipt of Benefit Entitlement (BE) due to mental illness within 2 years following childbirth. Maternal age at delivery, population group, Socio-Economic Status (SES), family status, employment status of the mother and her spouse, and infant mortality were the independent variables. Left truncation COX proportional hazard model with time-dependent variables was used, and birth number served as a time discrete variable. RESULTS: Bedouin and Arab women had significantly lower likelihood of BE (2.6 times lower and twice lower) compared with other ethnic groups (HR = 0.38; 95% CI: 0.26-0.56; HR = 0.47; 95% CI: 0.37-0.60 respectively). The probability of divorced or widowed women for BE was significantly higher compared to those living with a spouse (HR = 3.64; 95% CI: 2.49-5.33). Lack of employment was associated with higher likelihood of BE (HR = 1.54; 95% CI: 1.30-1.82). Income had a dose-response relationship with BE in multivariable analysis: lower income was associated with the nearly four-fold greater probability compared to the highest income quartile (HR = 3.83; 95% CI: 2.89-5.07). CONCLUSIONS: Despite the exceptionally high prevalence of PMAD among ethnic minorities, Bedouins and Arabs had lowest likelihood of Benefit Entitlement. In addition to developing programs for early identification of postpartum emotional disorders among unprivileged ethnic groups, awareness regarding entitlement to a mental health disability allowance among ethnic minorities should be improved.

Anxiety and coping strategies among nursing students during the covid-19 pandemic.

Anxiety is highly prevalent among nursing students even in normal circumstances. In Israel during the covid-19 pandemic and mandatory lockdown, nursing students encountered a new reality of economic uncertainty, fear of infection, challenges of distance education, lack of personal protection equipment (PPE) at work etc. The objective of this study was to assess levels of anxiety and ways of coping among nursing students in the Ashkelon Academic College, Southern District, Israel. A cross-sectional study was conducted among all 244 students in the nursing department during the third week of a national lockdown. Anxiety level was assessed using the Generalized Anxiety Disorder 7-Item Scale with a cut-off point of 10 for moderate and of 15 for severe anxiety. Factor analysis was used to identify coping components. The prevalence of moderate and severe anxiety was 42.8% and 13.1% respectively. Gender, lack of PPE, and fear of infection were significantly associated with a higher anxiety score. Stronger resilience and usage of humor were associated with significantly lower anxiety levels, while mental disengagement with higher anxiety levels. The nursing department's staff may contribute in lowering student anxiety by maintaining a stable educational framework, providing high quality distant teaching and encouraging and supporting students through this challenging period.

Personal and organizational factors related to initiative behavior among psychiatric nurses.

PURPOSE: To identify the degree of personal initiative (PI) among psychiatric nurses and to examine the influence of personal and organizational characteristics on their PI. DESIGN AND METHODS: Ninety-seven nurses completed a questionnaire on PI, work climate, self-efficacy toward initiatives and innovations, nursing work environment, and actual initiative at work. FINDINGS: Differences in actual initiative at work according to the level of education, and negative association between PI and age were found. Self-efficacy and work climate explained 56% of PI; self-efficacy, work climate, and age explained 30% of initiative behavior. PRACTICE IMPLICATIONS: Investing in young nurses, fostering higher education, and creating supportive work environment can help in conversion of innovative vision into actual initiatives.

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

AIM: To examine the association between perceived organisational values and organisational commitment among Israeli nurses in relation to their ethno-cultural background. 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. METHOD: Data were collected using a questionnaire among 106 hospital nurses. About 59.8% of the sample were Israeli-born. RESULTS: 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. CONCLUSION: Findings confirm the role of culture and ethnicity in the perception of organisational values and the level of organisational commitment among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: 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.

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.

Nurse/physician conflict management mode choices: implications for improved collaborative practice.

In today's complex healthcare organizations, conflicts between physicians and nurses occur daily. Consequently, organizational conflict has grown into a major subfield of organizational behavior. Researchers have claimed that conflict has a beneficial effect on work group function and identified collaboration as one of the intervening variables that may explain the relationship between magnet hospitals and positive patient outcomes. The purpose of this study was to identify and compare conflict mode choices of physicians and head nurses in acute care hospitals and examine the relationship of conflict mode choices with their background characteristics. In a cross-sectional correlational study, 75 physicians and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann Conflict Mode Instrument. No difference was found between physicians and nurses in choice of the most frequently used mode in conflict management. The compromising mode was found to be the significantly most commonly chosen mode (P = .00) by both. Collaborating was chosen significantly more frequently among head nurses (P = .001) and least frequently among physicians (P = .00). Most of the respondents' characteristics were not found to be correlated with mode choices. The findings indicate a need to enhance partnerships in the clinical environment to ensure quality patient care and staff satisfaction.

Readiness for future managerial leadership roles: nursing students' perceived importance of organizational values.

This study explored the values held by nursing students attending a baccalaureate program. Our aim was to determine whether nursing students' values change after being exposed to educators as well as mentors and ethics education and after experiencing today's challenging work environment, with an emphasis on the organizational domain of the students' values set. The conceptual framework that underpins the approach to values presented in this study argues that the total values set of a working person consists of three domains: personal, professional, and organizational values. Our sample consisted of first, third, and fourth year nursing students (N = 496) attending the Tel Aviv University in Israel. Participants were requested to answer a questionnaire and to rate their perceived importance of 30 values. The results revealed significant differences in the participants' perceived importance of the three values domains. The organizational values--the new business values--were perceived significantly to be least important. Sex was found to be significantly related to perception of values' importance. Year of study was not found to be significantly correlated to perception of values. The findings reflect that senior nursing students are only moderately prepared for their future managerial leadership roles and point out the need to provide students with more stimulating and supportive learning experiences.

Leadership style and choice of strategy in conflict management among Israeli nurse managers in general hospitals.

AIMS: To identify conflict mode choices of head nurses in general hospitals and examine the relationship between leadership style, choice of strategy in handling conflicts and demographic characteristics. BACKGROUND: Nurse managers deal with conflicts daily. The choice of conflict management mode is associated with managerial effectiveness. The ability to creatively manage conflict situations, towards constructive outcomes is becoming a standard requirement. METHODS: Head nurses (N = 60) in five general hospitals in central Israel were surveyed, using a 3-part questionnaire: The Thomas-Kilmann Conflict Mode Instrument, the Multi-factor Leadership Questionnaire, Form 5X-Short (MLQ 5X) and demographic data. RESULTS: Head nurses perceive themselves significantly more as transformational leaders than as transactional leaders. Compromise was found to be the most commonly used conflict management strategy. Approximately half of the nurses surveyed used only one mode in conflict management. Transformational leadership significantly affected the conflict strategy chosen. CONCLUSION: Head nurses tend to choose a conflict-handling mode which is concerned a form of a Lose-Lose approach. Preparation in conflict management should start from undergraduate education.

Getting ready for the future: assessing and promoting graduate students' organizational values.

Functioning as health care providers, autonomously and interdependently, require the development and acquisition of an appropriate set of personal, professional, and organizational values and ethical framework. Professional education at the graduate level is aimed at preparing nurses for leadership roles by contributing to the development of their unique bodies of professional knowledge and skills and internalizing values needed today in management roles. Values change with time, as does the organizational culture. This study examines whether value sets, of Israeli graduate nursing students, reflect internalization of the "new business values" in accordance with the new demands of the changing work environment. The sample consisted of 51 graduate students, from different classes, who participated in a seminar on aspects of nursing management during a three-year period. Results revealed that in each of the years examined, students ascribed significantly lower importance to organizational values, such as vision, competition, cooperation, risk taking, and status as compared to personal and professional values. The findings point to the need to strengthen the graduate students' organizational domain. Curricula should be designed to help nurses meet the emerging needs and the expected organizational outcomes.

Influence of a merger on nurses' emotional well-being: the importance of self-efficacy and emotional reactivity.

The influence of the merger of two major medical centres on the emotional well-being of nurses was investigated by use of a questionnaire on emotional distress, perception of threat, self-efficacy and emotional reactivity. Evaluations were carried out 1 month prior to the merger at the official announcement, and again half a year after the merger took place. Before the merger, threat perception was higher in the transferring nurses, but the difference was of borderline significance (P = 0.05). There was a significant positive correlation between threat perception and both emotional reactivity and emotional distress, and a significant negative correlation between self-efficacy and both threat perception and emotional distress (P < 0.001 for all). After the merger, the transferring nurses showed more emotional distress (P = 0.009). There was a significant positive correlation between threat perception, emotional distress and negative outcome variables such as burnout and stress (P < 0.001), and a significant negative correlation between threat perception and positive outcome variables such as growth (P < 0.01). This study identifies some personal characteristics that can affect the way nurses deal with hospital mergers and need to be considered during organizational changes in order to maintain job satisfaction.

Israeli nurse managers' organizational values in today's health care environment.

The total value set of a working individual consists of three components: personal, professional and organizational values. In the light of the changing health care environment, the individual nurse manager's values may no longer be applicable for coping with the needs of the work environment. For many nurses who developed their values in keeping with the humanistic tradition, the 'new' organizational values may create confusion, frustration and conflict. The purpose of this study was to determine if the organizational domain in the value sets of Israeli middle nursing managers in acute care hospitals reflect the process of shifting values needed in today's management roles. Analysis of the results revealed that head nurses did not yet fully internalize the 'new' organizational values. Implications of the results for planning undergraduate and graduate programmes are detailed.

Graduate students learn effective management.

This article describes an active learning approach used in a management seminar for master's students to assist them in internalizing knowledge gained in the seminar. Participating in a research project aimed at identifying the qualities of an effective nursing manager enabled students to improve their research abilities, examine their work environment, and thereby increase their motivation and satisfaction. The study results supported findings of earlier studies, emphasizing "human skills" as most important for effective management.