End of Life-Decisions: An Islamic Perspective

Patients who live with a low quality of life and suffer from chronic pain may wish to end their suffering through different means such as active euthanasia, passive euthanasia, and physician-assisted suicide. These alternatives to end one’s own life create many ethical dilemmas for health care professionals, patients, and family members. Some of these decisions are forbidden in Islamic Religion, while others are permitted. In this paper, the authors will discuss how Islam looks at these decisions. Knowing about how Islam deals with such decisions will be of great help for health care providers who take care of Muslim patients. It will also help patients and their families in making their decisions at the end of life

Spiritual care for cardiac patients admitted to coronary care units in Gaza Strip: Cardiac patients’ perception

 Heart disease is the leading cause of death among the Palestinian people. Since there is a high correlation between stress and heart disease, preventing and relieving stress become a major concern for this group of patients. One of the approaches to reduce stress is the provision of spiritual care. In spite of its importance, literature reveals not meeting spiritual needs of cardiac patients. Recently more attention is paid to spirituality in health care. As a result, many hospitals in the Western countries started to offer spiritual care to their clients. In Gaza Strip, there is no clear policy about providing spiritual care. Therefore, this study aimed to assess if spiritual care is provided to the hospitalized cardiac patients who live in Gaza Strip and who should provide this care. The design for this study was a cross-sectional design. 279 cardiac patients (response rate of 99.29%) participated in this study. Results revealed that there is a severe shortage of providing spiritual care to cardiac patients and the majority of them (n=159, 57%) preferred that nurses to provide spiritual care to them. As a conclusion, health policy makers need to pay more attention to this group of patients and need to adopt a spiritual care policy into the health care system, which will help to decrease their stress, length of hospitalization, and the cost of treatment. Key words: Spiritual care, cardiac patients, perceptio

Assessing spiritual well-being of Palestinian Cardiac Patients: A reflection for a new spiritual care policy

Religious and spiritual beliefs are important factors that influence quality of life outcome of patients diagnosed with chronic diseases such as heart disease. Spirituality is an important component of overall well-being as it helps in reducing the levels of stress, depression and anxiety. The purpose of this study was to assess spiritual well-being of Palestinian cardiac patients admitted to coronary care units in Gaza Strip. A cross-sectional design was used in this study using the Spiritual Well-Being Scale (SWBS). A total of 275 patients who were diagnosed with a heart disease and admitted to coronary care units at Gaza Strip's hospitals participated in this study. Results revealed high scores of SWBS. Scores for the total SWBS was 101.58 (±9.49) while was 57.25 (±1.18) for Religious Well-Being (RWB) and 44.32 (±6.20) for Existential Well-Being EWB subscales subsequently. Results of this study revealed high scores of SWBS which should be considered by health care providers and health policy makers to adopt new spiritual care policy for cardiac patients and other patients diagnosed with other chronic diseases

Post-traumatic stress disorder among health care providers two years following the Israeli attacks against Gaza Strip in August 2014: Another call for policy intervention

This study aimed to assess the level of posttraumatic stress disorder and to examine the relationship between exposure to war stress and posttraumatic symptoms among health care providers two years following Israeli offensives against Gaza Strip in 2014. Methodology: A cross-sectional design was used for this study. We targeted all nurses and doctors working in three governmental hospitals in the Gaza Strip who worked with victims of the 2014 war, more specifically, those who were working in emergency departments, intensive care units, operating rooms, surgical departments, and burn units. A demographic sheet and Impact Event Scale-Revised were used in this study. The Impact Event Scale-Revised has three sub-scales; intrusion, avoidance, and hyper-arousal. Results: The results showed that 291 (89.3%) out of 2444 participants had scores more than 35 (threshold cut-off point) on Impact Event Scale-Revised. Scores ranged from eight to 80 with a mean of 52.71. Females had higher levels of stress (55.33) than males (50.82) and nurses (52.67) had more stress than physicians (47.38). The most frequent symptoms of trauma subscales was “Intrusion” (mean=19.99), followed by “Avoidance” (mean=17.60), and then “Hyper-arousal” (mean=14.12). Level of trauma symptoms were not affected by place of living, hospital of work, while level of education had impacted level of trauma. Conclusion: The findings showed that health care providers still suffer from severe posttraumatic symptoms two years after exposure to a prolonged war stress. This level of trauma among health care providers warrants intervention programs to reduce stress and trauma among Gaza health care providers after the war.This study aimed to assess the level of posttraumatic stress disorder and to examine the relationship between exposure to war stress and posttraumatic symptoms among health care providers two years following Israeli offensives against Gaza Strip in 2014. Methodology: A cross-sectional design was used for this study. We targeted all nurses and doctors working in three governmental hospitals in the Gaza Strip who worked with victims of the 2014 war, more specifically, those who were working in emergency departments, intensive care units, operating rooms, surgical departments, and burn units. A demographic sheet and Impact Event Scale-Revised were used in this study. The Impact Event Scale-Revised has three sub-scales; intrusion, avoidance, and hyper-arousal. Results: The results showed that 291 (89.3%) out of 2444 participants had scores more than 35 (threshold cut-off point) on Impact Event Scale-Revised. Scores ranged from eight to 80 with a mean of 52.71. Females had higher levels of stress (55.33) than males (50.82) and nurses (52.67) had more stress than physicians (47.38). The most frequent symptoms of trauma subscales was “Intrusion” (mean=19.99), followed by “Avoidance” (mean=17.60), and then “Hyper-arousal” (mean=14.12). Level of trauma symptoms were not affected by place of living, hospital of work, while level of education had impacted level of trauma. Conclusion: The findings showed that health care providers still suffer from severe posttraumatic symptoms two years after exposure to a prolonged war stress. This level of trauma among health care providers warrants intervention programs to reduce stress and trauma among Gaza health care providers after the war

Negotiated reorienting: a grounded theory of nurses’ end-of-life decision-making in the intensive care unit

Background Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses’ end-of-life (EoL) decision-making practice across cultures. Objectives To understand nurses’ EoL decision-making practices in ICUs in different cultural contexts. Design We collected and analysed qualitative data using Grounded Theory. Settings Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine. Participants Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in

Attitude of Palestinian nursing students toward caring for dying patients: a call for change in health education policy

Death is a natural process that occurs each day. Some nursing students may encounter the experience of taking care of a dying patient while others do not. Therefore, their attitude toward death and caring for dying patients may vary. The purpose of this study was to assess Palestinian student nurses’ attitudes toward death and caring for dying patients and their families. In a cross-sectional, descriptive study, all fourth-year students at the College of Nursing, Islamic University of Gaza, Palestine, were invited to participate in this study. A total of 141 students completed the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B). Results revealed that the mean score on the FATCOD-B was (96.96 ± 8.30). Overall, nursing students in the sample demonstrated a relatively low attitude toward caring for dying patients and their families. No statistically significant differences of students’ attitudes toward caring

Mapping the road for a new spiritual care policy: Identifying barriers and enhancing factors for providing spiritual care to cardiac patients

This study is designed to explore barriers and solutions for providing spiritual care to hospitalized cardiac patients living in the Gaza Strip. A qualitative approach using a semi-structured interview format with 12 health care providers was used for data collection. Results revealed several barriers for providing spiritual care including inadequate preparation of staff, ambiguity of spirituality, lack of time, shortage of staff, policy barriers, and personal barriers. Participants suggested several strategies to overcome these barriers including policy innovation, organizational actions, educational and training preparation, and miscellaneous interventions

Importance of Spiritual Care for Cardiac Patients Admitted to Coronary Care Units in the Gaza Strip: Patients’ Perception

Purpose: This study aimed to assess the perception of hospitalized cardiac patients in coronary care units (CCUs) in the Gaza Strip about the importance of assessing and providing spiritual care to them. Design: This was a cross-sectional study. Methods: A valid and reliable instrument previously developed by Musa was used to assess patients’ perception about the importance of assessing spiritual needs and providing spiritual care to cardiac patients admitted to CCUs. Findings: Out of 279 cardiac patients, 275 (response rate of 98.6%) agreed to be involved in this study. Results revealed that both assessing spiritual needs (69.69%) and providing spiritual care (76.97%) were very important to cardiac patients with rating spiritual care intervention as more important than spiritual assessment. Conclusions: Assessing and providing spiritual care is crucial to cardiac patients. Therefore, health policy makers need to

الخيارات والخدمات المتعلقة بمنع الحمل في قطاع غزة ، فلسطين: تصورات مستخدمي ومقدمي الخدمات

Reliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives. Methods A convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data. Results Women reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods. Conclusion Women’s contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women’s choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.تُمكّن وسائل منع الحمل النساء والرجال من التخطيط لحجم أسرتهم وتجنب الحمل غير المقصود ،و الذي يمكن أن يسبب الضيق والقلق و يزيد من وفيات الأمهات. استكشفت هذه الدراسة العوائق المحتملة أمام استخدام وسائل منع الحمل للنساء في قطاع غزة ، فلسطين من منظور المستخدم والمزود للخدمة. منهجية البحث تم استخدام عينة ملائمة لأستقطاب النساء اللائي يستخدمن وسائل منع الحمل من ثلاث عيادات للرعاية الصحية و التي توفر رعاية تنظيم الأسرة ، اثنتان حكوميتان وواحدة غير حكومية. تم الانتهاء من استبيان من 16 بندا من قبل 204 امرأة ، بما في ذلك البيانات الاجتماعية والديموغرافية ، واستخدام وسائل منع الحمل وثمانية أسئلة استكشاف تجربة المستخدم. بالإضافة إلى ذلك ، تم أخذ بيانات من 51 امرأة في لقاءات تمت على عدة مراحل في مجموعات مختلفة للتعرف على نظرة أعمق لتجربة استخدام وسائل منع الحمل والعقبات المحتملة. علاوة على ذلك ، تمت مقابلة 14 من مقدمي الرعاية الصحية حول تجربتهم في تقديم الخدمات. النتائج أبلغت النساء عن استخدام ثلاث طرق رئيسية لمنع الحمل, حيث تقوم 35.2٪ من المشاركات باستخدام اللولب ، و 25.8٪ يستخدمن حبوب منع الحمل ، و 16.4٪ من المشاركات يستخدمن الواقي الذكري. كانت التوقعات من خدمات تنظيم الأسرة منخفضة حيث أن معظم النساء اللائي حضرن إلى العيادات قد قررن بالفعل طريقة منع الحمل مع اتخاذ القرارات من قبل الأزواج (41.2 ٪) أو النساء بالاشتراك مع شريكهن (33.3 ٪) ، 13.7 ٪ فقط أخذوا المشورة و النصح من مقدمي الخدمات. شهد مقدمو الرعاية الصحية انتشارًا كبيرًا للمعتقدات بأن وسائل منع الحمل الحديثة تسبب العقم والسرطان. وكانت الموانع الرئيسية التي تحول دون تقديم خدمات فعالة لتنظيم الأسرة هي المفاهيم الخاطئة عن الضرر المحتمل ، وقلة توافر وسائل منع الحمل محدودة

Quality of life of people wounded in the Gaza war

In the last eight years, there have been three wars between Israel and the Gaza Strip. The last war (2014) continued for 51 days and left 2191 dead and 10 895 wounded. This study aimed to assess quality of life (QOL) of people wounded in the 2014 war in Gaza strip. A cross sectional, descriptive design was used in this study. QOL was assessed by World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Three-hundred-and-hour patients participated in this study. The means for items of the WHOQOL-PREF ranged between 1.08 and 2.44 and the means of 18 items below two. Mean scores for the main domains of QOL were very low with an overall QOL score of 3.94 (maximum 8). Several variables such as age and need for hospitalization impacted the level of QOL of participants. The 2014 war left many people injured. The scores of their QOL were very low in all domains of QOL. These results