Barriers to Health Care Utilization Facing Prostate Cancer Survivors Living in Gaza Strip

There are several studies that aimed to identify barriers to health care utilization, but none of them was conducted in a developing country that addressed barriers to health care utilization facing prostate cancer survivors. This study aimed at identifying barriers to health care utilization facing prostate cancer survivors who live in Gaza Strip. A qualitative approach with a semi-structured interview was used to collect data. Participants reported several barriers to health care utilization. These barriers were categorized under the following major categories: 1) barriers due to unavailability, 2) organizational barriers, 3) communication barriers, 4) geographical barriers, 5) socioeconomic barriers, and 6) barriers related directly to the blockade imposed on Gaza Strip. Within each category several subcategories emerged

Quality of Life and Barriers to Health Care of Prostate Cancer Survivors Residing in Gaza Strip

Prostate cancer is the second common type of cancer worldwide and in Palestine. The use of different treatment options helped prostate cancer survivors to get cured or to live for longer periods of time. Because of the several complications of treatment options, issues related to quality of life (QOL) became highly important in the decision of which option to use

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

Identifying and Prioritizing the Research Needs Related to Mental Health in Gaza Strip-Palestine

Background: An important function of research is to identify community needs in certain fields. As mental health is a vital issue to us, identifying and prioritizing mental health needs is important to policy makers to help them in setting goals for different programs that meet the needs of a specific community in a certain health area. Purpose: To identify the health research needs in the field of mental health in Gaza Strip, Palestine. Design and Methods: The design was a qualitative design using focus group, need assessment and non-structured interview for data collection. Participants: Participants included three focus groups. First group consisted of students enrolled in a master program of community mental health nursing; second group included seven faculty members who were specialists in mental health; and third group included six key persons from the ministry of health and the chair of community mental health program in WHO at Gaza Strip. Results: Results of this qualitative study revealed several themes that emerged from the thematic analysis. Many health research needs were identified by participants. These needs included the following topics: stigma, family integration, aggression of children born to substance-abuse fathers, post-partum depression, counseling, talking therapy in clinical practice, behavioral problems, tramadole abuse, risk factors leading to drug dependence, autism, exploring the role of religion in mental health, and Wellness Recovery Action Plan. Implication for Practice: Well designed studies will help to identify and prioritize the health needs for a specific community. Identifying the needs related to community mental health is one of the first steps to help in pushing these needs into the agenda of health policy makers, who then will work to set goals and design policies and programs that aiming to meet the needs of the community, which hopefully will produce a community with less mental health problems.Background: An important function of research is to identify community needs in certain fields. As mental health is a vital issue to us, identifying and prioritizing mental health needs is important to policy makers to help them in setting goals for different programs that meet the needs of a specific community in a certain health area. Purpose: To identify the health research needs in the field of mental health in Gaza Strip, Palestine. Design and Methods: The design was a qualitative design using focus group, need assessment and non-structured interview for data collection. Participants: Participants included three focus groups. First group consisted of students enrolled in a master program of community mental health nursing; second group included seven faculty members who were specialists in mental health; and third group included six key persons from the ministry of health and the chair of community mental health program in WHO at Gaza Strip. Results: Results of this qualitative study revealed several themes that emerged from the thematic analysis. Many health research needs were identified by participants. These needs included the following topics: stigma, family integration, aggression of children born to substance-abuse fathers, post-partum depression, counseling, talking therapy in clinical practice, behavioral problems, tramadole abuse, risk factors leading to drug dependence, autism, exploring the role of religion in mental health, and Wellness Recovery Action Plan. Implication for Practice: Well designed studies will help to identify and prioritize the health needs for a specific community. Identifying the needs related to community mental health is one of the first steps to help in pushing these needs into the agenda of health policy makers, who then will work to set goals and design policies and programs that aiming to meet the needs of the community, which hopefully will produce a community with less mental health problems

An evidenced-based study :Measuring the effect of implementing an Infection Control Program on health care providers ' Compliance to Infection Control Measures'

In Palestinian, 10% of deaths among children under the age of five are related to infections. Practice of infection prevention and control reduces the number of hospital-acquired infections. The purposes of this study were to explore health care team perceptions of causes of hospital-acquired infections and to develop, implement and measure the impact of infection prevention program in the ICU of a specialty pediatric hospital in Gaza Strip. A quasi experimental with pretest-posttest design was used. All nurses and physicians were included in this study. Five dimensions were measured and investigated pre and post-intervention. An infection control educational program was designed and implemented. After implementing the staff-developed program, the five dimensions were improved: using sharp box increased from 46.6% to 90%, doing gloves and scrubbing improved from 53.3% to 55%, frequency of hand washing increased from 47.2% to 79.3%, awareness of Palestinian protocol of infection prevention increased from 27.5 to 80% and positive swabs cultures decreased from 56% to 34.6%. The study recommends rebuilding an the infection control committee, motivating and encouraging work team to apply control infection measures through training and continuous education, providing the necessary medical supplies. These are besides continuous monitoring and follow up from the administration.In Palestinian, 10% of deaths among children under the age of five are related to infections. Practice of infection prevention and control reduces the number of hospital-acquired infections. The purposes of this study were to explore health care team perceptions of causes of hospital-acquired infections and to develop, implement and measure the impact of infection prevention program in the ICU of a specialty pediatric hospital in Gaza Strip. A quasi experimental with pretest-posttest design was used. All nurses and physicians were included in this study. Five dimensions were measured and investigated pre and post-intervention. An infection control educational program was designed and implemented. After implementing the staff-developed program, the five dimensions were improved: using sharp box increased from 46.6% to 90%, doing gloves and scrubbing improved from 53.3% to 55%, frequency of hand washing increased from 47.2% to 79.3%, awareness of Palestinian protocol of infection prevention increased from 27.5 to 80% and positive swabs cultures decreased from 56% to 34.6%. The study recommends rebuilding an the infection control committee, motivating and encouraging work team to apply control infection measures through training and continuous education, providing the necessary medical supplies. These are besides continuous monitoring and follow up from the administration

Assessing Spiritual Well-Being of Arab Muslim Prostate Cancer Survivors: A Reflection for a New Spiritual Health Care Policy

Religious and spiritual beliefs are some of numerous factors that influence quality of life outcome of cancer survivors. Spirituality is believed to be an important component of overall well-being and it is especially significant in relation to how cancer survivors cope with their morbidity. The purpose of this study was to explore spiritual well-being of Arab, Muslim prostate cancer survivors living in Gaza Strip, Palestine. A cross-sectional design was used in this study using the Spiritual Well-Being Scale (SWBS). A total of 117 Arab, Muslim patients diagnosed with prostate cancer from Gaza Strip participated in this study. Results revealed high scores of SWBS. Score for the total SWBS was 101.16 (±5.47) while was 58.91 (2.06±) for Religious Well-Being (RWB) subscale and 42.25 (±4.58) for Existential Well-Being (EWB) subscale. Scores were not affected by demographic characteristics of participants

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

Maternal mortality in the Gaza strip: a look at causes and solutions

Background: Maternal mortality is an important health indicator for the overall health of a population. This study assessed the causes and contributing factors to maternal mortality that occurred in the Gaza-Strip between July 2014 and June 2015. Methods: This is a retrospective study that used both quantitative and qualitative data. The data were collected from available medical records, investigation reports, death certificates, and field interviews with healthcare professionals as well as families. Results: A total of 18 maternal mortalities occurred in Gaza between 1st July 2014 and June 30th 2015. Age at time of death ranged from 18 to 44 years, with 44.4% occurring before the age of 35 years. About 22.2% were primiparous, while 55.6% were grand multiparous women. The most common causes of death were sepsis, postpartum haemorrhage, and pulmonary embolism. The most striking deficiency was very poor medical documentation which was observed in 17 cases (94%). In addition, poor communication between doctors and women and their families or among healthcare teams was noticed in nine cases (50%). These were repeatedly described by families during interviews. Further aspects surfacing in many interviews were distrust by families towards clinicians and poor understanding of health conditions by women. Other factors included socioeconomic conditions, poor antenatal attendance and the impact of the 2014 war. Low morale among medical staff was expressed by most interviewed clinicians, as well as the fear of being blamed by families and management in case of adverse events. Substandard care and lack of appropriate supervision were also found in some cases. Conclusions: This study revealed deficiencies in maternity care, some of which were linked to the socioeconomic situation and the 2014 war. Others show poor implementation of clinical guidelines and lack of professional skills in communication and teamwork. Specialised training should be offered for clinicians in order to improve these aspects. However, the most striking deficiency was the extremely poor documentation, reflecting a lack of awareness among clinicians regarding its importance. Local policymakers should focus on systematic application of quality improvement strategies in order to achieve greater patient safety and further reductions in the maternal mortality rate.Background: Maternal mortality is an important health indicator for the overall health of a population. This study assessed the causes and contributing factors to maternal mortality that occurred in the Gaza-Strip between July 2014 and June 2015. Methods: This is a retrospective study that used both quantitative and qualitative data. The data were collected from available medical records, investigation reports, death certificates, and field interviews with healthcare professionals as well as families. Results: A total of 18 maternal mortalities occurred in Gaza between 1st July 2014 and June 30th 2015. Age at time of death ranged from 18 to 44 years, with 44.4% occurring before the age of 35 years. About 22.2% were primiparous, while 55.6% were grand multiparous women. The most common causes of death were sepsis, postpartum haemorrhage, and pulmonary embolism. The most striking deficiency was very poor medical documentation which was observed in 17 cases (94%). In addition, poor communication between doctors and women and their families or among healthcare teams was noticed in nine cases (50%). These were repeatedly described by families during interviews. Further aspects surfacing in many interviews were distrust by families towards clinicians and poor understanding of health conditions by women. Other factors included socioeconomic conditions, poor antenatal attendance and the impact of the 2014 war. Low morale among medical staff was expressed by most interviewed clinicians, as well as the fear of being blamed by families and management in case of adverse events. Substandard care and lack of appropriate supervision were also found in some cases. Conclusions: This study revealed deficiencies in maternity care, some of which were linked to the socioeconomic situation and the 2014 war. Others show poor implementation of clinical guidelines and lack of professional skills in communication and teamwork. Specialised training should be offered for clinicians in order to improve these aspects. However, the most striking deficiency was the extremely poor documentation, reflecting a lack of awareness among clinicians regarding its importance. Local policymakers should focus on systematic application of quality improvement strategies in order to achieve greater patient safety and further reductions in the maternal mortality rate

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised