Universal versus tailored solutions for alleviating disruptive behavior in hospitals

Background: Disruptive behavior among hospital staff can negatively affect quality of care. Motivated by a standard on disruptive behavior issued by The Joint Commission (LD 3.10), as well as the desire to improve patient care, minimize liability, and improve staff retention, hospitals are setting policies to prevent and resolve disruptive behaviors. However, it is unknown whether uniform conflict management tools are equally effective among different hospital settings. Methods: We surveyed residents and nurses to identify similarities and differences among hospital departments in the antecedents, characteristics, and outcomes of disruptive behaviors, and in the effectiveness of conflict management tools. We used a quantitative questionnaire-based assessment to examine conflict perceptions in eight different hospital departments at Rambam Medical Center in Haifa, Israel. Results: Most participants (89 %) reported witnessing disruptive behavior either directly or in other parties; the most significant causes were identified as intense work, miscommunication, and problematic personalities. The forms of these behaviors, however, varied significantly between departments, with some more prone to expressed conflicts, while others were characterized by hidden disruptive behaviors. These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools. Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents. Other tools, however, are antecedent-specific, falling into two principal categories: tools directly removing a specific problem and tools that offer a way to circumvent the problem. Conclusions: Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a “one-size-fits-all” approach. Electronic supplementary material The online version of this article (doi:10.1186/s13584-015-0018-7) contains supplementary material, which is available to authorized users

The Use of Developmental Rehabilitation Services. Comparison between Bedouins and Jews in the South of Israel

Some communities have peripheral zones inhabited by persons with a different culture than the majority of the general population, such as the Aboriginals in Australia, the Native Americans in the U.S. and Canada, the Eskimos in Lapland, and the Bedouins in Israel. These citizens are not receiving the same medical or rehabilitation services as the citizens of the metropolitan areas due to the fact that health and welfare programs are not adapted to their unique needs. At the Soroka University Medical Center in Beer-Sheva, Israel, the health and rehabilitation services have a very large and heterogeneous catch-up population serving most of the south of Israel. The purpose of this study was to look at the utilization and the number of appointments for child rehabilitation services by the Bedouin population compared to the general population in the south of Israel at the Zusman Child Development Center (CDC).The records of appointments to the CDC between the years 19951999 inclusive were studied and we randomly chose to limit the study to January, April, July, and October of each year, and randomly chose the daily records of nine therapists, three from each discipline (occuptional therapy [OT], physical therapy [PT], and speech and language therapy [SLT]). There were 8,504 appointments during these 4 months of the years 19951999, 2,255 of which were for Bedouin and 6,249 for Jewish children. Noncompliance with therapy appointments (NCTA) for the same period for both the Bedouins (31%) and Jewish children (26%), with a significant difference between the two populations, was noted. Of all the Jewish childrens appointments, the percentage of all three services was similar: 33% to PT, 38% to OT, and 29% to SLT, but for the Bedouin children, the percentage between the three services was significantly different: 62% to PT, 34% to OT, and 3% to SLT. These results seem to indicate that the Bedouin families prefer the PT and OT over the SLT. Our results enhanced the need for planning a model for supplying health services adapted to clients coming from different cultures. According to this model, we need to take into consideration the cultural differences, the accessibility to rehabilitation services, and the economical impact on the family; all in all, to give a better solution to the patient with special needs

The need for routine preoperative coagulation screening tests (prothrombin time PT/ partial thromoplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy.

Abstract In some medical centers, the routine pre-operative evaluation of healthy children undergoing elective tonsillectomy and/or adenoidectomy (T and A) includes coagulation screening tests (PT, prothrombin Time; PTT, partial thromboplastin time; and INR, international normalized ratio). In this retrospective study, we determined whether there is a positive correlation between prolonged PT/PTT/INR tests in healthy children, with no prior medical history of coagulation problems, and bleeding during surgery and/or bleeding in the month following surgery. We reviewed the records of 416 elective T and A surgeries performed at the Soroka University Medical Center in Beer-Sheva, Israel, over the course of 1999. One hundred and twenty-one (29.1%) patients had preoperative prolonged PT values but only four (3.3%) of these patients experienced light bleeding during surgery. Seven (5.8%) of the 121 patients with prolonged PT tests experienced bleeding episodes during the 1st month subsequent to the surgery. Of the 65 (15.6%) patients who had prolonged pre-operative INR values, only three (4.6%) experienced light bleeding during surgery. Two (3.1%) patients with prolonged INR values experienced light bleeding during the 1st month subsequent to surgery. Sixty-one (14.7%) patients had prolonged first preoperative PTT values, only five of whom (8.2%) experienced light bleeding during surgery. Two (3.3%) of the 61 with prolonged PTT values experienced light bleeding during the 1st month subsequent to surgery. We therefore concluded that pre-operative coagulation screening tests provide low sensitivity and low bleeding predictive value. As such, routine coagulation tests before T &A are not indicated unless a medical history of bleeding tendency is suspected

Health and Zionism

In this follow-up to her 2002 book, The Workers' Health Fund in Eretz, Israel: Kupat Holim, 1911-1937, historian Shifra Shvarts investigates the political and social forces that influenced Israel's health care system and policy during the early years of state building. Among the struggles Shvarts explores in this penetrating study are the debate over immigration health policy and the Law of Return, enacted in 1950; the battles over universal healthcare between the Workers' Health Fund and the Israeli government led by prime minister Ben Gurion; the urgent organization of military medical services during wartime; and the contested establishment of renown civilian medical facilities. These early conflicts have had far-reaching implications that continue to be felt throughout Israeli society. While many European countries successfully established unified, state-run health care systems, Israel's political rivalries and social turbulence gave rise to a mélange of "sick funds," large and small, public and private, that influence and complicate the delivery of health care to this day. Health and Zionism: The Israeli HealthCare System, 1948-1960, sheds light on the major conflicts, leaders, and historic events that shaped the current Israeli health care system, and has relevance to developing health care systems worldwide. Shifra Shvarts is Associate Professor, Faculty of Health Sciences, Ben Gurion University, Israel, and is author of The Workers' Health Fund in Eretz Israel Kupat Holim, 1911-1937 (University of Rochester Press, 2002)

Health and Zionism The Israeli Health Care System, 1948-1960

An exploration of the major conflicts and historic events that shaped the current Israeli health care system.Frontcover -- CONTENTS -- LIST OF ILLUSTRATIONS -- PREFACE -- ACKNOWLEDGMENTS -- NOTE TO THE READER -- INTRODUCTION -- 1 The Doctors' Revolt at Beilinson Hospital -- 2 From Beilinson to Tel Hashomer -- 3 Towards a State Health System -- 4 Health and Politics during the Great Mass Immigration -- 5 Kupat Holim and Mass Immigration -- 6 The Political Struggle to Establish a Central Hospital for the Negev -- CONCLUSION -- APPENDIX: The Law of Return -- NOTES -- GLOSSARY -- BIBLIOGRAPHY -- INDEX -- BackcoverAn exploration of the major conflicts and historic events that shaped the current Israeli health care system.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries

»The medical reasons, as you all know, are highly subjective«. Abortions, Doctors and the Nation-Building Process in Israel

The Israeli nation building process, which took place at the beginning of the last century, aimed to re-create the Jewish nation by relocating it in the promised land in one hand, and by establishing a new native Jew, on the other. This ideological theme was shared by national leaders and doctors as well, demanded of mothers to have a lot of children and to raise them according to specific rules and orders. Doctors and national leaders praised birth and its national benefits, and glorified motherhood. But they were quiet worried because of the low birth rates in the urban and educated strata, and from the high birth rates of the poor and uneducated – both Jewish Immigrants and poor Arab residence of the country. The doctors wrote in Israeli women magazines of the 30s and 40s about an anti-reproduction social sentiment and about the fear from bearing children. Using content analysis, articles from the Israeli women magazines will be discussed in order to conceptualize the significance of abortions in the Israeli nation building Process.The Israeli nation building process, which took place at the beginning of the last century, aimed to re-create the Jewish nation by relocating it in the promised land in one hand, and by establishing a new native Jew, on the other. This ideological theme was shared by national leaders and doctors as well, demanded of mothers to have a lot of children and to raise them according to specific rules and orders. Doctors and national leaders praised birth and its national benefits, and glorified motherhood. But they were quiet worried because of the low birth rates in the urban and educated strata, and from the high birth rates of the poor and uneducated – both Jewish Immigrants and poor Arab residence of the country. The doctors wrote in Israeli women magazines of the 30s and 40s about an anti-reproduction social sentiment and about the fear from bearing children. Using content analysis, articles from the Israeli women magazines will be discussed in order to conceptualize the significance of abortions in the Israeli nation building Process

Gender Differences in Psychosocial Outcomes of Hair Loss Resulting from Childhood Irradiation for Tinea Capitis

Recent studies have linked hair loss due to childhood irradiation for tinea capitis, a fungal infection of the scalp, to adverse psychosocial and health outcomes in women. However, no study to date has examined gender differences in the outcomes of this type of hair loss. The current study aimed to investigate gender differences in health and psychosocial outcomes of hair loss resulting from childhood irradiation for tinea capitis, and to identify the risk factors associated with depression in both men and women. Medical records held at the archives of the Israel National Center for Compensation of Scalp Ringworm Victims were retrospectively reviewed for 217 women and 105 men who received maximum disability compensation due to severe hair loss resulting from irradiation for tinea capitis. We found that women were at increased risk of developing psychosocial symptoms, including depression. Gender emerged as a significant predictor of depression, distinct from other predictors, such as marital status, age at radiation, exposure to verbal and physical bullying, low self-esteem, social anxiety, and physical health problems. Thus, the psychosocial needs of patients, particularly female patients, who were irradiated for tinea capitis during childhood need to be taken into account by the healthcare professionals treating them