Most at Risk Adolescence (MARA 13-19yrs) in Occupied Palestinian

The World Health Organization (WHO) defines adolescents as “people aged 10 to 19 years”. Adolescence is increasingly recognized as a life period that poses specific challenges and a time of vulnerability and risks. There are many vulnerability and risk factors for adolescent boys and girls that make them susceptible to be engaged in HIV risk behavior and/or unable to protect themselves from exploitation that can lead to HIV infection. Adolescents who engage in these behaviors are called “most-at-risk adolescents- MARA” (Homans, 2007). The study objective was to provide information and evidence on the level of risk behaviors among young people aged (13-19) years who are most at risk of HIV infection in the OPT To achieve this goal, 6 measurable objectives were set through quantitative. The study design : Quantitative approach . Study results the socio-demographic profile and living conditions for MARA were obtained from a sample of 149 adolescents; 71.8% males and 28.2% female. The participants’ age ranged from (14-19) years with an average of 17.9 years with 67.8% for the ages 18-19 years old. Place of residence and social status; the study participants were from all regions; 13.4% from Gaza and 86.6% from West Bank (23.5% from Jerusalem, 34.2% from middle region, 22.1% from north region and 6.8% from south region of West Bank). Education and school attendance; the data of 16% with no education and 26.6% elementary level of education” coupled with almost half of the older adolescents (only 22% out of the 40% who are 19 years). Employment of work; congruent with what is being indicated about, their low level  education, 65% of targeted adolescents are working; 41.6% work full time job and 23.5% worked sometime. Exposure to unusual experiences during work; 53% of workers have been exposed to unusual practices regardless of their work place; 30% were given cigarettes, 22.8% given money, 5.3% given drugs and 2.7% taken for a drive. The household's income in Shekel for all family members have ranged from (300-8000), the adolescents’ source of spending during last month was mainly; 60.4% from their own employment and 26.8% from family support and very few got from different sources where 2.7% received from social affairs and 1.4% from other sources. Drug users; the MARA mean age to start drug use was 15.8 years, they utilize  different kinds of drugs with the majority 76.5% smoked marijuana, 55% inhaled glue and other toxic substance and 34% used a variety of drug pills with more male users than female users on all items as indicated by their mean scores. Keywords: Most at Risk Adolescence (MARA 13-19yrs), Palestinian

Adolescence (13-19yrs) in Palestinian

Adolescence insights were explored through 4 open ended questions on; reasons, services needed for drug users, HIV prevention and services needed for people living with HIV.  Reasons that make MARA go outside the walk of their peers; The social status of the family was the most recognized response among the majority of the participants, many reported parents’ divorce and separation in addition to family financial status and unemployment as said “these are major factors that lead to the loss of their children”. Many commented on family violence and disrupted families; others criticized their family’s lack of care and guidance in raising children. Among girls’ respondents, early marriage was an issue that was stated bitterly where 6% of those few married girls were divorced. Some of the married ones reported that “husbands’ violence, use of drugs and alcohol drinking at home leads to sexual violence, force use of alcohol and drugs”. Services needed to be provided for drug users; many said “I do not know”, some asked for awareness raising and few others said “use of condom”. Such responses are very marked information that needs to be highlighted to all on the importance of awareness and prevention of STIs and HIV Services needed to prevent HIV; they emphasized the importance of knowledge and awareness as well as consistent guidance to help adolescents avoid risk behaviors and unusual practices. Few advised for not to practice sex outside marriage Services needed to provide care and support to people living with HIV; for this question there were 12 responses only. Of those; majority suggested provision of treatment, psychosocial support and care for people living with HIV, as said by one “do not isolate them” and other said “do not stigmatize them” The stakeholder representatives interviewees reiterated on many issues starting with their knowledge of the prevalence and size of the problem of MARA. All organizations representatives agreed that risk behaviors among adolescents is very much increasing particularly the drug use, but no one was able to give the correct number for the drug users in Palestine, their impressions are based on their own experiences and access to some of  these adolescents. One of them describe drug use among young people “it’s like a fire in a straw lot”. Other risk factors such as child labor is available and many of them face harassment, and maltreatment where they stay long hours of work with low wages. Sexual behaviors are also not identified in terms of data as reported by some “we have things like that, but not very often” and others said “family violence, sexual abuse and incest happens but can’t identify the real problem” Reasons and determining factors for MARA; again there was a consensus among all institutions for reasons and factors affecting adolescents; family status and family dynamics, low socio-economic conditions, poverty and unemployment among families, child school dropout and consequently child labor, unstable political conditions and harassment of young people. Coupled with Peer pressure, violence at home or outside, lack of recreational facilities, lack of information and/or misleading information are other determinants that allow young people to go outside the normal walk of their peers. Institutions’ preventive and protective interventions for MARA; Most of the institutions have common preventive and protective intervention strategies, with a variation among them regarding each specialization. But in general they all have education and awareness programs that deal with adolescents and youth needs at schools and university levels, local youth and women organization utilizing many modalities as peer educators, recreational activities, and many others that promote community engagement and young people development. There is a praiseworthy growing awareness raising against drugs among Palestinian youth and among all stakeholders by Palestinian Police –ANGA. BUT no one has specific intervention strategies targeting MARA except for Asadiq Tayyeb and Caritas being specialized in drug users’ rehabilitation. No one mentioned the adolescents’ laborers needs for care, awareness and or help to find an alternative for them The overall results for MARA are similar to local Palestinian studies done with MARP but it added value in terms of understanding this specific age group and the determining factors that lead adolescents to be at risk. The profile of MARA was similar to MARP, they are more economically and socially disadvantaged than the general population, but MARA are more subjected to harassment and manipulation particularly those who are working; being young and have little agency or control over their selves. An important indicator that jeopardizes adolescents to be at risk as been indicated by MARA and stakeholders subjective data was their families parenting styles and family dynamics (either these families do not care or are too rigid and aggressive – no dialogue among family members) and considered a determinant factor to cause early marriage of girls, school dropout and child labor which ultimately reflected on their children and adolescents future Keywords: Adolescence ( 13-19yrs) ,   Palestinia

Evaluating the effectiveness of the health educator intervention on health beliefs and attitudes of female Palestinian adolescents: Applying the Solomon Four-Group Design

Health and well being of the young people has been advocated by health planners in Palestine to become one of the main components of community health care. The national health information system such as vital statistics (PCBS) provides valuable information, but data on aspects of health relevant to young people are not easily available. Female adolescent health is a new area of concern in Palestine and most of the Palestinian adolescents' health studies have been concerned with the assessment of their health needs and problems. Some recent studies have assessed the adolescents' reproductive and sexual health needs. Very few studies indicated that health education programmes were developed and implemented based on those needs and problems but no one study has evaluated the effectiveness of the health educator role in those programmes. The diversity and lack of standards for health education programmes and for those who implement them may have an impact on the quality of health education/promotion services delivered to meet the changing health needs of society (WHO, 1998). To achieve a quality in health services offered, it largely depends on the people who deliver these services. Therefore; evaluation for the effectiveness of the health educator is one aspect for improving the quality of these services and thus the health status of the individuals and/or the communities. This experimental study is designed to evaluate the role of the health educator intervention in affecting change in the health beliefs and attitudes of Palestinian female adolescents aged 14- 17 years in four female public schools in the West Bank.. To answer the research questions of the study and to achieve its purpose and objectives, two theoretical frameworks were utilized: first, adolescence developmental approaches; the physiological, cognitive, psychological and social development. Second, the Stimulus-Organism-Response Model (S-O-R); (1) the stimulus element reflects the health educator intervention, (2) the organism element reflects the female adolescent health beliefs, values, knowledge and attitudes, and (3) the response element reflects the influence of health educator on the female adolescents' health beliefs and attitudes as measured at post test. The two frameworks were the base for the questionnaire construction and the base for implementing and evaluating the effectiveness of the health educator intervention. The following three experimental steps were followed to have the study completed: 1. An assessment of Palestinian female adolescents' health beliefs and attitudes toward their physiological, psychological and social development as the pre-intervention phase of the study. This assessment was conducted among 246 female students from 9th-II th grades in two public (governmental) female schools. It was based on quantitative type of data, a self-administered questionnaire that included socio-demographic variables and 92 checklist items, and qualitative type of data with two subjective questions. The questionnaire was constructed and developed by the investigator; its content validity was established through revision of the questionnaires by experts, and its reliability was measured by Cronbach's Coefficient alpha test. The findings of the pre-intervention data revealed that the Palestinian female adolescents' needs and concerns were associated with their biological, psychological and social development. The adolescents' general lack of knowledge regarding their sexual and reproductive health was evident in the quantitative as well as qualitative data, the feeling of low self esteem, poor self confidence, and the feeling of gender inequalities were of particular concerns. Based on those needs and concerns, a health education intervention programme was developed aiming at assisting them to have more information and knowledge regarding their sexual and reproductive health, and to increase their awareness regarding their psychological and social well-being. 2. The second experimental step of the study was the implementation of health education intervention programme to the experimental groups. The health education intervention programme was developed by the investigator based on the findings of pre-intervention data and implemented by an external heath educator with the presence of the investigator. The health educator has utilized the educational and community development models, as a guide for her role to implement different educational methods and strategies in order to help the adolescent students achieve the goals of the educational sessions assigned aiming at affecting change in their health beliefs and attitudes toward a healthy life style. 3. The third step of the study was a post-intervention data obtained for variables reflecting the psychological and social health beliefs and attitudes from experimental and control groups to evaluate the effectiveness of the health educator intervention provided to experimental groups under study. The study has employed an experimental research methodology; the Solomon-Four group design. This design has allowed for each of the four schools under study to be assigned to different condition; two were the experimental groups and two were the control groups, and each group was assigned as; CD The first experimental group has received pre-intervention assessment (pre-test), health educator intervention and post test, Q) the first control group has received pre-intervention assessment and post test, @ the second experimental group has received the health educator intervention only and post test, @ the second control group, was not assigned to intervention nor to pre-intervention assessment, but received the post test only. Statistical analyses were performed using the Statistical Package for Social Science (SPSS) version 10. Descriptive statistics were used to analyze the socio-demographic variables. The ttest for significance of means was the statistical analysis technique utilized to compare for differences between two group means or two means of one group at two levels; Q) at pre-test to compare for equality of mean groups prior to intervention, and (£> at post test multiple comparison for the mean differences between subjects in the four different groups was made to indicate for the effects of the pre-test, the health educator intervention: and for the pre-test intervention-interaction on 8 dimensions of the adolescents' psychological and social beliefs and attitudes for all groups. The major findings of the study at the post test data included the followings: 1. The findings showed a significant difference in the mean scores of the female adolescents' psychological health beliefs and attitudes dimension as a result of; the pre-test, the intervention, and the pre-test-intervention interaction. There was a significant difference for those who received the pre-test when compared with those who did not, but this difference was less than those who received the intervention. The difference for those who received the pre-test and intervention was stronger than those who received the pre-test or vii intervention .alone. This means that an interaction between pre-test and intervention gives stronger effects on adolescents' psychological health beliefs and attitudes. 2. The findings showed neither the pre-test nor the intervention or the pre-test intervention-interaction implied any effectiveness for the adolescents' social health beliefs and attitudes dimension which included the family, school and society sub dimensions. This is expected since these students do not live in a vacuum, and such programmes have to target their environment especially their family and school systems. The study design was helpful in assessing the adolescents' health beliefs and attitudes and identifying their needs and concerns; also it was helpful in developing culturally appropriate interventions according to those needs. Therefore, emphasis on the needs and concerns of the adolescents to be assessed prior to any intervention is of importance and highly recommended to have effective outcomes for any planned educational programmes. Furthermore; the design was helpful in identifying that direct health education instruction can be effective on female adolescent psychological/emotional well-being but not on their social well-being. This effectiveness was recognized by the significant difference in the mean scores of the experimental groups compared to control groups. The effectiveness of health education on the adolescents' health beliefs and attitudes was estimated immediately after the intervention; however, a further follow up study is required to estimate if this acquired effectiveness is maintained and sustained in those adolescents. Research studies emphasizes that while it may be relatively easy to influence attitudes and behaviour short-term, it can be very difficult for people to sustain behaviour change over the longer term (Pill, 1990). Therefore; continuity of such programmes and involvement of interdisciplinary approaches particularly for the psychosocial aspect of the female adolescents' development is required to have an effective and successful intervention programmes

Effects of Selected Organizational Climate Factors on Nursing Performance and Patient Satisfaction in Renal Dialysis Units in West Bank Hospitals

The effectiveness of an organizational climate is one of many essential requirements for many health care institutions all over the world to be succeeded.  Aim: This study aimed to assess the selected organizational climate factors (motivation, social interpersonal relations and leadership style) that affect nurse’s performance and patient’s satisfaction in dialysis units in West Bank Hospitals. Methods: This study was a descriptive purposeful study. It described the relations between organizational climate and nursing performance and the effectiveness of this performance on patient’s satisfaction in  renal dialysis units in West Bank governmental hospitals. The study sample consisted of 69 nurses who work in 10 dialysis units in West Bank Hospitals and 198 renal patients. Data collection was through 2 questionnaires, one for nurses which consistd of  2 sections; the first one consistd of socio-demographic variables (Nurse’s age, gender, years of experience, academic degree and work place) and the second one consistd of 3 domains and 23 statements to identify the organizational climate factors affecting nursing performance in dialysis units in West Bank Hospitals, these domains were: leadership style with six statements, social interpersonal relations with six statements and motivations with eleven statements. In addition, there were 15 statemements to investigate the nursing performance. The second questionnaire was for the patients which consisted of  2 sections; the first one consisted of socio-demographic and health conditions of patients attending to dialysis units, the second section consistd of patient’s satisfaction with 3 domains (leadership style with six statements, social interpersonal relations with 4 statements and motivation with 7 statements). Results and Recommendations: Nursing performance in dialysis units was with moderate response (69.3%) for many reasons; there was significant shortage in nursing staff in dialysis units in 10 West Bank Hospitals, insufficient time for doing all nursing procedures, lack of breaks during shift period,  lack of knowledge and skills about dialysis equipments and tools (59.4%) of nurses hold Diploma Degree (2 years), and there were no administrative punishment or reward system for evaluation of  nursing performance in dialysis units, so that it is recommended to inform policy makers in Palestinian ministry of health to stand on this significant problem and to increase the skillful staff members as quick as possible and to hold training and educational sessions in that regard. Patient satisfaction was with moderate response (73.3%) for many reasons; inflexible working hours,  lack the Renal specialist, social workers specialist and diet specialist, and insufficient using of developed dialysis machines, tools, signs and educational plates in all dialysis units in West Bank Hospitals. So that, it is recommended to increase the specialist staff members and to develop the awareness of nursing staff with the proper using of machines in these units. Motivation factor was with moderate response (54.5%) because of low salary in comparing with effort, no equal opportunities between staff members in term of motivation, training sessions and scholarships, insufficient working vacations, no transportation and risk allowance, and administration dose not encourage the relation between nursing staff, so that it is recommended to pay attention for nurses by improving motivation system (Training sessions, scholarship). Female (58%) nursing staff was more than male (42%) nursing staff in dialysis units which affect the nursing performance and the nature of work (vacations, opportunities and Work load)

Factors Affecting Time Management and Nurses’ Performance in Hebron Hospitals

Background: Nursing is a demanding job and it can often feel as though there are not enough hours in the day to complete all of tasks required. Unlike other jobs, priorities can change rapidly when a patient is in urgent need for attention. Aim of the Study: The purpose of this study was to investigate the factors affecting time management( personal, and administration obstacles) and nurses performance in Hebron hospitals. The study used a quantitative descriptive design and stratified random sampling approach to select 181 nurses working in Hebron district Hospitals in the West Bank. The data was collected through questionnaire which consisted demographic variable, and 57 statements divided into four dimensions to examine the effectiveness of time management on nurses’ performance. These dimensions are; time management (Analyzing time, follow-up, planning time, and time commitment) , personal as (uses phone, fear from mistakes) and administrative obstacles of time management as(lack priorities or plans daily, Lack of incentives, Procrastination), and nursing performance in Hebron hospitals. The total number of responders was 181 nurses distributed among five hospitals in Hebron government and non government hospitals in the West Bank. The governmental hospitals included: Alia Hospital, 65 nurses and Abu Al-Hassan hospital18 nurses; while the non-governmental hospitals included: Al Ahli Hospital 60 nurses, Al-Mizan hospital 20 nurses, and Red Crescent hospital 18 nurses. Results: The majority of the responders were young with age less than 39 years old, with less than ten years of experience, and 60% of them had a bachelor degree or more. Time management in Hebron hospital was high with rate 69.5% and there were two major factors affecting to time management for nurses including personal obstacles with a rate less than 50%, and administrative and organizational obstacles with a rate of 69.3%. There was a positive significant correlation between time management and nurses performance ( ? ? 0.05). There was also a significant correlation between. time management obstacles and nurses performance ( ? ? 0.05). However, there was no significant correlation between gender, academic degree, experience or qualification of participants and time management or nurses’ performance with ? ? 0.05. Conclusion: Attention is needed to address the obstacles of time management within governmental hospitals. More studies about obstacles of time management among nurses are needed to expand the concepts of interest, and the meaning of scientific and technical methods to manage time

Demographic Variable (Age, Gender, Marital Status, and Educational Qualifications, in Come ) and effecte i n Nurses’ Performance in Hebron Hospitals

Background: Nurses spend more time with patients than other health care providers, and patient outcomes are affected by nursing care quality. Aim of the Study: The purpose of this study was to investigate the level of nursing performance and the factors affect of nursing performance in Hebron hospitals. The study used a quantitative descriptive design and stratified random sampling approach to select 181 nurses working in Hebron district Hospitals in the West Bank. The data was collected through questionnaire, which consisted demographic variable, and 15 statements. The total number of responders was 181 nurses distributed among five hospitals in Hebron government and non-government hospitals in the West Bank. The governmental hospitals included Alia Hospital, 65 nurses and Abu Al-Hassan hospital18 nurses; while the non-governmental hospitals Included Al Ahli Hospital 60 nurses, Al-Mizan hospital 20 nurses, and Red Crescent hospital 18 nurses. Results: The majority of the responders were young with age less than 39 years old, with less than ten years of experience, and 60% of them had a bachelor degree or more. 31.5% from nurses the income less than 2500 NS, 38.7% the income between 2500 – 3499 NS, 29.8 from nurses the income between More than 3500 NS. Nursing performance in Hebron hospital is high 71%. However, there was no significant correlation between gender, academic degree, experience or qualification of participants and nurses’ performance with α ≤ 0.05. The study recommended more study in nursing performance in other factors

Demographic Variable (Age, Gender, Marital Status, and Educational Qualifications, in Come ) and Afeecte in Nurses’ Performance in Hebron Hospitals

Background: Nurses spend more time with patients than other health care providers, and patient outcomes are affected by nursing care quality. Aim of the Study: The purpose of this study was to investigate the  level of nursing performance  and the factors affect of nursing performance in Hebron hospitals. The study  used a quantitative descriptive design and stratified random sampling approach to select 181 nurses working in Hebron district Hospitals in the West Bank. The data was collected through questionnaire which consisted demographic variable, and 15 statements . The total number of responders was 181 nurses distributed among five hospitals in Hebron government and non government hospitals in the West Bank. The governmental hospitals included: Alia Hospital, 65 nurses and Abu Al-Hassan hospital18 nurses; while the non-governmental hospitals included: Al Ahli Hospital 60 nurses, Al-Mizan hospital 20 nurses, and Red Crescent hospital 18 nurses. Results: The majority of the responders were young with age less than 39 years old, with less than ten years of experience, and 60% of them had a bachelor degree or more. 31.5% from nurses the income less than 2500 NS, 38.7% the income between 2500 – 3499 NS, 29.8 from nurses the income between More than 3500 NS. Nursing performance in hebron hospital is high 71%. However, there was no significant correlation between gender, academic degree, experience or qualification of participants and nurses’ performance with α ≤ 0.05. the study recommended more study in nursing performance in other factors

Impact of Night Shift and Training Development Factors on Performance of Professional Nurses in North West Bank Governmental Hospitals

Background: Organizational factors are considered to be the cornerstone in achieving psychological and professional security at work, which in turn are positively reflected in job performance both quantitatively and qualitatively. Aim of the Study: The study aimed to assess night shift and education / training developmental factors on performance of professional nurses in north West Bank governmental hospitals. Subjects and methods: A quantitative descriptive study utilized stratified random sampling of 185 nurses. A self administered questionnaire was developed with a response rate of 97%. The questionnaire was validated by experts, and reliability was obtained by Cronbach’s alpha coefficient was (0.86) Data were analyzed using SPSS.  Results: The overall level of  night shift factor  affecting performance of professional nurses was high (79.0 %) and ; the education / training developmental factors moderate  (68.8%)  as perceived by nurses. It was found that there are significant differences at α = 0.05 between the total score of night shift and education / training developmental factors  towards workplace  in favor  to Dr. Nazal Hospital. Conclusion and recommendation: The night shift and education/ training developmental factors affected the performance of the professional nurses.  The findings of this study provide recommendations and suggestions to improve the performance of professional nurses in governmental hospitals such as:  reduce the strain of long work hours on night shift and motivation t. Providing continuous professional development of nurses in service training program. Keywords: night shift,  education / training development, professional nurse, Performance