Zvika Orr
Address: Jerusalem
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Papers by Zvika Orr
Improving patient experience and satisfaction in the emergency department (ED) is challenging but beneficial. Previous studies have shown an association between social and structural factors and patient satisfaction. This study examined the structural and social factors related to the ED patient experience among Jewish and Arab patients in a Jerusalem hospital.
Methods
A cross-sectional study was conducted among ED patients in a Jerusalem hospital. Data were collected via questionnaires. The sample included 257 Jewish patients and 170 Arab patients. The outcome variable was a positive or negative ED experience.
Results
Jewish and Arab patients had different factors related to ED experience. Cultural differences, including a language barrier and access to information, were associated with a negative experience among Arab patients. Among Jewish patients, frequent use of community health services was associated with a negative ED patient experience.
Conclusion
This study shows an association between social and structural factors and patient experience, illustrating gaps for and vulnerability of different ethnic groups that affect their experience with healthcare services. Understanding these issues and implementing solutions formulated at the institutional and national levels can promote equity by providing structurally competent care.
Design: A qualitative design was used. This research is part of an extensive ongoing study of orthodox and ultraorthodox (Haredi) students volunteering with people with disabilities.
Methods: Data from 13 semi-structured interviews, conducted between July and September 2017, with 14 male students (two students chose to be interviewed together) and four people with disabilities were analyzed using thematic analysis.
Results: Volunteering enhanced students' awareness of the needs of people with disabilities, changed their attitude towards this population and enhanced their confidence as nurses. The individuals with disabilities valued the help they received as well as the opportunity to change the students' prior notions and stigmas regarding disability.
Conclusions: Projects such as ours could improve the attitude of nursing staff towards individuals with disabilities and improve nursing care. We recommend involving people with disabilities in designing such projects.
Methods: A retrospective cohort study was conducted of patients referred to an ED in Jerusalem by either their PCP or a group of UCCs with a full range of laboratory tests and basic imaging capabilities between January 2017 and December 2017. The data were analyzed to identify referrals involving diagnoses, specialist consultations, and examinations unavailable in the PCP’s office or UCC (e.g., ultrasound, CT, echocardiogram, or stress test); these referrals were considered necessary for completion of the patient work-up. If patients were evaluated by an ED physician and sent home after an examination or laboratory test available at least in the UCC, the referrals were considered potentially unnecessary.
Results: Significantly more referrals were made by PCPs than UCCs (1712 vs. 280, p < 0.001). Significant differences were observed for orthopedics, general surgery, and obstetrics/gynecology referrals (p = 0.039, p < 0.001, p = 0.003). A higher percentage of patients referred by PCPs had potentially unnecessary visits compared to patients referred by UCCs (13.9% vs. 7.9%, p = 0.005).
Conclusion: A robust UCC system may help further reduce potentially unnecessary visits (including complex patients) to the ED.
ability to recognize how social, political, economic, and
legal structures shape diseases and symptoms. Although
structural competency has become an increasingly accepted
framework for training and teaching, it usually
has not addressed nursing students and has not included
marginalized patients as trainers. Method: This article analyzes
a structural competency training model for nursing
students that includes five components: Theory, Observations,
Learning from patients, Engagement, and Research
(the TOLERance model). Results: The TOLERance model
increases the understanding of the interrelation between
the individual clinical level and the sociopolitical structural
level. It encourages nursing students to actively engage in
social, political, and policy issues that affect their patients’
health and to advocate for policy change. Conclusion:
The moral and professional commitment of nurses to their
patients demands that they do not ignore the structural
forces that are detrimental to their patients’ health. The
TOLERance model provides nursing students with skills
and competencies that help them to fulfill this commitment.
[J Nurs Educ. 2020;59(8):425-432.]
Improving patient experience and satisfaction in the emergency department (ED) is challenging but beneficial. Previous studies have shown an association between social and structural factors and patient satisfaction. This study examined the structural and social factors related to the ED patient experience among Jewish and Arab patients in a Jerusalem hospital.
Methods
A cross-sectional study was conducted among ED patients in a Jerusalem hospital. Data were collected via questionnaires. The sample included 257 Jewish patients and 170 Arab patients. The outcome variable was a positive or negative ED experience.
Results
Jewish and Arab patients had different factors related to ED experience. Cultural differences, including a language barrier and access to information, were associated with a negative experience among Arab patients. Among Jewish patients, frequent use of community health services was associated with a negative ED patient experience.
Conclusion
This study shows an association between social and structural factors and patient experience, illustrating gaps for and vulnerability of different ethnic groups that affect their experience with healthcare services. Understanding these issues and implementing solutions formulated at the institutional and national levels can promote equity by providing structurally competent care.
Design: A qualitative design was used. This research is part of an extensive ongoing study of orthodox and ultraorthodox (Haredi) students volunteering with people with disabilities.
Methods: Data from 13 semi-structured interviews, conducted between July and September 2017, with 14 male students (two students chose to be interviewed together) and four people with disabilities were analyzed using thematic analysis.
Results: Volunteering enhanced students' awareness of the needs of people with disabilities, changed their attitude towards this population and enhanced their confidence as nurses. The individuals with disabilities valued the help they received as well as the opportunity to change the students' prior notions and stigmas regarding disability.
Conclusions: Projects such as ours could improve the attitude of nursing staff towards individuals with disabilities and improve nursing care. We recommend involving people with disabilities in designing such projects.
Methods: A retrospective cohort study was conducted of patients referred to an ED in Jerusalem by either their PCP or a group of UCCs with a full range of laboratory tests and basic imaging capabilities between January 2017 and December 2017. The data were analyzed to identify referrals involving diagnoses, specialist consultations, and examinations unavailable in the PCP’s office or UCC (e.g., ultrasound, CT, echocardiogram, or stress test); these referrals were considered necessary for completion of the patient work-up. If patients were evaluated by an ED physician and sent home after an examination or laboratory test available at least in the UCC, the referrals were considered potentially unnecessary.
Results: Significantly more referrals were made by PCPs than UCCs (1712 vs. 280, p < 0.001). Significant differences were observed for orthopedics, general surgery, and obstetrics/gynecology referrals (p = 0.039, p < 0.001, p = 0.003). A higher percentage of patients referred by PCPs had potentially unnecessary visits compared to patients referred by UCCs (13.9% vs. 7.9%, p = 0.005).
Conclusion: A robust UCC system may help further reduce potentially unnecessary visits (including complex patients) to the ED.
ability to recognize how social, political, economic, and
legal structures shape diseases and symptoms. Although
structural competency has become an increasingly accepted
framework for training and teaching, it usually
has not addressed nursing students and has not included
marginalized patients as trainers. Method: This article analyzes
a structural competency training model for nursing
students that includes five components: Theory, Observations,
Learning from patients, Engagement, and Research
(the TOLERance model). Results: The TOLERance model
increases the understanding of the interrelation between
the individual clinical level and the sociopolitical structural
level. It encourages nursing students to actively engage in
social, political, and policy issues that affect their patients’
health and to advocate for policy change. Conclusion:
The moral and professional commitment of nurses to their
patients demands that they do not ignore the structural
forces that are detrimental to their patients’ health. The
TOLERance model provides nursing students with skills
and competencies that help them to fulfill this commitment.
[J Nurs Educ. 2020;59(8):425-432.]