Biomedicine has played a key role in the dissemination of modern social norms, such as the emphas... more Biomedicine has played a key role in the dissemination of modern social norms, such as the emphasis on individual autonomy and the distinction between science and religion. This study examines the way the mostly-Jewish members of the medical staff at an emergency department of a Jerusalem hospital perceive Jewish ultra-Orthodox and Arab patients' behaviors vis-à-vis the existing biomedical norms. We analyzed participants' perceptions in terms of the social constructs they reveal, their meanings, and their implications. Semi-structured in-depth interviews were conducted with 24 staff members and were analyzed using content analysis. The staff described challenges in treating Arab and ultra-Orthodox patients, which they related to both groups' embeddedness in traditional "cultures" and collective identities. According to the participants, in both cases, the patients' cultural affiliations constrained their sense of individual autonomy and rationality. However, in the comparative analysis, two differences emerged. First, while both groups were perceived to diverge from modern norms of individual autonomy, in the case of Arab patients, these characteristics were presented as disruptive and potentially threatening to the hospital staff. By contrast, in the case of ultra-Orthodox patients, adherence to traditional and collective values was more likely to be represented as a risk to the patient, rather than to the staff. Second, staff were more likely to provide accommodations for ultra-Orthodox patients than for Arab patients. These accommodations were often described in the frame of "cultural competency." We suggest that divergences in how staff understood and responded to perceived cultural differences of each group reflect unequal impacts of structural determinants of health, including of political conflict. We recommend moving beyond the conceptual framework of cultural competency to strengthen the staff's structural competency, cultural and structural humility, and critical consciousness.
International Journal of Environmental Research and Public Health , 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: A growing body of research demonstrates that economic conditions and racial and ethni... more Background: A growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance. Methods: A cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days. Results: There were differences between Jewish and Arab patients' social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty. Conclusion: The study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.
is a low point in the history of nursing, as many nurses participated in programs of compulsory s... more is a low point in the history of nursing, as many nurses participated in programs of compulsory sterilization, "euthanasia," and annihilation conducted by the Nazis (Benedict & Shields, 2014; Shields et al., 2022). Despite the importance of this era for understanding processes that affect present and future nursing, Holocaust and genocide studies are not part of the curriculum in most nursing school programs. Recently, there has been a call to include this topic in health professions curricula (Chelouche, 2021;
Background: Medical neutrality is a normative arrangement that differentiates a zone of medical t... more Background: Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on health inequity. This article analyzes how healthcare professionals understand and negotiate the depoliticized space of the emergency department (ED) through their views on neutrality. It also examines how medical staff use depoliticized concepts of culture to account for differences in the health status of patients from disadvantaged groups. These questions are examined in the context of the Israeli-Palestinian conflict. Methods: Twenty-four in-depth, semi-structured interviews were conducted with healthcare personnel in a Jerusalem hospital's ED. All but one of the participants were Jewish. The interviews were analyzed using qualitative content analysis and Grounded Theory. Results: The ED staff endorsed the perspective of medical neutrality as a nondiscriminatory approach to care. At the same time, some medical staff recognized the limits of medical neutrality in the context of the Israeli-Palestinian conflict and negotiated and challenged this concept. While participants identified unique health risks for Arab patients, they usually did not associate these risks with the effects of conflict and instead explained them in depoliticized terms of cultural and behavioral differences. Culture served as a non-controversial way of acknowledging and managing problems that have their roots in politics. Conclusions: The normative demand for neutrality works to exclude discussion of the conflict from clinical spaces. The normative exclusion of politics is a vital but under-appreciated aspect of how political conflict operates as a structural determinant of health. Healthcare personnel, especially in the ED, should be trained in structural competency. This training may challenge the neglect of issues that need to be solved at the political level and enhance health equity, social justice, and solidarity.
Organ trafficking is widely recognised as a human rights concern. Medical professionals play a de... more Organ trafficking is widely recognised as a human rights concern. Medical professionals play a decisive role in bringing international norms regarding organ trafficking into the local context as translators and localisers. In Israel, this localisation reflects the tensions and gaps between global and local values, moralities and beliefs. Based on in-depth interviews with 92 stakeholders, this article examines the Israeli medical professionals' approach toward organ trafficking, the moral conflicts, challenges and dilemmas they faced given these tensions and gaps, and their attempts to address them in practice. The findings reveal that many Israeli healthcare professionals subscribed to an ambivalent stance on organ trafficking and a non-judgmental approach towards patients who engage in organ trafficking, preferring to turn a blind eye to this phenomenon. They internalised key aspects of the deeply rooted local ethical perceptions regarding organ trafficking. This internalisation points to the limitations of translators' freedom of operation between transnational and domestic languages. Localisation is not merely a result of pragmatic compromises but stems from the localisers' identification with local moralities. This study contributes to understanding the role of professionals in processes of societal change and the complex ramifications of this role.
Background
Improving patient experience and satisfaction in the emergency department (ED) is chal... more Background 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.
Structural competency is the trained ability to discern and respond to the impact of social, poli... more Structural competency is the trained ability to discern and respond to the impact of social, political, and economic structures on health. This article discusses a new online standardized patient simulation method that enhances the structural competency of nurses and nursing students. This method has been used to train nurse practitioner students. The article suggests that simulation-based learning can help nurses translate the theoretical comprehension of macro-level forces into clinical practices. This method expands the nurses' perspective, develops their social-political awareness, and encourages them to lead interventions. This simulation can contribute to dismantle structural racism and reduce health inequities.
International Journal of Environmental Research and Public Health , 2021
In recent years, there has been increased recognition of the significance and relevance of Holoca... more In recent years, there has been increased recognition of the significance and relevance of Holocaust studies to nurses. However, these studies are rarely integrated in the nursing curriculum, and even when they are, the focus is usually on healthcare personnel who collaborated with the Nazi regime. This article aims to bridge this gap by analyzing a comprehensive requisite curriculum on the Holocaust for graduate nursing students. We emphasize the work of Jewish healthcare professionals during the Holocaust and the dilemmas they faced, as well as the trauma and resilience of Holocaust survivors, their treatment today, and implications for treating other patients. This article examines how studying these issues affected the graduate students. It analyzes the reflective accounts written by the students, using qualitative content analysis and Grounded Theory. The findings suggest that students received tools to act professionally and empathetically while demonstrating greater sensitivity to the patients’ identity, past experiences, trauma, and how the hospital as a “total institution” affects them. Many of the students developed conscious leadership. The program used a personalized pedagogical approach that contributed to experiential learning but was also emotionally challenging for the participants. We recommend including Holocaust studies as a requisite component in nursing programs worldwide.
Background: People with disabilities identify negative staff attitudes and behaviors as barriers ... more Background: People with disabilities identify negative staff attitudes and behaviors as barriers to accessing health services. Studies show that nursing education activities specific to people with disabilities improves nursing care. This study explores the experience of orthodox Jewish nursing students volunteering with people with disabilities, how their attitudes towards this population changed.
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.
Translators of global liberal human rights ideas into religious conservative communities are inte... more Translators of global liberal human rights ideas into religious conservative communities are intermediaries who occupy a liminal position. They are located at a complex crossroad of incompatible values and norms. This article examines the translators' challenges and dilemmas that stem from this position. The article focuses on translators of human rights of people with disabilities in Jewish ultra-Orthodox communities in Israel as a case study. The article analyzes the translators' questions of identity and belonging, as well as their dilemmas and difficulties when there is a contradiction between the human rights discourse and the ultra-Orthodox discourse. It also illuminates the dilemmas that result from the tension between the state authorities' perspective and the ultra-Orthodox perspective. These dilemmas differ from those discussed in the literature, which are usually related to choosing activist strategies. Furthermore, the findings suggest that, unlike previous studies that have portrayed human rights translators as actors with "double subjectivity" who can flexibly move between the global and the local moral worlds, the translators in this case are deeply entrenched in the local religious world. For them, localization is not merely an instrumental means to legitimize the global human rights principles but, rather, an essential way to settle their conflicting identities and beliefs.
Le concept de compétence structurelle permet d’aborder les inégalités sociales et de santé en Isr... more Le concept de compétence structurelle permet d’aborder les inégalités sociales et de santé en Israël dues aux structures sociopolitiques. Ainsi, la rencontre entre des soignants de Jérusalem et leurs collègues d’hôpitaux palestiniens fait prendre conscience des disparités liées à l’oppression.
Background: Emergency department (ED) crowding is an international phenomenon dependent on input,... more Background: Emergency department (ED) crowding is an international phenomenon dependent on input, throughput, and output factors. This study aims to determine whether patterns of potentially unnecessary referrals from either primary care physicians (PCPs) or urgent care centers (UCCs) can be identified, thereby to reduce ED visits by patients who could be treated elsewhere. Literature from the United States reports up to 35% unnecessary referrals from UCCs. 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.
Background: Structural competency is the trained
ability to recognize how social, political, econ... more Background: Structural competency is the trained 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.]
Structural competency is the trained ability to discern and acknowledge how health care outcomes ... more Structural competency is the trained ability to discern and acknowledge how health care outcomes are shaped by larger political, social, economic, policy, and legal forces and structures. Although structural competency has become an increasingly known framework for training and teaching, especially in the United States, it has usually not been used in nursing and nursing education. Moreover, very little is known about how to implement structural competency programs in conflict zones. Due to depoliticization that often prevails in both the higher education system and the health care system, the political conflict and the structural violence that significantly impact people's health are rarely discussed in these systems. This article examines the potential contribution of structural competency training programs for nurses and nursing students in conflict areas by analyzing a program that has emphasized the impact of the Israeli-Palestinian conflict on the health of Jerusalem's Palestinian residents. The article explains how this program has challenged the denial and silencing of conflict-related sociopolitical issues. At the same time, this program has created heated disagreements and friction. We suggest that structural competency training programs that are adapted to the political context in question may help nurses become organic intellectual leaders and agents of social change for those whose voices are not heard.
Biomedicine has played a key role in the dissemination of modern social norms, such as the emphas... more Biomedicine has played a key role in the dissemination of modern social norms, such as the emphasis on individual autonomy and the distinction between science and religion. This study examines the way the mostly-Jewish members of the medical staff at an emergency department of a Jerusalem hospital perceive Jewish ultra-Orthodox and Arab patients' behaviors vis-à-vis the existing biomedical norms. We analyzed participants' perceptions in terms of the social constructs they reveal, their meanings, and their implications. Semi-structured in-depth interviews were conducted with 24 staff members and were analyzed using content analysis. The staff described challenges in treating Arab and ultra-Orthodox patients, which they related to both groups' embeddedness in traditional "cultures" and collective identities. According to the participants, in both cases, the patients' cultural affiliations constrained their sense of individual autonomy and rationality. However, in the comparative analysis, two differences emerged. First, while both groups were perceived to diverge from modern norms of individual autonomy, in the case of Arab patients, these characteristics were presented as disruptive and potentially threatening to the hospital staff. By contrast, in the case of ultra-Orthodox patients, adherence to traditional and collective values was more likely to be represented as a risk to the patient, rather than to the staff. Second, staff were more likely to provide accommodations for ultra-Orthodox patients than for Arab patients. These accommodations were often described in the frame of "cultural competency." We suggest that divergences in how staff understood and responded to perceived cultural differences of each group reflect unequal impacts of structural determinants of health, including of political conflict. We recommend moving beyond the conceptual framework of cultural competency to strengthen the staff's structural competency, cultural and structural humility, and critical consciousness.
International Journal of Environmental Research and Public Health , 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: A growing body of research demonstrates that economic conditions and racial and ethni... more Background: A growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance. Methods: A cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days. Results: There were differences between Jewish and Arab patients' social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty. Conclusion: The study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.
is a low point in the history of nursing, as many nurses participated in programs of compulsory s... more is a low point in the history of nursing, as many nurses participated in programs of compulsory sterilization, "euthanasia," and annihilation conducted by the Nazis (Benedict & Shields, 2014; Shields et al., 2022). Despite the importance of this era for understanding processes that affect present and future nursing, Holocaust and genocide studies are not part of the curriculum in most nursing school programs. Recently, there has been a call to include this topic in health professions curricula (Chelouche, 2021;
Background: Medical neutrality is a normative arrangement that differentiates a zone of medical t... more Background: Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on health inequity. This article analyzes how healthcare professionals understand and negotiate the depoliticized space of the emergency department (ED) through their views on neutrality. It also examines how medical staff use depoliticized concepts of culture to account for differences in the health status of patients from disadvantaged groups. These questions are examined in the context of the Israeli-Palestinian conflict. Methods: Twenty-four in-depth, semi-structured interviews were conducted with healthcare personnel in a Jerusalem hospital's ED. All but one of the participants were Jewish. The interviews were analyzed using qualitative content analysis and Grounded Theory. Results: The ED staff endorsed the perspective of medical neutrality as a nondiscriminatory approach to care. At the same time, some medical staff recognized the limits of medical neutrality in the context of the Israeli-Palestinian conflict and negotiated and challenged this concept. While participants identified unique health risks for Arab patients, they usually did not associate these risks with the effects of conflict and instead explained them in depoliticized terms of cultural and behavioral differences. Culture served as a non-controversial way of acknowledging and managing problems that have their roots in politics. Conclusions: The normative demand for neutrality works to exclude discussion of the conflict from clinical spaces. The normative exclusion of politics is a vital but under-appreciated aspect of how political conflict operates as a structural determinant of health. Healthcare personnel, especially in the ED, should be trained in structural competency. This training may challenge the neglect of issues that need to be solved at the political level and enhance health equity, social justice, and solidarity.
Organ trafficking is widely recognised as a human rights concern. Medical professionals play a de... more Organ trafficking is widely recognised as a human rights concern. Medical professionals play a decisive role in bringing international norms regarding organ trafficking into the local context as translators and localisers. In Israel, this localisation reflects the tensions and gaps between global and local values, moralities and beliefs. Based on in-depth interviews with 92 stakeholders, this article examines the Israeli medical professionals' approach toward organ trafficking, the moral conflicts, challenges and dilemmas they faced given these tensions and gaps, and their attempts to address them in practice. The findings reveal that many Israeli healthcare professionals subscribed to an ambivalent stance on organ trafficking and a non-judgmental approach towards patients who engage in organ trafficking, preferring to turn a blind eye to this phenomenon. They internalised key aspects of the deeply rooted local ethical perceptions regarding organ trafficking. This internalisation points to the limitations of translators' freedom of operation between transnational and domestic languages. Localisation is not merely a result of pragmatic compromises but stems from the localisers' identification with local moralities. This study contributes to understanding the role of professionals in processes of societal change and the complex ramifications of this role.
Background
Improving patient experience and satisfaction in the emergency department (ED) is chal... more Background 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.
Structural competency is the trained ability to discern and respond to the impact of social, poli... more Structural competency is the trained ability to discern and respond to the impact of social, political, and economic structures on health. This article discusses a new online standardized patient simulation method that enhances the structural competency of nurses and nursing students. This method has been used to train nurse practitioner students. The article suggests that simulation-based learning can help nurses translate the theoretical comprehension of macro-level forces into clinical practices. This method expands the nurses' perspective, develops their social-political awareness, and encourages them to lead interventions. This simulation can contribute to dismantle structural racism and reduce health inequities.
International Journal of Environmental Research and Public Health , 2021
In recent years, there has been increased recognition of the significance and relevance of Holoca... more In recent years, there has been increased recognition of the significance and relevance of Holocaust studies to nurses. However, these studies are rarely integrated in the nursing curriculum, and even when they are, the focus is usually on healthcare personnel who collaborated with the Nazi regime. This article aims to bridge this gap by analyzing a comprehensive requisite curriculum on the Holocaust for graduate nursing students. We emphasize the work of Jewish healthcare professionals during the Holocaust and the dilemmas they faced, as well as the trauma and resilience of Holocaust survivors, their treatment today, and implications for treating other patients. This article examines how studying these issues affected the graduate students. It analyzes the reflective accounts written by the students, using qualitative content analysis and Grounded Theory. The findings suggest that students received tools to act professionally and empathetically while demonstrating greater sensitivity to the patients’ identity, past experiences, trauma, and how the hospital as a “total institution” affects them. Many of the students developed conscious leadership. The program used a personalized pedagogical approach that contributed to experiential learning but was also emotionally challenging for the participants. We recommend including Holocaust studies as a requisite component in nursing programs worldwide.
Background: People with disabilities identify negative staff attitudes and behaviors as barriers ... more Background: People with disabilities identify negative staff attitudes and behaviors as barriers to accessing health services. Studies show that nursing education activities specific to people with disabilities improves nursing care. This study explores the experience of orthodox Jewish nursing students volunteering with people with disabilities, how their attitudes towards this population changed.
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.
Translators of global liberal human rights ideas into religious conservative communities are inte... more Translators of global liberal human rights ideas into religious conservative communities are intermediaries who occupy a liminal position. They are located at a complex crossroad of incompatible values and norms. This article examines the translators' challenges and dilemmas that stem from this position. The article focuses on translators of human rights of people with disabilities in Jewish ultra-Orthodox communities in Israel as a case study. The article analyzes the translators' questions of identity and belonging, as well as their dilemmas and difficulties when there is a contradiction between the human rights discourse and the ultra-Orthodox discourse. It also illuminates the dilemmas that result from the tension between the state authorities' perspective and the ultra-Orthodox perspective. These dilemmas differ from those discussed in the literature, which are usually related to choosing activist strategies. Furthermore, the findings suggest that, unlike previous studies that have portrayed human rights translators as actors with "double subjectivity" who can flexibly move between the global and the local moral worlds, the translators in this case are deeply entrenched in the local religious world. For them, localization is not merely an instrumental means to legitimize the global human rights principles but, rather, an essential way to settle their conflicting identities and beliefs.
Le concept de compétence structurelle permet d’aborder les inégalités sociales et de santé en Isr... more Le concept de compétence structurelle permet d’aborder les inégalités sociales et de santé en Israël dues aux structures sociopolitiques. Ainsi, la rencontre entre des soignants de Jérusalem et leurs collègues d’hôpitaux palestiniens fait prendre conscience des disparités liées à l’oppression.
Background: Emergency department (ED) crowding is an international phenomenon dependent on input,... more Background: Emergency department (ED) crowding is an international phenomenon dependent on input, throughput, and output factors. This study aims to determine whether patterns of potentially unnecessary referrals from either primary care physicians (PCPs) or urgent care centers (UCCs) can be identified, thereby to reduce ED visits by patients who could be treated elsewhere. Literature from the United States reports up to 35% unnecessary referrals from UCCs. 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.
Background: Structural competency is the trained
ability to recognize how social, political, econ... more Background: Structural competency is the trained 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.]
Structural competency is the trained ability to discern and acknowledge how health care outcomes ... more Structural competency is the trained ability to discern and acknowledge how health care outcomes are shaped by larger political, social, economic, policy, and legal forces and structures. Although structural competency has become an increasingly known framework for training and teaching, especially in the United States, it has usually not been used in nursing and nursing education. Moreover, very little is known about how to implement structural competency programs in conflict zones. Due to depoliticization that often prevails in both the higher education system and the health care system, the political conflict and the structural violence that significantly impact people's health are rarely discussed in these systems. This article examines the potential contribution of structural competency training programs for nurses and nursing students in conflict areas by analyzing a program that has emphasized the impact of the Israeli-Palestinian conflict on the health of Jerusalem's Palestinian residents. The article explains how this program has challenged the denial and silencing of conflict-related sociopolitical issues. At the same time, this program has created heated disagreements and friction. We suggest that structural competency training programs that are adapted to the political context in question may help nurses become organic intellectual leaders and agents of social change for those whose voices are not heard.
Daphna Golan, Jona Rosenfeld, and Zvika Orr (eds.), Bridges of Knowledge: Campus-Community Partne... more Daphna Golan, Jona Rosenfeld, and Zvika Orr (eds.), Bridges of Knowledge: Campus-Community Partnerships in Israel. Tel Aviv: Mofet Institute Publishing, 2017 (in Hebrew, with English abstracts).
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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.]