Health Management
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- ItemNutrition Knowledge, Attitude and Practice among Nurses and Physicians working at Palestinian Hospitals in the West Bank and Jerusalem(Al-Quds University, 2024-01-02) Margaret Zaed Ayed Zayed; مرجريت زيد عايد زايدNutrition is an important factor in the promotion of health and improving health outcomes of people, especially in hospital settings. Good nutrition also reduces the risk of nosocomial infections and postoperative complications which are both related to shorter hospital stays and less medical cost. Nutrition care needs a multidisciplinary team to achieve the optimal goal. Physicians should diagnose, advice, and coordinate with dietitians to provide nutritional advice. Nurses also have the responsibility to screen patients for malnutrition, support them and ensure their needs are met through monitoring and communicating with other health care teams. Aim: to determine nutrition knowledge, attitudes and practices among physicians and nurses regarding nutrition in four selected hospitals in West Bank and Jerusalem Methods: descriptive-analytical, cross-sectional designs were used. The study population included all nurses and physicians in four Palestinian hospitals in the West Bank and Jerusalem. The sample size was 258 physicians and nurses. Data were collected by self-reported questionnaire that was divided into six major parts asking about Nutrition knowledge, attitudes and practices of nurses and physicians with their sociodemographic factors, in addition to questions about nutrition education, training and general nutrition care given.205 questionnaires were returned with 79% response rate. The validity of the questionnaire were ensured by both content and face validity; Reliability of questionnaire was also ensured and Cronbach’s alpha results showed (α=0.812, 0.725, 0.901 for Knowledge, Attitude and practice questions respectively. Data analysis was done with the help of (SPSS version 27) Results: Most of the participants were nurses (76.1%) aged from 26-30 years old. Participants showed moderate knowledge towards Nutrition in hospitals. Most of them agreed about the importance of care, either in terms of its priority (42.9% agree and 35.6% strongly agree), the importance of nutrition in fostering health recovery (44.4% agree and 47.8% strongly agree) and the need for individualized nutritional care for patients by the nutritionist (40.5% agree and 47.3% strongly agree). The study shows neutral attitudes towards nutrition among the participants. However, results found poor practices toward nutrition, 50% of them never check patients when eating to ensure they are eating well. Female health care professions tend to practice more supporting nutritional practices than males while age was significantly correlated to better attitudes and practice in both genders. Conclusion: The study shows good nutritional knowledge and attitudes among nurses and physicians, while their practice in daily routines are not enough. The study also shows that most of the participants didn’t receive any in-work training and they also agree that they need such continuous training during their work life. Adding nutrition curriculum to medical and nursing schools is recommended in addition to effective and efficient training and education programs in all hospitals to target all nurses and physicians who have direct contact with patients.
- ItemThe Contributions of the International Funds to Developing the Palestinian Health Care System: Focus on NGOs-Gaza(Al-Quds University, 2012-09-01) Mohammed Shokri Al-Khaldi; محمد شكري محمد الخالديInternational Fund (IF) has become an important source in developing countries including Palestine. The overall aim of this study was to assess the role of IF in supporting the Palestinian Health System at NGOs sector in Gaza governorates. The study design is cross sectional with triangulation of quantitative and qualitative approaches. The instruments used were interviewed-questionnaire and in-depth interviews with 8 key informants. The study population included 52 NGOs, 48 of them responded (88%). General measures of validity and reliability were administered such as standardization of instrumentation and implementation. The SPSS program has been used for quantitative analysis and open coding thematic analysis for the qualitative analysis. Reliability test analysis was high (0.8) indicating high consistency of the study questionnaire. The research findings show that 85.4% of the NGOs directors were males; most of them were trained at BSc. degree level and had 15 years of experience in average. Most of the NGOs were located in Gaza City (58%) followed by Khanyounis (14.6%). Responses indicated that 95% of NGOs were engaged in providing health services and 54.2% reported working in development oriented activities, 25% in rehabilitation services and 10% were reported working in advocacy and mobilization fields. The overall perceived IF contribution’s score was 2.05 out of 3 (68.46%) indicating that perceptions about IF role were moderate. Reported perceptions about sustainability were more positive and elicited higher mean scores (78.30%). The revealed scores reflecting perceptions about the contributions of IF were as follows efficiency, effectiveness, relevancy and appropriateness was around 75%, evaluation and monitoring domain 73%, transparency and governance 71.41%, meetings of NGOs needs and development domain was 68.79%, while the IF nature domain was 68.63%. Perceptions about responsiveness to the needs of the Palestinian population such as alliveiating human suffering, minimizing the consequences of the occupation and promoting the socio-economic status had elecited moderate scores also. The overall scores reflecting the extent to which IF improves the national health indicators by improving the quality of health serives was moderate (64.86%) indicating gaps in adequacy or utilization of IF. The IF contributions to meeting the Millennium Development Goals such as reducing infant and maternal mortality, fertility, poverty and unempolyment elicited 63.39%. Perceptions about coordination and cooperation were the lowest scores of the study domains (60.67%). More than 70% of respondents stated that their NGOs had suffered from financial deficits mainly due to insufficient funds and the major obstacles in securing fund were political conditions and inadequacy of interactions with donors. The revealed scores reflecting perceptions about the IF contribution to development rather than relief was 75.69%. There were factors affecting and/or affected by the IF in the health field, mainly politics, security, absence of coordination, health NGOs and donors’ vision and goals incompatibility, organizational factors such as NGO strategic management and economical and financial factors. The researcher recommends that donors and NGOs need to proactively coordinate in order to meet the needs of the Plaestinan community. Areas which require more attention include developing mutual vision, closer coordination and paying more attention effectiveness, efficiency and sustainability. NGOs need to improve their capacity to strtagically manage funds in a way that promote meeting public health needs and priorities.
- ItemEvaluation of Natal-Care Services Provided by Governmental Hospitals in Gaza Governorates(Al-Quds University, 2012-12-01) Sahar Abdel Wahhab Shalabi; سحر عبد الوهاب شلبيBirth is an occasion that changes life. It is a natural process, and there must be a good reason to interfere with this natural process in order not to expose women to high rates of intervention, unfamiliar personnel, lack of privacy and other situations that may be felt as harsh. The overall aim of the study is to evaluate the natal care services provided by governmental hospitals in Gaza Governorates. The design of this study is a quantitative, descriptive, analytical, cross-sectional one and was conducted in governmental maternity hospitals in Gaza Governorates. Data were collected from forty low- risk women during labour and birth using an observational checklist that was prepared to assess the practices for normal childbirth in relation to evidence-based childbirth care and to obtain a rough estimate of the frequency of certain practices. And another checklist for medical records to evaluate the quality of documentation of medical records in terms of completeness, and accuracy. Data were analyzed using Statistical Package for the Social Sciences, Version 17.0. The results indicated that non-evidence-based practices are commonly used to support, and manage birth in Gaza Governorates. High levels of obstetric interventions were observed giving evidence of their inappropriate or routine use, and largely deviated from the well-known best practice recommended by World Health Organization for normal birth. It was found that Intra Venous fluids were used for 60% of the observed women, fetal heart sounds were checked during the 2nd stage of labour in 37.5% , 66.7% of them by continuous Cardiotocograph Partogram was filled in 35% of cases, labour was augmented with oxytocin in 62.5% of cases and with artificial rupture of membranes in77.5% of them. Birthing women were not always treated with respect and their privacy was violated many times, with frequent lack of communication with health care providers and lack of support from health care providers and family members. There were clear differences between observation, and documentation. Augmentation of labour was used commonly by oxytocin (62.5 %), but it was less documented in medical records (52.5%). Blood pressure was measured in the observation only in 37.5% of cases but documented in 72.5%. The overall completeness of records was found to be poor (46.4%). The completeness of demographic information (67.5%) was good in general. But it was for some items very poor, such as general examination and vital signs (12.5%), abdominal examination (10%), vaginal examination (2.5%), and Partograms filling (20%). Incomplete and inaccurate documentation of health records were detected indicating poor quality of care which stresses the need to increased attention for documentation of medical records. This study provides recommendations to support evidence-based practices and encourage normal deliveries, and standardization of medical records among governmental hospitals.
- ItemDrugs Prescribing Patterns and Practices at UNRWA Health Centers – Gaza Governorates(Al-Quds University, 2012-06-04) Mona Arafat El Baba; منى عرفات الباباThe practice of rational drug prescribing is of great importance for the safety of patients and the health facility expenditure. This study aimed to examine prescription patterns among prescribers working at UNRWA health centers and to determine their level of adherence to WHO standards of drug use indicators. The popula"on of the study consisted of #$% prescribers and the sample si&e was #'# prescribers ()$ males and *+ females,- with response rate %%..%/ and #+'# prescrip"ons from all UNRWA health centers in Ga&a Strip. For data collection- constructed- self administered questionnaire and checklist for drug indicators were used. For data analysis- the researcher used frequencies- means- standard deviation- Chi square and One way ANOVA test. The results showed that ))/ of study par"cipants reported knowing the meaning of essen"al drugs- )6.6/ knew the meaning of generic name- $6.'/ knew the generic name for all prescribed drugs. **.*/ knew the generic name for most of the drugs and )).#/ were familiar with the concepts of standards treatment guidelines. Only '*.$/ used generic name very o7en- $$.$/ used generic name o7en and only '*.*/ received training about prescribing patterns. Also- )).8/ reported that a copy of 9:; was available- )8.6/ were using the 9:;- of them- 6'.8/ found that 9:; was easy to be used. Regarding shortage of drugs- +$.*/ of study par"cipants said that they experienced shortage of drugs and +8.8/ reported that the main shortage was in antibiotics followed by dermatological drugs (*8.'/, and NSA<:s (*#.$/,. The ma=ority of study par"cipants )6.#/ said that there is a monitoring system for prescribing of drugs- )'.$/ said that there is a wri>en technical instruc"ons for prescribing- only '..'/ received wri>en feedback and 8+.'/ received verbal feedback regarding their prac"ce. Concerning drug use indicators- the mean number of prescribed drugs was '.%% per prescrip"on- percentage drugs prescribed by generic name was '8.$- percentage of prescribed an"bio"cs was *'.6- percentage of drugs prescribed from 9:; was 6).*% and percentage pf prescribed in=ec"ons was *.#. The results indicated that the highest rate of prescribing drugs in general and from 9:; was from North governorate- the highest number of prescribed drugs was in general ?les (m @ '.)', and the lowest was in mother ?les (m @ '.%.,. The highest rate of prescribing drugs was in the third #. days of the month (m @ '.6+,. The study concluded that further educational activities should be taken to achieve rational prescribing and standards of drug use indicators.
- ItemFactors Hindering the Implementation of Quality Improvement at the MoH-Gaza.(Al-Quds University, 2012-07-10) Mahmoud Mohammed Radwan; محمود محمد رضوانQuality has been identified as one of the key drivers of improved health outcomes and greater efficiency in health service delivery in developing countries. In a fragmented and inefficient health system like the Palestinian one, where resources are scarce and health problems are complex, the need for implementation of Quality Improvement (QI) is even more crucial than elsewhere. Little is known about the most influencing factors for impeding the implementation of QI at the Ministry of Health (MoH). This study aims to investigate the most perceived barrier factors to the successful implementation of QI at the MoH facilities. The study employed a descriptive, analytical cross sectional design with a triangulated approach (quantitative and qualitative). Self-administered questionnaires and key informant interviews were used for data collection. A randomized multi stage stratified sampling was used to select the eligible healthcare providers working at the MoH in two medical complexes (Shifa in Gaza and Nasser in Khanyounis) and five PHC centers (level 4). The calculated sample size was 450, out of them, 397 responded and completed the questionnaires, with a response rate of 88.2%. The overall reliability coefficient for the study instrument was acceptable 0.787. Semi structured, face to face, audiotaped in-depth interviews were conducted with eight key informants as a second data collection instrument. Findings revealed that the most perceived barrier factors to the implementation of QI were top management commitment (Mean=2.17), followed by organizational culture (Mean=2.29), leadership (Mean=2.33), health information system (Mean=2.48), human resources management (Mean=2.49), staff training (Mean=2.53), and staff engagement (Mean=2.57). Although the most common obstacle for the implementation of QI, mentioned by all key informants, was the lack of a strategic plan, majority of them reported the same obstacles elicited from quantitative data. However, the perception of healthcare providers reflected a limited implementation of QI with percentage of (25.1%). Such perception was widely concurred by the key informants. Participants working at hospitals and PHC centers revealed similar perception towards the barrier factors affecting the implementation of QI with statistically insignificant differences (P˃0.05). The findings showed variation in the perceived barriers to the implementation of QI in reference to gender, specialties, and job positions (P˂0.05). Pearson test showed a weak positive correlation between the implementation of QI and top management commitment, structure, leadership, human resource management, monitoring & supervision, staff engagement and training, health information system, financial support, and material resources. The researcher recommends prioritizing the QI in the strategic plan as an approach to improve the performance and the provided healthcare services at the MoH facilities; in addition, strengthening the role of management and leadership through dissemination of quality culture, ensuring the resources, and investment in the training.