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Nurse managers and team co-workers' disruptive behaviors (DBs) are negatively associated with a perceived safe climate. Moreover, DBs are a risk factor for patients' safety. Yet, it remains unknown whether and to what extent these effects were prevalent in COVID-19 wards and among witnesses of DBs.A cross-sectional study.A questionnaire was distributed on social networks and completed by nurses in various Israeli healthcare organizations using snowball sampling between October and December 2021. The questionnaire included seven previously published measures and a question checking whether the participants had worked in a COVID-19 ward. The minimal sample size for any analysis was 236. Hypotheses were tested with correlations and structural equation modeling.DBs of nurse managers and team co-workers toward nurses were higher in COVID-19 teams. As hypothesized, DBs were negatively correlated with a safe climate and positively with patient safety (fewer errors). The data were consistent with a model suggesting that a safe climate is related to fewer DBs and DBs largely mediate the effects of safe climate on errors. Surprisingly and importantly, the strongest predictor of errors, including preventable mortality, is witnessing DBs and not being a victim of DBs.DBs may impede open communication and collaboration among co-workers, particularly in COVID-19 teams. This study shows the links between nurse shaping of a safe climate, DBs toward nurses, and patient safety.Nurse managers who create a safe climate and show zero tolerance for DBs could reduce the risk of errors in care.

AIM To examine the associations between religious Jewish nurses' exposure to sexual harassment by patients, the ward's listening climate, the quality of nursing care, and nurses' avoidance of therapeutic contact with harassing patients. BACKGROUND A few studies have examined nurses' exposure to sexual harassment by patients but this phenomenon has not been studied among religious Jewish nurses. METHODS A cross-sectional study of 85 nurses who study at a religious Jewish nursing school. Respondents completed self-administered structured questionnaires. Multiple regression analysis was performed to reveal antecedents of the quality of nursing care provided to sexually harassing patients. RESULTS The more religious the nurses, the more they avoided therapeutic contact with harassing patients. The strongest predictor of reported quality of care for harassing patients was the avoidance of therapeutic contact. forty two percent of the variance in reported quality of nursing care was explained by the employment type and by the avoidance of therapeutic contact, which was related to the nurses' level of religiosity. CONCLUSIONS Nurses' level of religiosity is related to the quality of care provided to sexually harassing patients. IMPLICATIONS Nursing leadership must raise awareness of sexual harassment by patients and develop policy and implementation programs with sensitivity to religious nurses.

Aim To raise awareness of a patient-related antecedent of missed nursing care. Background Missed nursing care is negatively associated with patient outcomes; accordingly, hospitals employ strategies to mitigate missed care. While antecedents of missed nursing care resulting from the work environment of nurses are recognized, sexual harassment by patients is not. Methods This study is a hidden population study using respondent-driven sampling. We analysed data from thirty letters of frontline nurses from a tertiary Israeli hospital using the six steps of Aronson's thematic analysis. Findings Six themes emerged. Nurses (a) felt objectified and that the sacred nurse-patient therapeutic space was desecrated; (b) felt a lack of support from ward managers; (c) felt unprotected, lonely, and alienated; (d) did not share the experience with managers; (e) coped with sexual harassment by ending treatment quickly and later realized they missed some tasks; and (f) considered leaving nursing. Conclusion (s) Policymakers are called upon to adopt the eight steps suggested for effectively coping with sexual harassment by patients and thus to reduce missed nursing care. Implications for nursing management Managers are called upon to modify their management style and to provide support to nurses who experience sexual harassment in order to alleviate their stress, which is an also antecedent of missed nursing care.

Viruses are efficient metabolic engineers that actively rewire host metabolic pathways to support their lifecycle, presenting attractive metabolic targets for intervention. Here we chart the metabolic response of lung epithelial cells to SARS-CoV-2 infection in primary cultures and COVID-19 patient samples. Bulk and single-cell analyses show that viral replication induces endoplasmic stress and lipid accumulation. Protein expression screen suggests a role for viral proteins in mediating this metabolic response even in the absence of replication. Metabolism-focused drug screen showed that fenofibrate reversed lipid accumulation and blocked SARS-CoV-2 replication. Analysis of 3,233 Israeli patients hospitalized due to COVID-19 supported in vitro findings. Patients taking fibrates showed significantly lower markers of immunoinflammation and faster recovery. Additional corroboration was received by comparative epidemiological analysis from cohorts in Europe and the United States. A subsequent prospective interventional open-label study was carried out in 15 patients hospitalized with severe COVID-19. The patients were treated with 145 mg/day of nanocrystallized fenofibrate (TriCor®) in addition to standard-of-care. Patients receiving fenofibrate demonstrated a rapid reduction in inflammation and a significantly faster recovery compared to control patients admitted during the same period and treated with the standard-of-care. Taken together, our data show that elevated lipid metabolism underlies critical aspects of COVID-19 pathogenesis, suggesting that pharmacological modulation of lipid metabolism should be strongly considered for the treatment of coronavirus infection.

Every year, millions of people die of diabetes-related complications. Despite this risk, patients’ nonadherence to lifesaving medical recommendations remains a persistent crisis. One factor that could increase adherence is the formation of an alliance with the medical staff. This alliance, in turn, may increase when the patient perceives that the health care staff is willing to listen. To test this model, we asked people with diabetes, N = 76, to report (a) perceptions of listening by their nurse and physician, (b) their working alliance with the medical-staff members, and (c) several indicators of adherence with medical recommendations. The results suggested that listening is highly correlated with working alliance, r = .84, both with the nurse and the physician. Furthermore, both listening by the physician, r = .27, and alliance with the physician, r = .44, were associated with medication adherence. Listening by the physician, and alliance with the physician were not associated with adherence to life-st...

Background Worldwide, there is a widespread and disturbing pattern of violence towards healthcare workers. However, violent occurrences in Israeli hospitals have often been unrecognized and underreported. Moreover, most studies have not sufficiently differentiated among the different types of violence. To examine the different types of violence experienced by nurses and physicians, the types of perpetrators and the specialty fields involved. Methods A quantitative questionnaire was used to assess the incidence of a “basket” of violent behaviors, divided into eight types of violent manifestations. The study population consisted of 729 physicians and nurses in a variety of hospital divisions and departments (surgery, oncology, intensive care, ambulatory services including day care, and emergency room) in a large general hospital. Six hundred seventy-eight of them responded to the survey for a response rate of 93%; about two thirds of respondents (446) were nurses and about one third (232) were physicians. The questionnaires were completed during staff meetings and through subsequent follow-up efforts. Results In the 6 months preceding the survey, the respondents experienced about 700 incidents of passive aggressive behavior, 680 of verbal violence and 81 of sexual harassment. Types of violence differed between patients and companions; for example, the latter exhibited more verbal, threatening and passive aggressive behaviors. Violence was reported in all departments (ranging from 52–96%), with the departments most exposed to violence being the emergency room and outpatient clinics. Nurses in the emergency room were 5.5 times at a higher risk of being exposed to violence than nurses in the internal medicine department. Nurses were exposed to violence almost twice as much as physicians. There was a positive association between the physician’s rank and his/her exposure to violence. A multiple regression model found that being older reduced the risk of being exposed to violence, for both physicians and nurses. Conclusions These findings suggest that uniform definitions of a range of different violent behaviors and assessments of their prevalence are important to creating an improved discourse about hospital violence in both research and operational settings. The study findings could assist policy makers in the Israeli healthcare system in implementing interventions on a national level and can promote leaders’ commitment to violence prevention and management. This is an important contribution, as executive commitment is necessary and critical for the necessary organizational changes to occur.

The kidney plays a critical role in fluid homeostasis, glucose control, and drug excretion. Loss of kidney function due to drug-induced nephrotoxicity affects over 20% of the adult population. The kidney proximal tubule is a complex vascularized structure that is particularly vulnerable to drug-induced nephrotoxicity. Here, we introduce a model of vascularized human kidney spheroids with integrated tissue-embedded microsensors for oxygen, glucose, lactate, and glutamine, providing real-time assessment of cellular metabolism. Our model shows that both the immunosuppressive drug cyclosporine and the anticancer drug cisplatin disrupt proximal tubule polarity at subtoxic concentrations, leading to glucose accumulation and lipotoxicity. Impeding glucose reabsorption using glucose transport inhibitors blocked cyclosporine and cisplatin toxicity by 1000- to 3-fold, respectively. Retrospective study of 247 patients who were diagnosed with kidney damage receiving cyclosporine or cisplatin in combination with the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin showed significant (P < 0.001) improvement of kidney function, as well as reduction in creatinine and uric acid, markers of kidney damage. These results demonstrate the potential of sensor-integrated kidney-on-chip platforms to elucidate mechanisms of action and rapidly reformulate effective therapeutic solutions, increasing drug safety and reducing the cost of clinical and commercial failures.