Yulia Gendler

Aim: To explore the hidden emotional burdens faced by nurses in acute care, focusing on experiences with ‘unpopular’ patients, compassion fatigue, and the second victim phenomenon, and how these intersect to influence patient safety. Design: A qualitative study using a narrative inquiry approach. Methods: Semi‐structured, in‐depth interviews were conducted between September and November 2025 with 24 nurses from hospital departments. Data were analysed using narrative and conventional content analysis within a hermeneutic framework. Results: Content analysis identified emotional solitude in coping as the overarching theme. Two main categories emerged: (1) the manager's role in second‐victim situations, highlighting managers as second victims themselves and the burden of responsibility overload; and (2) implications for nursing practice, involving distancing from patients, hesitation in clinical decision‐making, and disrupted teamwork. Conclusion: Caring for unpopular patients and experiencing second‐victim distress creates significant emotional strain and isolation. Integrating compassion fatigue and second‐victim awareness into organizational practice is essential for a supportive care environment. Implications: Leadership should implement targeted support systems to address emotional solitude, preventing clinical hesitation and patient distancing that compromise safety. Impact: Problem: The study addressed how compassion fatigue and second‐victim distress intersect with challenging patient encounters to threaten safety. Findings: Emotional solitude leads to professional distancing, clinical hesitation, and impaired teamwork. Impact: Results inform nursing leadership and administrators on developing targeted support systems. Reporting Method: Adhered to COREQ guidelines. Patient or Public Contribution: No patient or public contribution. Global Clinical Contribution: Identifies ‘emotional solitude’ as a barrier to recovery and safety. Highlights managers' unique vulnerability as second victims. Shows how the emotional burden, increasing risk by narrowing care to basic tasks, increases.

Objectives: Patient decision aids (PtDAs) are effective interventions to support patient involvement in health decisions and have the potential to impact favourably on health inequities by reducing gender bias in clinical practice. The aim was to explore sex and gender reporting and differences in randomised controlled trials (RCTs) evaluating PtDAs for adults making treatment or screening decisions. Design: Secondary analysis of the Cochrane review of PtDAs of RCTs that reported sex and/or gender. The original review searched MEDLINE, Embase, PsychINFO and EBSCO from journal inception to March 2022. Two team members independently screened citations, extracted data and assessed risk of bias. For this secondary analysis, we only included primary outcomes from the original review. We assessed appropriate use of terminology for sex (biological attribute) and gender (social construct). When terms were used interchangeably, it was considered inaccurate. Findings were synthesised descriptively, and we used meta-analysis when two or more RCTs were conducted with females/women or males/men using similar outcome measures. Primary and secondary outcome measures: Informed values-choice congruence and the quality of the decision-making process (eg, knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision making, undecided) and adverse events (eg, decision regret, emotional distress) by sex and gender. Results: Of 209 RCTs in the original review, 206 reported sex and/or gender, with 35 (17%) using accurate terminology. Of 206 RCTs, 70 were with females/women only, 27 males/men only, 12 analysed by sex/gender and 97 RCTs did not disaggregate findings by sex or gender. Meta-analysis comparing RCTs for females/women to usual care and RCTs for males/men only compared with usual care showed similar mean differences in knowledge scores (10.84 vs 9.38 out of 100; p=0.44). Males/men had significantly higher self-reported participation in decision making compared with females/women (RR 3.16 vs 0.95; p<0.01). Meta-analysis showed no significant differences in other outcomes. Conclusions: In PtDA RCTs, sex and gender terms are used interchangeably and 6% analysed outcomes by sex or gender. Meta-analysis of males/men only given PtDAs showed higher self-reported decision making participation in clinical practice compared to usual care versus females/women only compared with usual care. Researchers must improve reporting sex and gender in PtDA RCTs to assess how it influences health inequities.

Background. Parents of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) often encounter complex treatment decisions, especially the initiation of pharmacologic therapy. While evidence-based decision aids facilitate informed, values-congruent choices, tools remain limited outside English-speaking settings. Objective. This study aimed to develop and evaluate the feasibility and acceptability of a Hebrew-language decision aid intended to support parents in making informed decisions regarding the initiation of ADHD medication for their children. Methods. The development process adhered to the International Patient Decision Aid Standards and was guided by the Ottawa Decision Support Framework. Acceptability testing involved 20 stakeholders using a mixed-methods questionnaire. Field testing used a pre/post design with 38 parents of children recently diagnosed with ADHD. Outcomes, measured using validated instruments, were knowledge, decisional conflict, decision self-efficacy, decision preparedness, and preference about SDM. Results. Most participants found the decision aid to be clear, well-structured, and easy to understand. All (100%) agreed it would be helpful for others facing similar decisions. Compared with baseline, post–decision aid parental knowledge significantly increased (67.4 to 84.7 out of 100; P < 0.001) and decisional conflict decreased (29.8 to 20.8 out of 100; P = 0.01). Decision self-efficacy increased from 83.6 to 90.0 out of 100 ( P = 0.09). Participants reported high decision preparedness (mean = 89.5 of 100), and 45% preferred shared decision making with the physician. Conclusions. The systematically developed decision aid about ADHD treatments demonstrated feasibility and acceptability. It showed potential to enhance informed, value-based parental decision making; reduce decisional conflict; and facilitate shared decision making in pediatric clinical care. Highlights: A decision aid was developed to support parents in making ADHD medication decisions. The decision aid significantly increased parents’ knowledge about ADHD and treatment options and reduced parents’ decisional conflict. Stakeholders, including parents and health care professionals, reported that the decision aid was acceptable. The decision aid prepared parents for shared decision making within pediatric ADHD care.

Background: In healthcare settings, staff and their leaders frequently struggle to support colleagues who are affected by adverse events, often referred to as second victims. Existing support systems have proven inadequate, leaving a gap in addressing both emotional and professional needs. Aims: This work aims to explore the effect of educating and training charge nurses through targeted programs, while strengthening the hospital's support infrastructure. Methods: The initiative was developed by the Patient Safety and Risk Management unit of an acute care hospital, which includes ambulatory clinics, with support from the hospital's Human Resources unit. A structured educational and training program, led by a psychologist, was designed to equip charge nurses with skills to effectively support second victims. The program included three 8-h sessions with theoretical instruction, simulations, role-playing, and reflective discussions on charge nurses’ roles. The Theory of Change approach was used to define the causal pathway from training to improved peer support, clarify key assumptions, and guide evaluation. The work adheres to SQUIRE 2.0 guidelines for nonrandomized evaluations. Findings: The intervention received positive feedback, with charge nurses reporting increased confidence in supporting second victims. Early indicators suggest improved peer support and staff awareness. Ongoing monitoring and adaptation will ensure program effectiveness. Conclusions: Integrating charge nurses as second victim supporters strengthens resilience and psychological safety. Future steps include continuous assessment, content refinement, and evaluation of long-term outcomes to ensure sustained impact.

Large language models (LLMs) like ChatGPT are being explored as clinical decision support tools, but their reliability in pediatric acute care remains uncertain. This pilot study assessed ChatGPT-4.0’s performance in the early management of critically ill children using real-world clinical data. We retrospectively analyzed 20 children emergently admitted from the emergency department (ED) to a tertiary pediatric intensive care unit (PICU). ChatGPT-4.0 was prompted at four time points: ED arrival (diagnostic and therapeutic plans), ED transfer (differential diagnosis and hospitalization decision), PICU admission (diagnostic and therapeutic plans), and 24 h into PICU stay (differential diagnosis). Outputs were compared to actual care and evaluated for accuracy, safety, and omissions. At ED and PICU admission, 94% (95% CI, 91–97%) and 98% (95% CI, 95–99%) of diagnostic recommendations were rated as appropriate. Only 82% (95% CI, 76–87%) of therapeutic recommendations were considered appropriate at both points (p < 0.001). Potentially harmful therapeutic suggestions were more common than diagnostic ones: 7% vs. 2% in the ED (p = 0.016) and 10% vs. 0% in the PICU (p < 0.00001). In the PICU, critically missing therapeutic recommendations occurred at 0.95 per case, compared to 0.15 for diagnostic ones (p = 0.0073). The correct diagnosis appeared in 100% of ED discharge and 95% (95% CI, 85–100%) of PICU 24-h differentials. Triage decisions were accurate in all PICU cases. Conclusion: ChatGPT-4.0 showed good diagnostic and triage performance but requires caution, especially for therapeutic decisions and broader pediatric use. What is Known: • LLMs like ChatGPT are being explored as clinical support tools. • Their diagnostic potential has been studied in adults, but pediatric data using real patient cases are limited. What is New: • This is the first study evaluating ChatGPT in real PICU cases. • It showed good diagnostic and triage performance but requires caution, especially regarding therapeutic decisions.

Objective: To compare the performance of the Generative Pre‐trained Transformer model 4 (ChatGPT‐4) with that of a paediatric intensive care unit (PICU) specialist in responding to open‐ended medical education questions.Methods: A comparative analysis was conducted using 100 educational questions sourced from a PICU trainee WhatsApp forum, covering factual knowledge and clinical reasoning. Ten PICU specialists from multiple tertiary paediatric centres independently evaluated 20 sets of paired responses from ChatGPT‐4 and a PICU specialist (the original respondent to the forum questions), assessing overall superiority, completeness, accuracy, and integration potential.Results: After excluding one question requiring a visual aid, 198 paired evaluations were made (96 factual knowledge and 102 clinical reasoning). ChatGPT‐4's responses were significantly longer than those of the PICU specialist (median words: 189 vs. 41; p < 0.0001). ChatGPT‐4 was preferred in 60% of factual knowledge comparisons (p < 0.001), while the PICU specialist's responses were preferred in 67% of clinical reasoning comparisons (p < 0.0001). ChatGPT‐4 demonstrated superior completeness in factual knowledge (p = 0.02) but lower accuracy in clinical reasoning (p < 0.0001). Integration of both answers was favoured in 37% of cases (95% CI, 31%–44%).Conclusions: ChatGPT‐4 shows promise as a tool for factual medical education in the PICU, excelling in completeness. However, it requires oversight in clinical reasoning tasks, where the PICU specialist's responses remain superior. Expert review is essential before using ChatGPT‐4 independently in PICU education and in other similarly underexplored medical fields.

Background: As the life expectancy of people with cystic fibrosis (PwCF) increases, understanding long‐term complications, including CF‐related bone disease (CFBD), is crucial.Objective: This study aimed to longitudinally characterize CFBD and to compare the bone status of pancreatic sufficient (PS) and pancreatic insufficient (PI) PwCF.Methods: This longitudinal analysis included PwCF older than 8 years of age who had at least one dual‐energy X‐ray absorptiometry test between 2008 and 2021. Data were collected on serum parameters of bone metabolism, nutritional history, habitual activity, and fractures in addition to other demographic and clinical characteristics.Results: The study included 80 PwCF: 32 (40%) were PS and 48 (60%) PI. Normal dual‐energy X‐ray absorptiometry results were found in 42 (53%) patients: 16 (50%) in the PS group and 26 (54%) in the PI group (p = 0.72). Three (9%) of the PS group and seven (15%) of the PI group had at least one Z‐score below −2 (p = 0.49). The longitudinal bone density decline over a mean of 4.8 years was similar in the two groups. In a logistic regression analysis, pancreatic insufficiency was not found to be a risk factor for CFBD. Female sex was the only significant risk factor for a pathological Z‐score.Conclusions: The prevalence and severity of CFBD were not found to correlate with pancreatic sufficiency. The similar prevalence of CFBD between patients with PS and PI suggests that screening, and eventually treatment, should be offered to all PwCF, irrespective of pancreatic status.

Background: The COVID‐19 pandemic has exacerbated the global nursing shortage, leading to increased turnover intentions among nurses due to heightened workplace stress, burnout, and job dissatisfaction. This study investigates the mediating effects of burnout and job satisfaction on the relationship between professional identity, occupational stress, and nurses' turnover intentions. Additionally, it explores the impact of socio‐demographic factors on these relationships in the post‐pandemic era. Methods: A cross‐sectional study of 338 nurses across 4 hospitals in Israel was conducted between June 2023 and January 2024. Self‐reported questionnaires were utilized to measure turnover intention using the Turnover Intention Scale, with professional identity and occupational stress as predictors and burnout and job satisfaction as mediators. A fixed effect path analysis approach was employed to assess the hypothesized mediation model, controlling for hospital‐level variance and socio‐demographic variables. Results: The findings revealed that professional identity was negatively associated with burnout ( β = −0.26, p < 0.001) and positively associated with job satisfaction ( β = 0.25, p < 0.001). Occupational stress was positively associated with burnout ( β = 0.57, p < 0.001) and negatively associated with job satisfaction ( β = −0.42, p < 0.001). Burnout ( β = 0.35, p < 0.001) and job satisfaction ( β = −0.10, p = 0.025) were both significantly associated with turnover intentions. Mediation analysis indicated that job satisfaction and burnout fully mediated the relationship between professional identity and turnover intentions, and partially mediated the relationship between occupational stress and turnover intentions. Linking Evidence to Action: The study highlights that professional identity mitigates nurse turnover by increasing job satisfaction and reducing burnout, while occupational stress drives turnover intentions by increasing burnout and decreasing job satisfaction. Tailored interventions aimed at enhancing professional identity and addressing occupational stress, particularly in light of pandemic‐related challenges, are essential for improving nurse retention and well‐being in the post‐pandemic era.