title: Between a Rock and a Hard Place: Ethical and Professional Dilemmas in a Psychiatric Hospital Under Missile Attacks.
abstract: Israeli hospitals must continuously develop various mechanisms to protect both patients and staff against the physical threat of missile attacks during war situations.
  
  
  
  To examine the difficulties and dilemmas with which the staff of a psychiatric hospital had to deal during missile attacks.
  
  
  
  A quality improvement project consisting of three stages (1) establishment of a steering committee; (2) execution of a staff nurses' focus group; and (3) categorization of issues raised and suggestions for care improvement in future emergencies.
  
  
  
  The project stressed the challenges of dealing with restrained patients during missile alarms, waking up patients or dealing with those who refuse to enter the protected area, mismatching of the security needs in protected areas, and institutionalized emotional support for staff members.
  
  
  
  Suitable policies for clinical and management behavior and for information transfer between management and wards are essential during a continuous emergency.
authors.affiliation: Ilya Kagan, RN, PhD, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ilya
authors.initials: I
authors.lastname: Kagan
authors.affiliation: Razia Schor, RN, MA, Ness Tziona Mental Health Center, Ness Tziona, Israel.
authors.forename: Razia
authors.initials: R
authors.lastname: Schor
authors.affiliation: Ronit Kigli-Shemesh, RN, MA, Ness Tziona Mental Health Center, Ness Tziona, Israel; Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Kigli-Shemesh
authors.affiliation: Karin Lee Ovadia, RN, MA, Assaf Harofeh Medical Center, Tzrifin, Israel.
authors.forename: Karin Lee
authors.initials: KL
authors.lastname: Ovadia
authors.affiliation: Semyon Melnikov, RN, PhD, Tel Aviv University, Tel Aviv, Israel melniko@tauex.tau.ac.il.
authors.forename: Semyon
authors.initials: S
authors.lastname: Melnikov
mesh_terms: D017144:Focus Groups; D006778:Hospitals, Psychiatric / Q000941:ethics*; D006801:Humans; D007557:Israel; D061214:Patient Safety; D012149:Restraint, Physical; D014857:Warfare
keywords: ethical and professional dilemmas; missile attacks; psychiatric hospital