The overall aim in this thesis was to describe the lived experiences of children with spina bifida (SB) and their mothers while living under specific social and cultural conditions in West Bank, Palestine. A further aim was to gain knowledge about the impact of SB on self-perceived health and sense of coherence (SOC) among a group of children and adolescents with SB in comparison to their healthy peers.

Spina bifida (SB) is the second most common birth defect worldwide. Mothers of children with SB face extraordinary challenges due to the complicated conditions and disability of their children. Little is known about the impact of these challenges on the mothers' well-being, particularly in Middle Eastern culture, where chronic illness and disability are perceived as a stigma, and care of disabled children has traditionally been the responsibility of the mother. The aim of this study was to illuminate mothers' lived experience of having a child with SB in Palestine. Twenty Arab-Muslim mothers living in Palestine were purposefully recruited from several rehabilitation centers in Palestine and were interviewed in 2014. The transcribed interviews were analyzed according to phenomenological hermeneutics. The mothers' experiences were described in the main theme: From feeling broken to looking beyond broken. Four themes were interwoven: living with constant anxiety, living with uncertainty, living with a burden, and living with a difficult life situation. These findings highlight the burden and resilience of the Arab-Muslim Palestinian mothers while striving to maintain the well-being of the whole family as well as facilitating the child's welfare.

Background: Patient satisfaction is one of the important indicators in the health system that should be considered when evaluating the quality of health services provided and the impact of accreditation systems. This study aims to assess the level of patient satisfaction in accredited and non-accredited hospitals in Palestine.Methods: Quantitative descriptive cross-sectional design used to compare patient satisfaction in two Palestinian hospitals. The researcher measured the patient satisfaction between October and November 2016 using the SERVQUAL tool to assess five dimensions of quality (reliability, assurance, tangibility, empathy and responsiveness). The sample size included was 332 inpatients, who were recruited by the researcher through convenient sampling method, and the data was analyzed using SPSS version 18. Results:The patients have a high level of satisfaction with a total mean of (4.34) out of (5) and a (0.70) standard deviation. The results indicated that there are statistically significant differences at the level (P ≤ 0.05) between the means of patient satisfaction relating to patient demographic characteristics (with the exception of gender), and also indicated that there are no statistically significant differences related to hospital characteristics. Moreover, for all satisfaction dimension patients have more satisfaction in non-accredited hospitals than accredited ones. Conclusion:The study indicated that there are no significant differences between the means of patient satisfaction attributed to accreditation status. The results reinforce that the patient perspective should also be given much importance in the health system, and certifies that it should be taken into consideration to ensure the quality of services provided by healthcare organizations.

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