Identifying factors affecting a healthy lifestyle in the post-COVID-19 era.

BACKGROUND: A healthy lifestyle is one of the important global concepts in the post-COVID-19 era, which can lead to maintaining and improving the health of societies. This study aimed to identify the factors affecting a healthy lifestyle in the post-COVID-19 era. MATERIALS AND METHODS: The current research is a qualitative study that was conducted in the field by theoretical sampling method. The qualitative method used in the current research was Strauss-Corbin's method. The data collection tool in the current research was a semi-structured interview. The researcher reached theoretical saturation by the end of the 13th interview, and for more certainty, the interviews continued until the 15th interview. The statistical population of the research was all professors and experts with specialized doctorate degrees in Mashhad University of Medical Sciences, and finally, 15 people were selected according to the entry and exit criteria for the study. Data analysis was done by summarizing and coding and analyzing the hidden content from expert interviews using MAXQDA software. RESULTS: The factors affecting a healthy lifestyle in the post-COVID-19 era (cultural norms, social norms, biological norms, technological factors, and economic factors) emerged from the intuitive opinions of experts. CONCLUSION: Providing and maintaining health is not a simple task, as it involves biological, individual, familial, cultural, societal, economic, political, and health factors. Promotion of healthy lifestyles is not merely the responsibility of health-related organizations and bodies; rather, they necessitate extensive coordination and empathy among educational, health, cultural, service, and even political institutions and bodies.

Situational Analysis of Essential Surgical Care Management in Iran Using the WHO Tool.

BACKGROUND: Surgery is an essential component of health care, yet it has usually been overlooked in public health across the world. OBJECTIVES: This study aimed to perform a situational analysis of essential surgical care management at district hospitals in Iran. MATERIALS AND METHODS: This research was a descriptive and cross-sectional study performed at 42 first-referral district hospitals of Iran in 2013. The World Health Organization (WHO) Tool for the situational analysis of emergency and essential care was used for data collection in four domains of facilities and equipment, human resources, surgical interventions, and infrastructure. Data analysis was conducted using simple descriptive statistical methods. RESULTS: In this study, 100% of the studied hospitals had oxygen cylinders, running water, electricity, anesthesia machines, emergency departments, archives of medical records, and X-ray machines. In 100% of the surveyed hospitals, specialists in surgery, anesthesia, and obstetrics and gynecology were available as full-time staff. Life-saving procedures were performed in the majority of the hospitals. Among urgent procedures, neonatal surgeries were conducted in 14.3% of the hospitals. Regarding non-urgent procedures, acute burn management was conducted in 38.1% of the hospitals. Also, a few other procedures such as cricothyrotomy and foreign body removal were performed in 85.7% of the hospitals. CONCLUSIONS: The results indicated that suitable facilities and equipment, human resources, and infrastructure were available in the district hospitals in Iran. These findings showed that there is potential for the district hospitals to provide care in a wider spectrum.

Psychological factors explaining the referral behavior of Iranian family physicians.

BACKGROUND: The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs. OBJECTIVES: This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist. PATIENTS AND METHODS: An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%). RESULTS: The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r = 0.38, P < 0.001) and perceived behavioral control (r = 0.43, P < 0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior. CONCLUSIONS: The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by family physicians and are of great value in developing interventions to reduce the variation in referral rate of patients to medical specialists at primary care health centers.

Psychometric properties of the Persian version of the "Hospital Ethical Climate Survey".

In order to improve the ethical climate in health care organizations, it is important to apply a valid measure. This study aimed to investigate the psychometric properties of the Persian version of the Hospital Ethical Climate Survey (HECS) and to assess nurses' perceptions of the ethical climate in teaching hospitals of Iran. A cross-sectional study of randomly selected nurses (n = 187) was conducted in three teaching general hospitals of Tehran, capital of Iran. Olson's Hospital Ethical Climate Survey (HECS), a self-administered questionnaire, was used to assess the nurses' perceptions of the hospital ethical climate. Descriptive statistics, confirmatory factor analysis (CFA), internal consistency, and correlation were used to analyze the data. CFA showed acceptable model fit: an standardized root mean square residual (SRMR) of 0.064, an non-normalized fit index (NNFI) of 0.96, a comparative fit index (CFI) of 0.96, and an root mean square error of approximation (RMSEA) of 0.075. The Cronbach's alpha values were acceptable and ranging from 0.69 to 0.85. The overall Cronbach's alpha coefficient was 0.94. The factor loadings for all ethical climate items were between 0.50 and 0.80, which revealed good structure of the Persian version of the HECS. Survey findings showed that the "managers" subscale had the highest score and the subscale of "doctors" had the lowest score. This study shows that the Persian version of the HECS is a valid and reliable instrument for measuring nurses' perceptions of the ethical climate in hospitals of Iran.

Parallel quality assessment of emergency departments by European foundation for quality management model and Iranian national program for hospital evaluation.

BACKGROUND: European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM. METHODS: This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings. RESULTS: The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs' scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs. CONCLUSION: The INPHE's assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs' scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs' (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable.

The role of nurse practitioners in health sector reform in Iran (2011).

BACKGROUND: Most countries use educated nurses called "nurse practitioners" (NPs) besides the family physicians for diagnosis, treatment, and specifically health education of the family. The main goal of this study was to redefine the role of NPs for better use of their capabilities in the so-called "family physician reform" in Iran. MATERIALS AND METHODS: This is a qualitative and comparative study carried out in three stages (triangulation method) in 2011. In the first stage, we conducted a literature review to design a conceptual framework. The second stage was a comparative study on four countries. In this study, we focused on the role of NPs, which in turn helped to redefine this role in the health sector reform of Iran. In the third stage, two expert panels were involved and the suggested roles were confirmed. RESULTS: In the United States, NPs are licensed by the state in which they practice and have a national board certification. In Canada, nurses involved in clinics should participate in specific training course of diagnosis and management of health care after registration. In Austria, nurses in Nursing homes and maternity do some of the medical procedures under the supervision of the physicians. In the United Kingdom, NPs increasingly substitute for GPs in the care of minor illness and routine management of chronic diseases. CONCLUSIONS: There is still debate in nursing and medical circles about what the focus of the NP roles should be. In Iran, whereas a noticeable reform toward "family physician" is ongoing, redefining the nurses' role is essential. They can perform more active roles in associating with GPs in the clinics of family physicians, both in urban and rural areas, even with higher degrees of autonomy.

Development of an effective risk management system in a teaching hospital.

BACKGROUND: Unsafe health care provision is a main cause of increased mortality rate amongst hospitalized patients all over the world. A system approach to medical error and its reduction is crucial that is defined by clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury. The aim of this study was to develop and implement a risk management system in a large teaching hospital in Iran, especially of the basis of WHO guidelines and patient safety context. METHODS: WHO draft guideline and patient safety reports from different countries were reviewed for defining acceptable framework of risk management system. Also current situation of mentioned hospital in safety matter and dimensions of patient safety culture was evaluated using HSOPSC questionnaire of AHRQ. With adjustment of guidelines and hospital status, the conceptual framework was developed and next it was validated in expert panel. The members of expert panel were selected according to their role and functions and also their experiences in risk management and patient safety issues. The validated framework consisted of designating a leader and coordinator core, defining communications, and preparing the infrastructure for patient safety education and culture-building. That was developed on the basis of some values and commitments and included reactive and proactive approaches. RESULTS: The findings of reporting activities demonstrated that at least 3.6 percent of hospitalized patients have experienced adverse events and 5.3 percent of all deaths in the hospital related with patient safety problems. Beside the average score of 12 dimensions of patient safety culture was 46.2 percent that was considerably low. The "non-punitive responses to error" had lowest positive score with 21.2 percent. CONCLUSION: It is of paramount importance for all health organizations to lay necessary foundations in order to identify safety risks and improve the quality of care. Inadequate participation of staff in education, reporting and analyzing, underreporting and uselessness of aggregated data, limitation of human and financial resources, punitive directions and management challenges for solutions were the main executive problems which could affect the effectiveness of system.

Root-cause analysis of a potentially sentinel transfusion event: lessons for improvement of patient safety.

Errors prevention and patient safety in transfusion medicine are a serious concern. Errors can occur at any step in transfusion and evaluation of their root causes can be helpful for preventive measures. Root cause analysis as a structured and systematic approach can be used for identification of underlying causes of adverse events. To specify system vulnerabilities and illustrate the potential of such an approach, we describe the root cause analysis of a case of transfusion error in emergency ward that could have been fatal. After reporting of the mentioned event, through reviewing records and interviews with the responsible personnel, the details of the incident were elaborated. Then, an expert panel meeting was held to define event timeline and the care and service delivery problems and discuss their underlying causes, safeguards and preventive measures. Root cause analysis of the mentioned event demonstrated that certain defects of the system and the ensuing errors were main causes of the event. It also points out systematic corrective actions. It can be concluded that health care organizations should endeavor to provide opportunities to discuss errors and adverse events and introduce preventive measures to find areas where resources need to be allocated to improve patient safety.