Prevalence of depression, anxiety, and stress and associated reasons among Iranian primary healthcare workers: a mixed method study.

BACKGROUND: Different mental disorders may be associated with many work-related factors to which primary health care workers (PHCWs) are exposed. The current research aims to measure the rates of depression, anxiety, and stress among PHCWs, and their associated causes in primary health care (PHC) settings. METHODS: An explanatory sequential mixed methods design was employed in this research from January 2021 to January 2022 in Tabriz, Iran's PHC centers. First, this study followed an online-based cross-sectional survey using a self-reported questionnaire. The Depression, Anxiety and Stress Scale-21 Items (DASS-21) and questions on demographic and work-related characteristics were completed by 303 frontline PHCWs during the quantitative phase. In the qualitative phase, a semi-structured interview was held with 12 PHCWs who had the highest level of depression, anxiety, and stress to identify the reasons and sources of mental health prevalence. Quantitative data were analyzed using descriptive statistics via SPSS-26. A content analysis was performed to analyze qualitative data. RESULTS: The results showed that self-reported stress, anxiety, and depression had a prevalence of 40.3%, 42.9%, and 42.6%, respectively. Symptoms of at least one mental disorder were experienced by 54% of respondents, while 28% had all three. Major sources of stress, anxiety, and depression among PHCWs were working environment conditions, organizational policies, job-related reasons, and interpersonal relations. CONCLUSIONS: The results of current study indicated that PHCWs experienced high levels of depression, anxiety, and stress. The main factors and reasons that contributed to these mental health issues among PHCWs were work environment conditions, organizational policies, job-related reasons and interpersonal relations. Therefore, interventions should be implemented to promote mental health of PHCWs. This can include measures such as psychological screening, supportive care, workload management, flexible scheduling, and access to mental health resources. Additionally, training programs can be implemented to enhance resilience and coping skills among healthcare professionals.

Nurses' perceptions of patient safety competency: A cross-sectional study of relationships with occurrence and reporting of adverse events.

Although, strengthening patient safety competencies in nursing has been emphasized for enhancing quality care and patient safety. However, little is known about the association of nurses' perceptions of patient safety competency with adverse nurse outcomes in Iranian hospitals. This study aimed to measure nurses' levels of patient safety competency in the hospitals of Iran and examines the relationship between patient safety competency with the occurrence and reporting of adverse events (AEs). This cross-sectional research was applied in eight teaching hospitals in Tehran, Iran, between August and December 2021. A sample of 511 nurses was randomly selected using the table of random numbers. The validated Patient Safety Competency Self-Evaluation questionnaire was used. Furthermore, two questions were used to measure the incidence and reporting of AEs. Data analysis was performed using descriptive statistics, independent t-tests, and two binary logistic regression models through SPSS version 24.0. The mean patient safety competency score was 3.34 (SD = 0.74) out of 5.0; 41.5% of nurses rated their patient safety competency as less than 3. Among subscales, "skills of patient safety" scores were the highest, and "knowledge of patient safety" scores were the lowest. Nurses with higher Knowledge and Attitude scores were less likely to experience the occurrence of AEs (OR = 1.50 and OR = 0.58, respectively). Regarding AEs reporting, nurses with higher Skill and Attitude scores were 2.84 and 1.67 times, respectively, more likely to report AEs (OR = 2.84 and OR = 3.44, respectively). Our results provide evidence that enhancing PSC leads to reduced incidence of AEs and increased nurses' performance in reporting. Therefore, it is recommended that managers of hospitals should enhance the patient safety competency of nurses in incidents and reporting of patient safety adverse outcomes through quality expansion and training. Additionally, researchers should carry out further research to confirm the findings of the current study and identify interventions that would strengthen patient safety competencies and reduce the occurrence of AEs, and rise their reporting among nurses.

The effect of a simulation-based training program in basic life support on the knowledge of Palestinian nurses: a quasi-experimental study in governmental hospitals.

BACKGROUND: Basic Life Support (BLS) plays an important role in increasing the survival rate of hospitalized heart attack patients. There are no previous studies on the effect of BLS training among Palestinian nurses. This study aimed to evaluate the effect of simulation-based BLS training program on nurses' knowledge Palestinian nurses at governmental hospitals. METHODS: A quasi-experimental, pre & post-test design was used. 700 nurses were recruited proportionally using a simple random sampling method among 2980 nurses from 13 public hospitals in the Gaza Strip. This study was conducted from June to August 2022. A practical BLS test consisting of 10 multiple-choice questions according to American Heart Association guidelines (2020) was collected and sociodemographic characteristics. SPSS software, version 24 was used for the statistical analysis. Descriptive statistics and weighted mean were used. T-Test and One-way analysis of variance (ANOVA) were applied to determine differences in means among groups. RESULTS: Most of the participating nurses (55.7%) were male, while (44.3%) were female. The majority of nurses (84.4%) are under 40 years of age. The weighted mean scores in the pre-test ranged from 52.2 to 75.1% and the mean scores was (6.16 ± 1.97). After applying conventional BLS training, the weighted mean scores ranged from 85.6 to 97.3% and the mean scores was (9.19 ± 1.04). The study revealed that the nurses' knowledge increased after applying simulation-based training program. The mean of knowledge scores was statistically significant between the pre and post-test on the basis of the current work hospital (P-value < 0.001). CONCLUSION: This study affords significant evidence of the positive effects of the BLS training program in improving nurses' knowledge; we recommend advanced BLS training for all healthcare providers, doctors, and nurses working in hospitals and healthcare centers. Nursing managers can implement systematic strategies to enhance nurses' knowledge and practice in BLS to target low-scoring Governorates.

Guidance for management competency identification and development in the health context: a systematic scoping review.

BACKGROUND: Using management competency-based frameworks to guide developing and delivering training and formal education to managers has been increasingly recognized as a key strategy in building management capacity. Hence, interest in identifying and confirming the competency requirements in various contexts have been witnessed. Therefore, learnings from how competency studies were designed and conducted, how competencies were identified, and strategies in ensuring success in competency identification are of great value to researchers planning and conducting competency studies in their own country. METHODS: A scoping review was conducted guided by the Arksey and O'Malley framework and reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). All papers that published empirical studies aiming at identifying and assessing manager's competencies at the peer-reviewed journals were identified from Web of sciences, PubMed, Scopus and Emerald Management between 2000 and 2021. In order to maximize learning, studies focusing on health and non-health sectors are all included. RESULTS: In total, 186 studies were included in the review including slightly more than half of the studies conducted in health sector (54.5%). 60% of the studies focused on mid to senior level managers. Surveys and Interviews were the two most commonly used methods either solely or as part of the mix-method in the studies. Half of the studies used mixed methods approach (51.1%). Large proportion of the papers failed to include all information that is necessary to contribute to learning and improvement in future study design. Based on the results of the scoping review a four steps framework was developed that can guide designing and implementing management competency studies in specific country vs. sector context and to ensure benefits of the studies are maximised. CONCLUSION: The review confirmed the increasing trend in investing in management competency studies and that the management competency identification and development process varied substantially, in the choice of methods and processes. The identification of missing information in majority of the published studies calls for the development of more rigorous guidelines for the peer-review process of journal publications. The proposed framework of improving the quality and impact of the future management competency study provides clear guidance to management competency identification and development that promotes the functional alignment of methods and strategies with intended uses and contexts.

Defensive medicine and its related risk factors: evidence from a sample of Iranian surgeons.

OBJECTIVES: Defensive medicine (DM) is the deviation of a physician from normal behavior or what is a good practice and is aimed at reducing or avoiding the risk of legal litigation from patients or their families. Therefore, this study aimed to determine DM-related behaviors and associated risk factors among Iranian surgeons. METHODS: In this cross-sectional study, 235 surgeons were selected using convenience sampling. The data gathering tool was a researcher-made questionnaire confirmed as a reliable and valid tool. Factors associated with DM-related behaviors were identified using logistic regression analysis. RESULTS: DM-related behaviors ranged from 14.9% to 88.9%. The most common positive DM-related behaviors, including unnecessary biopsy (78.7%), imaging and laboratory tests (72.4% and 70.6%), and refusing high-risk patients (61.7%), was the most common negative DM-related behavior. The likelihood of DM-related behaviors was more in younger and less experienced surgeons. Other variables, such as gender, specialty, and lawsuit history, positively affected some DM-related behaviors (p < 0.05). CONCLUSION: This study showed that the proportion of surgeons who frequently performed DM-related behaviors was higher than those who rarely performed it. Therefore, strategies including reforming the rules and regulations for medical errors and litigations, developing and implementing medical guidelines and evidence-based medicine, and improving the medical liability insurance system can reduce DM-related behaviors.

Effect of ISBAR Clinical Handover Application on Nurses' Perception of Communication and Attitudes toward Patient Safety at Emirates Maternity Hospital in Gaza Strip, Palestine.

Background: Good communication is necessary for safety and quality of health. This study aims to determine the effect of ISBAR communication on nurses' perception of communication and attitudes toward patient safety in the Emirates Maternity Hospital in the Gaza Strip, Palestine. Method: A single-group hospital-based intervention study (pre and posttest) was conducted. A census sample was used Participants opinions about the effect of ISBAR were gathered using two tools established by Shortell, Rousseau, Sexton, and Helmreich to assess the communication awareness and nurses' attitudes towards safety, respectively, before and after the use of the ISBAR program. Results: After the ISBAR application, nurses' perception of communication demonstrated a positive and significant increase in the three sub-items (openness, accuracy and understanding, and shift communication) in the nurse-nurse communication. Moreover, in four sub-items (openness, accuracy, and understanding, timeliness, and satisfaction) in nurse-doctor communication, (p < 0.05). Further, the nurses' attitudes toward patient safety showed a significant and positive increase in teamwork climate (p<0.001), safety climate (p = 0.007), job satisfaction and working condition (p<0.001), stress recognition (p= 0.008), and perception of management (p = 0.001). Conclusion: The results provide significant evidence of the positive effects of the ISBAR program in improving nurses' perceptions of communication and attitudes toward patient safety. It is recommended that healthcare providers use ISBAR communication in their practice. Moreover, periodic training programs are required for effective ISBAR communication among the healthcare team.

Occurrence and types of medication error and its associated factors in a reference teaching hospital in northeastern Iran: a retrospective study of medical records.

BACKGROUND: Medication errors are categorized among the most common medical errors that may lead to irreparable damages to patients and impose huge costs on the health system. A correct understanding of the prevalence of medication errors and the factors affecting their occurrence is indispensable to prevent such errors. The purpose of this study was to investigate the prevalence and types of medication errors among nurses in a hospital in northeastern Iran. METHODS: The present descriptive-analytical research was conducted on 147 medical records of patients admitted to the Department of Internal Medicine at a hospital in northeastern Iran in 2019, selected by systematic sampling. The data were collected through a researcher-made checklist containing the demographic profiles of the nurses, the number of doctor's orders, the number of medication errors and the type of medication error, and were finally analyzed using STATA version 11 software at a significance level of 0.05. RESULTS: Based on the findings of this study, the mean prevalence of medication error per each medical case was 2.42. Giving non-prescription medicine (47.8%) was the highest and using the wrong form of the drug (3.9%) was the lowest medication error. In addition, there was no statistically significant relationship between medication error and the age, gender and marital status of nurses (p > 0.05), while the prevalence of medication error in corporate nurses was 1.76 times higher than that of nurses with permanent employment status (IRR = 1.76, p = 0.009). The prevalence of medication error in the morning shift (IRR = 0.65, p = 0.001) and evening shift (IRR = 0.69, p = 0.011) was significantly lower than that in the night shift. CONCLUSION: Estimating the prevalence and types of medication errors and identified risk factors allows for more targeted interventions. According to the findings of the study, training nurses, adopting an evidence-based care approach and creating interaction and coordination between nurses and pharmacists in the hospital can play an effective role in reducing the medication error of nurses. However, further research is needed to evaluate the effectiveness of interventions to reduce the prevalence of medication errors.

Developing a framework for the participation of nursing managers in the health policy-making process in Iran: A Delphi study.

AIMS: The aim of this study was to develop a framework for nursing managers to participate in the health policy-making process. BACKGROUND: Nursing managers must be involved in the health policy process to provide appropriate health services, focus on nursing professional excellence, and improve the performance of the health system. METHODS: This multimethod research was based on the Delphi study and experts' panel. Faculty members of the nursing, health policy, health services management, and nursing managers working at hospitals were selected via purposive sampling. The data collection tool was a demographic form and an open-ended questionnaire in the first round and a structured questionnaire in the next round. In the two rounds of Delphi, experts discussed and rated items of nursing managers' participation framework in the health policy-making process. At the expert panel session, the framework was finalized with a 12-part checklist. The data were analysed quantitatively using SPSS software version 22. RESULTS: A total of 28 items were entered into the Delphi study. Experts who met the inclusion criteria responded to rounds 1 (n = 20) and 2 (n = 16). Following the two rounds of the Delphi study, 27 items were selected and discussed by experts using a 12-part checklist related to the framework. The final participation framework was divided into five sections: Barriers, facilitators, advantages, disadvantages, and factors affecting the participation of nursing managers in the health policy-making process. CONCLUSION: In our findings, the relationship between the components of the framework and policy cycle was shown, which should be considered to lay the groundwork for participation. This can lead to health promotion, accountability, and financial participation in the health system, which can improve the proactive involvement of nursing managers in the health policy-making process. IMPLICATIONS FOR NURSING MANAGEMENT: The proposed framework can be utilized across the spectrum of nursing, including practice, leadership, and education to enhance the participation of nursing managers in health policy activity.

Knowledge, Attitudes, and Practice towards Occupational Health and Safety among Nursing Students in Gaza Strip, Palestine.

Background: Health and safety in the workplace are critical components in healthcare institutions. Unsafe working conditions are among the causes of poor quality of care and burnout. This study aims to assess the knowledge, attitudes, and practice of occupational health and safety among nursing students at Al-Israa University. Methods: In this cross-sectional study, a structured online questionnaire was distributed from March to May 2021. Of the 350 eligible students, 219 students answered the questionnaire (Response rate=62.6). Data were analyzed using the statistical software IBM-SPSS version 22. Descriptive statistic, Independentsamples T-Test, and ANOVA tests were used. Results: The majority of participants were female (81.7%) and studying in a diploma program. 21% of nursing students have experienced a needle stick injury. The mean scores for knowledge, attitudes, and practice were (M±SD:78.2% ±12.9, M±SD:80.6% ±7.1, and M±SD:81.2% ±7.6) respectively. In terms of knowledge, attitudes, and practice the mean scores were statistically significant between nursing students who attended a safety precautions course and those who didn not (P-value <.05). In terms of attitudes, the mean scores were statistically significant between diploma and bachelor students (P-value =.026). In terms of practice, the means scores were statistically significant between males and females (Pvalue =.017), nursing students who had experience with needle sticks and those who didn't (P-value =.015). Conclusions: The authors recommend that clinical training departments and universities continue to offer occupational health and safety courses and training for health science students. Since the training had a positive impact on the students' practices.

Prevalence of physical activity using validated tools among adults during the COVID-19 pandemic in the Eastern Mediterranean region: A systematic review and meta-analysis.

Many interventions have been taken around the world to limit the spread of COVID-19. These interventions have affected people's lifestyles such as physical activity. The aim of this systematic review and meta-analysis was to determine the prevalence of physical activity using validated tools among adults during the COVID-19 pandemic in the Eastern Mediterranean region. A systematic literature review and meta-analysis were conducted in October 2021. We searched three electronic databases (Web of Science, Scopus, and PubMed) for English-language original articles of observational studies (cross-sectional, case-control, and cohort studies) with original data reporting the prevalence of physical activity among adults in 22 countries from EMR during the COVID-19 pandemic. Hoy's risk of Bias tool was applied to assess the biases in individual studies. The result was reported as a percentage for prevalence. A meta-analysis was conducted using the random-effect model with a 95% confidence interval. A total of 363 articles were retrieved. Finally, 15 articles were selected and included in the statistical analysis. The selected studies included 16,585 participants. The result of the meta-analysis showed that the overall physical activity was 51.6% (95% confidence interval: 42.1, 61: p = 0.745). The result of subgroup analysis based on different tools was 60.2%, 39.5%, 36.3%, 39.4%, and 55.2% for Global Physical Activity Questionnaire , The Godin-Shephard Leisure-Time Physical Activity Questionnaire, International Physical Activity Questionnaire, International Physical Activity Questionnaire-BREF, and International Physical Activity Questionnaire-short form, respectively. Our study highlights the urgent need for large-scale measurement and reporting of physical activity and the use of standard tools that can allow for the regular assessment and screening of the PA prevalence to support evidence-informed policy and programs development at both national and regional levels.

Perceived risk of infection and death from COVID-19 among community members of low- and middle-income countries: A cross-sectional study.

Background: Risk perceptions of coronavirus disease 2019 (COVID-19) are considered important as they impact community health behaviors. The aim of this study was to determine the perceived risk of infection and death due to COVID-19 and to assess the factors associated with such risk perceptions among community members in low- and middle-income countries (LMICs) in Africa, Asia, and South America. Methods: An online cross-sectional study was conducted in 10 LMICs in Africa, Asia, and South America from February to May 2021. A questionnaire was utilized to assess the perceived risk of infection and death from COVID-19 and its plausible determinants. A logistic regression model was used to identify the factors associated with such risk perceptions. Results: A total of 1,646 responses were included in the analysis of the perceived risk of becoming infected and dying from COVID-19. Our data suggested that 36.4% of participants had a high perceived risk of COVID-19 infection, while only 22.4% had a perceived risk of dying from COVID-19. Being a woman, working in healthcare-related sectors, contracting pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, as well as seeing or reading about individuals infected with COVID-19 on social media or TV were all associated with a higher perceived risk of becoming infected with COVID-19. In addition, being a woman, elderly, having heart disease and pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, and seeing or reading about individuals infected with COVID-19 on social media or TV had a higher perceived risk of dying from COVID-19. Conclusions: The perceived risk of infection and death due to COVID-19 are relatively low among respondents; this suggests the need to conduct health campaigns to disseminate knowledge and information on the ongoing pandemic.

The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review.

BACKGROUND: Defensive Medicine (DM) concept refers to all medical care provided by physicians without increasing the benefits to the patient, the primary purpose of which is to prevent the risk of litigation. Although several studies have been published investigating the occurrence of DM around the world, no review conducted on DM among physicians. Therefore, this study aims to summarize and map the available evidence on occurrence, types of behaviors, and reasons for practicing of DM among physicians and possible solutions and strategies to reduce DM in the literature. METHODS: This is a scoping review in which we searched Web of Science, Scopus, and PubMed in December 2021. Our target was original studies of any type that included data on DM among physicians between 2000 and 2021. We followed the JBI guideline for conducting a scoping review and for increasing the rigor of the study. First, the percentage was used to summarize the occurrence of DM, and then, findings related to types of behaviors and reasons for practicing DM and mitigation strategies were analyzed inductively in NVivo 10 in three stages. RESULTS: Twenty-seven studies were included in the review. The overall occurrence of DM practice ranged from 6.7 to 99.8%. Two types of DM behaviors including assurance and avoidance behaviors have been identified. The common reasons for practicing DM were categorized into four themes, patient-related reasons, physician-related reasons, organization-related reasons, and society-related reasons. The main strategies to prevent or reduce DM are structured training and education, restoring physician-patient relationships, reform of the health system, and reform of the liability system. CONCLUSIONS: The vast majority of research studies were conducted in high-income countries, and studies are needed to measure this phenomenon and its consequences in depth in low- and middle-income countries. Various solutions and strategies are needed to reduce defensive behaviors such as structured training and education, restoring physician-patient relationships, reforming the health system, and reforming the liability system.

Challenges of the organizational structure of county health network in Iran: findings from a qualitative study.

BACKGROUND: Primary healthcare with the right structure is the base for any highly efficient healthcare system to achieve better health outcomes at the lowest cost. Challenges of this system, including structural weaknesses, are one of the factors of inefficiency. Therefore, the purpose of this study was to identify challenges of the organizational structure of county health network in Iran. METHODS: An exploratory qualitative face-to-face semi-structured interviews were carried out with 21 key informants including experts and managers in Ahvaz-Iran. Purposive sampling method with maximum diversity were used. Interviews were recorded digitally and transcribed verbatim. Interview transcripts were analyzed based on a thematic analysis approach via NVivo-11. RESULTS: In analysis of the interviews, after removing the duplicate codes and merging similar items, finally 6 main challenges and 56 sub-themes were obtained. The themes of structural challenges included formalization, complexity, centralization, culture, environment, and resources. CONCLUSIONS: Based on the present situation, the challenges in the current organizational structure and a change in the goals and strategies of the healthcare system in Iran, the appropriate structure needs to be designed and implemented at different levels in accordance with the goals and strategies. The separation and independence of health centers management and hospitals (treatment) in the county can provide a basis for understanding the challenges to the provision of health services.

Strategies for utilisation management of hospital services: a systematic review of interventions.

BACKGROUND: To achieve efficiency and high quality in health systems, the appropriate use of hospital services is essential. We identified the initiatives intended to manage adult hospital services and reduce unnecessary hospital use among the general adult population. METHODS: We systematically reviewed studies published in English using five databases (PubMed, ProQuest, Scopus, Web of Science, and MEDLINE via Ovid). We only included studies that evaluated interventions aiming to reduce the use of hospital services or emergency department, frequency of hospital admissions, length of hospital stay, or the use of diagnostic tests in a general adult population. Studies reporting no relevant outcomes or focusing on a specific patient population or children were excluded. RESULTS: In total, 64 articles were included in the systematic review. Nine utilisation management methods were identified: care plan, case management, care coordination, utilisation review, clinical information system, physician profiling, consultation, education, and discharge planning. Primary case management was shown to effectively reduce emergency department use. Care coordination reduced 30-day post-discharge hospital readmission or emergency department visit rates. The pre-admission review program decreased elective admissions. The physician profiling, concurrent review, and discharge planning effectively reduced the length of hospital stay. Twenty three studies that evaluated costs, reported cost savings in the hospitals. CONCLUSIONS: Utilisation management interventions can decrease hospital use by improving the use of community-based health services and improving the quality of care by providing appropriate care at the right time and at the right level of care.

Patient safety culture in Iranian teaching hospitals: baseline assessment, opportunities for improvement and benchmarking.

BACKGROUND: Patient safety culture is an essential factor in determining the ability of hospitals to treat and reduce patient risks. Healthcare professionals, especially nurses, play an important role in patient safety because they are responsible for direct and ongoing patient care. Few studies in Iran examine the patient safety culture in Iranian teaching hospitals, particularly from the perspective of nursing staff. This research assessed patient safety culture in teaching hospitals in Iran from the nurses' point of view and compared the outcomes with similar regional and global studies. Furthermore, the study identified the factors influencing patient safety culture and its association with outcomes. METHODS: A cross-sectional study was accomplished in thirty-two teaching hospitals in five provinces of Iran. A total of 2295 nurses were chosen through convenience sampling. Collection data were done using the Hospital Survey of Patient Safety Culture (HOPSC) from October 2018 and September 2019. We analyzed the data using descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis. RESULTS: The results demonstrated the overall percentage of positive response rate for the HOPSC tool (36.4%). The average percentage of positive responses among all dimensions ranged from 27.1% in "Staffing" to 53.8% in "Teamwork across Hospital Units". Benchmarking analysis shows that Iranian hospitals are equal or better performance than the benchmark on several composites compared to regional and global findings. The results of multiple linear regression analysis showed that the age, gender, total years of experience in nursing, work area or unit, work hours, and size of the hospital were significant predictors of the perceptions patient safety culture of nurses (p <  0.05). CONCLUSIONS: This is one of few studies that examine nurses' perceptions of patient safety culture in public hospitals in Iran. Although the results of the present study showed that the results of Iran were at or better than the many composites in Jordan, Turkey, KSA, and the Philippines. The findings confirmed that all 12 dimensions can be considered as areas requiring improvement, and these results demonstrated that there was a severe shortage in patient safety culture among the included hospitals.

The association of professionalism and systems thinking on patient safety competency: A structural equation model.

AIMS: The aim of this study is to identify how professionalism and systems thinking contribute to patient safety competency among Iranian nurses. BACKGROUND: Professionalism, systems thinking and patient safety competency play important roles in the quality of care. Strategies to enhance the patient safety competency of nurses must be devised by identifying the relationships between these variables. METHODS: A cross-sectional, descriptive survey study was conducted in 10 teaching hospitals in Tabriz, Iran. A total of 358 nursing staff with at least 12 months of experience in nursing were enrolled. Data were collected using the Professionalism scale, Systems Thinking Scale and Patient Safety Competency Self-Evaluation tool. Structural equation modelling analysis was performed to test the relationship between variables. RESULTS: The final model illustrated a good fit (χ2 /df = 2.329, goodness-of-fit index = 0.990, Tucker-Lewis index = 0.906 and root mean square error of approximation = 0.068). Professionalism directly influenced patient safety competency (ß = 0.59, p < 0.001) and indirectly influenced systems thinking (ß = 0.29, p < 0.001). Systems thinking directly influenced patient safety competency (ß = 0.46, p < 0.001). Results indicated that 91% of the variance in patient safety competency was explained by professionalism while 40.1% of the variance in the systems thinking was explained by professionalism. CONCLUSIONS: The professionalism and systems thinking of hospital nurses play a pivotal role as predictors in patient safety competency. Training opportunities, mentorship and nursing managers' leadership are needed to assist hospital nurses in their perceptions of professionalism and systems thinking. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing educators and managers should implement patient safety training strategies and improve the professionalism and systems thinking of hospital nurses to promote patient safety and quality care.

Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a sample of health professionals: a cross-sectional study.

BACKGROUND: Although the Depression Anxiety Stress Scale-21 Items (DASS-21) has been used in different countries and translated into different languages, the Persian version of this scale has not been validated for healthcare professions in Iran. Therefore, the purpose of this study was to examine the psychometric properties of the Persian version of DASS-21 for nurses. METHODS: This cross-sectional study was conducted among 1135 nurses working in public hospitals, who were selected through convenience sampling. DASS-21, which consists of 21 items and three dimensions (depression, anxiety, and stress), has been translated into Persian, and there is an online version available. A confirmatory factor analysis (CFA) was performed to examine the factor structure of this scale. Cronbach's alpha coefficient was also measured to establish internal consistency. Besides, the intraclass correlation coefficient (ICC) was calculated to assess the test-retest reliability. RESULTS: The Cronbach's alpha coefficient was acceptable for anxiety (0.79), stress (0.91), and depression (0.93). An acceptable test-retest reliability (0.740-0.881, P < 0.01) was also reported for DASS-21 and its three dimensions. The results of CFA showed acceptable model fit (χ2/(df) = 1457/(186), P < 0.001), root mean square error of approximation (RMSEA = 0.078), Tucker-Lewis index (TLI = 0.906), comparative fit index (CFI = 0.917), and standardized root mean square residual (SRMR = 0.047). Fifty-seven nurses were included in the test-retest. The ICCs for all dimensions ranged from 0.75 to 0.86, indicating the acceptable test-retest reliability of the scale. CONCLUSION: The Persian version of DASS-21 showed good psychometric characteristics, and it was confirmed as a valid and reliable tool for evaluating depression, anxiety, and stress among Iranian nurses. However, further validation studies of the Persian DSASS-21 are needed among other healthcare professionals, including physicians, midwives, and allied health professionals.

Disaster preparedness and core competencies among emergency nurses: A cross-sectional study.

AIM: With the rise in frequency and severity of disasters in recent decades, it is essentially important that nurses must be adequately prepared to handle them. This study was aimed to evaluate the levels of disaster core competencies and preparedness of nurses in the emergency department. DESIGN: A cross-sectional survey design was used. METHODS: This cross-sectional research was conducted from August 2020 to December 2020 among 271 nurses in the emergency departments of six hospitals in Qazvin, Iran. The participants completed the "Nurses Perceptions of Disaster Core Competencies Scale" (NPDCC) (45 items) and the disaster preparedness (a single-item visual scale). Data were analysed by one-way analysis of variance, independent t-tests and multiple linear regression analysis. RESULTS: The mean scores of disaster preparedness and core competencies of nurses were 6.75 out of 10 (SD = 1.63) and 2.88 out of 5 (SD = 0.80), respectively. "Technical skills" (mean = 3.24, SD = 0.91) were the highest and "communication skills" (mean = 2.57, SD = 0.95) were the lowest across the subscales of the scale. A significant association was found between disaster core competencies and preparedness of nurses (p < .001). Regression analysis results indicated that nursing disaster core competencies were perceived betted by older nurses (B = -0.405) who had experience in the disaster stage (B = 0.228) and nurses with disaster response experience (B = 0.223) and lower professional experience (B = 0.309). Nurses with a postdiploma degree (B = -0.480) and bachelor's degree (B = -0.416) were perceived to have lower disaster core competency than nurses with a master's or PhD degree. CONCLUSION: There are still gaps in disaster preparedness and core competencies for emergency nurses that need to be addressed. Nursing managers must support an improvement in nursing disaster core competencies. This may be done by conducting sessions for routine disaster scenarios and providing formal disaster preparedness training.

Impact of Patient Communication Preferences on the Patient Trust in Physicians: A Cross-Sectional Study in Iranian Outpatient's Clinics.

There are widely emerging concerns that patient confidence in physicians is diminishing as physician-patient communication is threatened globally. This study aimed to assess patient communication preferences and their impact on patient trust in physicians. A cross-sectional study was conducted among outpatient clinics of 2 public and private hospitals in Tabriz, Iran. A total of 704 patients were selected conveniently. Of the 704 patients, 6.39% had low trust, 36.79% moderate trust, 35.37% had a high trust, and 21.45% had blind trust in physicians. Overall patient communication preference score was more in a private clinic rather than a public one (P = .008). Patients of private hospitals and those who were living in rural areas have been shown to have more trust in physicians. Patients' trust in physicians showed a significant association with patient communication preference (B = 0.58; 95% CI: 0.53-0.63, P < .001).

The impact of nurses' perceptions of systems thinking on occurrence and reporting of adverse events: A cross-sectional study.

AIMS: To assess systems thinking level and its relationship with occurrence and reporting of adverse events in Iranian nurses. BACKGROUND: Systems thinking has recently emerged as an important element of patient safety and quality improvement in health care systems. It helps health care professionals to understand the different elements of health care systems, the interrelatedness and interdependencies of these elements in the health care systems. METHODS: This cross-sectional survey was carried out in 10 teaching hospitals in Tehran, Iran. A total of 511 nurses were selected using simple random sampling. Systems thinking was measured using the validated Systems Thinking Scale. Data analysis was performed by descriptive analyses, independent t test and logistic regression analysis. RESULTS: The average score for total systems thinking was a mean of 49.45 (SD = 12.10; range 0-80). In total, 67.5% of participants reported the experience of the occurrence of adverse events leading to harm to patients, and 65.2% of them responded as having appropriate adverse events reporting behaviours. Nurses who had higher scores in systems thinking were found to be more likely to report adverse events (odds ratio = 1.07; 95% CI = 1.05-1.09), whereas they were less prone to experience adverse events (odds ratio = 0.97; 95% CI = 0.95-0.98). CONCLUSION: Our results indicated that the nurses' systems thinking level was moderate. Systems thinking had a significant role in preventing the occurrence of adverse events as well as improving the reporting of adverse events. Therefore, it is recommended to enhance the competency of nurses' systems thinking to prevent the occurrence of adverse events and to improve the reporting of adverse events. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers need to focus on the systems thinking weaknesses and the occurrence and the reporting of adverse events in policymaking, practice and research. Also, systems thinking should be integrated with the health care system for preventing the occurrence of adverse events and improving reporting of adverse events. They should support, lead and allocate the essential pragmatic strategies and resources for the involvement of all health care members in policymaking.