Hospital disaster risk management improving strategies: A systematic review study.

OBJECTIVE: Hospitals are the basic infrastructure for disaster response. While they themselves are exposed to disasters, they also play an important role during the disaster response period. Therefore, they are expected to be able to maintain their performance during and immediately after disasters. The aim of this study is to discover strategies to improve the hospital disaster risk management. DESIGN: This study is a systematic qualitative study with thematic analysis. Data sources including Persian and international databases were searched using the "Hospital, Disaster, Risk management, Risk reduction, Improvement, and Strategy" keywords and their combinations of them. The search time period ranged from January 2010 to January 2020. Data were extracted by two independent arbitrators for qualitative thematic analysis. RESULTS: In total, 889 articles and documents were retrieved. Of which, 166 articles were deleted due to duplication, 436 articles did not meet the objectives of the research, and 263 articles did not meet the eligibility criteria and were deleted. Finally, 24 articles were included in the study. After thematic analysis, 33 subthemes were obtained and classified into five themes of organizational-managerial strategies, preventive and risk reduction strategies, preparedness strategies, response strategies, and recovery strategies. Not all articles discuss all categories. CONCLUSION: Applying strategies to improve the hospital disaster risk management resulting from this study can be useful in improving the preparedness of hospitals in the face of disasters.

Disaster risk management challenges in military hospitals: A qualitative study.

BACKGROUND: Disaster can pose significant challenges to the health infrastructure in the community. Hospitals are the central unit for providing health services in the disaster response plan. With regard to the vital role of military hospitals in health response to disaster, this study was carried out with the aim of investigating the disaster risk management (DRM) challenges in military hospitals in Iran. MATERIALS AND METHODS: The current study was qualitative research performed in 2020 in military hospitals in Iran. Participants consisted of 12 managers and staff of the military hospitals in Tehran and professionals in health in emergencies and disasters who were included in the study by the purposive sampling technique. Semistructured individual interviews based on the interview guide were exploited for the data collection, and a content analysis method was used to analyze them. RESULTS: DRM challenges in military hospitals were explained in the form of six categories: "management and leadership, planning, prevention and mitigation, preparedness, response, and recovery" and 22 subcategories. CONCLUSION: Managers' awareness of DRM challenges in hospitals, particularly military hospitals, and the design and implementation of solutions can lead to the promotion of hospital DRM and hospital preparedness to deal with disasters.

A comparative study of patient safety in the intensive care units.

AIM: This study aimed to assess patient-safety principles in ICUs. DESIGN: This is a descriptive-comparative study. METHODS: The research environment includes ICUs of hospitals affiliated to the two universities of medical sciences in Tehran. Sampling was done by census using Time and Event Sampling methods. Research instrument was "Patient Safety Principles Checklist". Data analysis was performed using SPSS-20 and descriptive-inferential statistics with a significance level of 0.05. RESULTS: There is no significant difference (p-value = .15) in the level of observance of patient-safety principles in two university-affiliated hospitals A (133.26 ± 9.14) and B (128.16 ± 18.01). Evaluation of the mean scores obtained in each dimension and in each of the ICUs was showed that only in dimension No.3 the difference was significant (F[68,2] = 5.20, p-value = .008) and in the AICUs (16.13 ± 1.8) (p-value = .04), it was significantly lower than other ICUs. Identifying risk factors for the patient's immunity reduces the side effects of patient care.

Challenges of Hospital Disaster Risk Management: A Systematic Review Study.

OBJECTIVE: This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts. METHODS: This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis. RESULTS: A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories. CONCLUSIONS: The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.

Evaluating the Effect of Peer-Assisted Education on the Functioning in Family Caregivers of Patients with Schizophrenia: A Clinical Trial Study.

BACKGROUND: High levels burden of long-term care of patients with schizophrenia can disrupt the functioning of family caregivers. This study evaluated a peer-assisted education method on family caregivers' functioning of patients with schizophrenia. METHODS: In this randomized controlled trial, 64 family caregivers of schizophrenia patients in military hospitals of Tehran, Iran, were selected and randomly allocated to intervention and control groups, in 2018-2019. The peer-assisted education was performed in the experimental group for six 1-hour sessions and the family functioning was measured in both groups by the Family Assessment Device Scale. The data were analyzed by SPSS software ver. 16.0 (SPSS Inc., Chicago, IL, USA) and group differences at a level of P-value <0.05 were considered as significant. RESULTS: There was no significant differences between groups in the pre-intervention phase in all dimensions of family functioning (P>0.05). There were significant differences between intervention and control groups, in the post-intervention phase in mean problem-solving dimension (11.80 vs. 15.53, P=0.012) and in 2 weeks after intervention, in the dimensions of roles (21.71 vs. 23.43, P=0.015), affective involvement (19.03 vs. 21.59, P=0.017), behavior control (23.90 vs. 26.93, P=0.045), general functioning (27.15 vs. 31.40, P=0.013), and total family functioning (134.12 vs. 153.09, P=0.001). CONCLUSION: The peer-assisted education significantly influenced the functioning of family caregivers of schizophrenic patients and can be recommended to improve the functioning of caregivers.

Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial.

BACKGROUND: Prolonged immobilization after transfemoral coronary angiography (TFA) may cause pain and vascular complications in patients. This study aimed to evaluate the effectiveness of a change in position to decrease pain and vascular complications for patients after TFA. METHODS: This randomized clinical trial was conducted in 2020. Purposive sampling of 72 eligible patients undergoing TFA were selected and randomly assigned to either an experimental or control group. Patients in the experimental group (EG) were placed in a supine position for 2 h after angiography, followed by a semi-seated position with the bed angle gradually increased to 45° over 4 h. Patients in the control group (CG) remained in the supine position for 6 h. Vital signs, groin, back and leg pain, hematoma, hemorrhage, and urinary retention were assessed in both groups before, immediately after, and over 6 h after angiography. The Visual Analogue Scale was used to measure pain, the Christensen scale to measure hematoma, counting bloody gases to measure hemorrhage, and patient self-rating to determine urinary retention. RESULTS: There was no significant difference between EG and CG on score of groin (2.69 ± 1.00 vs. 2.61 ± 1.00, P = 0.74), back (2.19 ± 0.98 vs. 2.47 ± 0.87, P = 0.21), and leg pain (2.14 ± 0.71 vs. 2.50 ± 1.08, P = 0.27) before the TFA. However, from the second hour to the sixth hour after the TFA, the pain in the EG was significantly less than the CG (P < 0.001). So that pain in the groin (1.36 ± 0.48 vs. 3.28 ± 0.81), back (1.25 ± 0.50 vs. 3.81 ± 1.06), and leg (1.44 ± 0.55 vs. 3.28 ± 0.81) for the EG patients was significantly less than the CG in the sixth hour after TFA (P < 0.001). No patients experienced hematoma. No differences were noted between groups in hemorrhage and urinary retention. CONCLUSIONS: Position change to a semi-seated position in patients after TFA is effective and safe for reduction of pain without increasing vascular complications. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT registration number: IRCT20200410047011N1, Registration date: 30/04/2020.

Burnout among Iranian nurses: a national survey.

BACKGROUND: Nurses, particularly critical care nurses, are exposed to high levels of stress and burnout. Burnout is associated with many deleterious consequences affecting health care outcomes. The present study is intended to determine the dimensions of burnout in nurses on surgical, medical and critical care units and its relationship with demographic characteristics. METHODS: In this descriptive research study, performed at critical and non- critical care units, 743 nurses were randomly selected by quota sampling from medical sciences universities in Iran. Data collection instruments included a "demographic questionnaire" and the "Persian version of the Copenhagen Burnout Inventory. Data were analyzed using SPSS20. RESULTS: The findings showed that regarding all dimensions, the lowest level of burnout belonged to surgical wards whereas the highest level pertained to critical care wards indicating a significant difference among various aspects of burnout in different wards, i.e., surgery, medical, and critical care. There was no significant difference in gender, academic degree, and marital status in any of the aspects of burnout in critical care units; yet, the difference was significant between surgical and medical wards (P < 0.05). There were a negative significant correlation between some dimensions of burnout with age and nursing experience in critical care and medical wards (P < 0.05). Whereas in surgical wards, there were a positive significant correlation between some aspects of burnout with nursing experience and age (P < 0.05). CONCLUSION: This study found that the critical care nurses have significantly higher level of burnout compared to the medical-surgical nurses. These results should be considered when planning burnout prevention schedules for nurses.

Comparing two teaching methods based on concept map and lecture on the level of learning in basic life support.

Education and training about Basic Life Support is necessary for different medical groups such as nurses. Different teaching methods have been developed to preserve essential medical information, knowledge and skills. The purpose of the study was to determine the effect of concept map-based and lecture-based teaching methods on the level of nursing students' learning in Basic Life Support. This quasi-experimental study was conducted in 2015 on 57 nursing students from a nursing school in Tehran. Students were selected by census and then divided into lecture (n = 29) and concept map groups (n = 28) by random allocation. The effect of education on knowledge (before, immediately after, one week after and one month after session) and practice (before and immediately after session) was studied. No significant differences were found between the mean scores of knowledge and practice before intervention (P > 0.05). After intervention the mean scores of knowledge were not statistically significant between the two groups (P > 0.05) but mean scores of practice were significantly higher in the concept map group (P = 0.03). In achieving skill and practice goals, it seems that the concept map-based teaching method was more effective than the lecture method.

Assessment of risk factors for coronary artery disease in military personnel: A study from Iran.

INTRODUCTION: Cardiovascular diseases are the most significant cause of mortality. Although the risk factors of this disease are well known, the strength of these factors varies in different populations and needs to be investigated. AIM: The aim of this study is to estimate the amount of the effect of each classic risk factor on CAD (coronary artery disease) among Aja personnel. MATERIALS AND METHODS: This matched case-control study was conducted on 1000 male Aja personnel admitted selecting Aja hospitals in Tehran in 2017. The samples were selected using purposive-graded sampling method. The 250 military patients hospitalized for CAD were considered as a case group. Each case was individually matched for age and service force with tree military patients without CAD. Data were gathered using standard demographic information and history of risk factors questionnaire and analyzed using SPSS 23 and statistical tests. Odds ratio measured trough Cochran-Mantel-Haenszel test and used to estimate the amount of the effect of each classic risk factors on CAD. RESULTS: Data analysis indicated that the risk factors including diabetes, hyperlipidemia, smoking, hypertension, and positive family history of CAD enhance the probability of CAD as much as 79.2%, 77.3%, 67.7%, 64.1%, and 56.6%, respectively. CONCLUSION: Diabetes and other modifiable risk factors have the greatest impact on CAD among the concerned Aja personnel. Hence, the authorities can consider the independent amount of the effect of each risk factor and modify them in order to prevent the disease more effectively and purposefully among the personnel.

Translation and psychometric properties of the "ethical conflict in nursing questionnaire: critical care version" in Iran.

INTRODUCTION: Ethical conflict is one of ICU nurses' main problems, which rise for several reasons that must be measured. Unfortunately, there is no native instrument for measuring ethical conflicts for ICU nurses in Iran. One of the more suitable and new tools for the measurement of ethical conflict is called the "Ethical Conflict in Nursing Questionnaire: Critical Care Version (ECCNQ-CCV)." This study was aimed to translate and investigate psychometric properties of the ECCNQ-CCV in Iranian nurses. METHODS: In this methodological study, after translation and cultural adaptation, face validity, content validity, and construct validity were assessed. Then, internal consistency and stability were measured for reliability. Two software programs (SPSS version 20 and AMOS) were used for data analysis. RESULT: Face and content validities were acceptable. Confirmatory factor analysis was not fitted. Thus, exploratory factor analysis was done, which showed five factors. However, some of the scenarios in a factor were not compatible with each other, and choosing the fit name for factors was not possible. Thus, all the scenarios were put into one factor, which has been proposed by the developer in the original version. The alpha Cronbach was 0.92 for the total scale. CONCLUSIONS: Findings show that the one factor Persian version of the ECNQ-CCV has acceptable psychometric properties. It can be used to evaluate ethical conflicts in Iranian ICU nurses.

Experiences of Iranian Nursing Faculty Members on Working in Conflict Climate.

BACKGROUND: Few studies have been conducted on role conflict in nursing faculty in the world. This research reports the first study about this subject in Iran. OBJECTIVES: The purpose of this research was to explore the experiences of role conflict in Iranian nursing faculty members. MATERIALS AND METHODS: We conducted a qualitative study using a conventional content analysis approach. We used semi-structured and in-depth interviews by purposive sampling of 19 (15 instructors, three group managers and one educational assistant) participants to identify the influential factors of role conflict among nurse faculty members, working in seven nursing colleges in Iran. RESULTS: The three following categories emerged from data analysis: "roles Interference"; "role ambiguity", and "conflicting expectations". The main theme was "working in conflict climate". CONCLUSIONS: This study highlighted the influential factors that could produce role conflict for nursing faculty members. The results can help university leaders to improve nursing faculty working conditions.