Management Strategies During the COVID-19 Pandemic Crisis: The Experiences of Health Managers from Iran, Ardabil Province.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) outbreak is the most threatening public health challenge in the 21th century, and more than 200 countries are affected. Considering that Iran was one of the first countries influenced by the COVID-19 pandemic, this study aimed to explain the crisis management strategies during the COVID-19 pandemic in Ardabil province. METHODS: This study used a qualitative method using content analysis in which 12 health-care managers or decision-makers involved in the management of the COVID-19 crisis were recruited through purposeful sampling. In-depth, semi-structured interviews were used to collect data, which continued until data saturation. RESULTS: Data analysis led to nine categories, including prior preparation for the COVID-19 crisis; challenges and management of workforce shortages; benefiting from the participation of volunteer staff; challenges and strategies for physical space, supplies, and personal protective equipment (PPE); designation of referral centers for COVID-19; protocolized patient transport; benefiting from donations and charity support; management of information about COVID-19; and learning from the prior stages of crisis. CONCLUSION: This study revealed that, in critical situations, managers use multiple and, to some extent, unique strategies for decision-making and crisis control. Therefore, the health system can use the findings of the current study for proper response to similar crises and training of future managers.

Experiences of Radiology Personnel About the COVID-19 Crisis: A Qualitative Content Analysis.

Background: The COVID-19 pandemic has affected all health care systems. During these critical times, radiology personnel and nurses have been heavily involved in the diagnosis and management of patients with COVID-19. Purpose: This study investigates the experiences of radiology personnel about the COVID-19 crisis. Methods: This qualitative content analysis was conducted on seven radiology personnel. In-depth semistructured interviews were used to collect data. Purposive sampling was carried out to select the participants. Findings: The data analysis led to the emergence of six categories, including psychological-emotional reactions, knowledge-related challenges, humaneness, workplace conditions, hopefulness, and support. Conclusion: Learning from the experiences of radiology personnel and nurses during the COVID-19 crisis can help better manage any subsequent health crises.

The Barriers and Facilitators of Self-Management Among Adults with Type 2 Diabetes Mellitus: A Trans Theoretical Model (TTM)-Based Mixed Method Study in Iran.

AIM: This study planned to determine:( 1) the behavioral intention or profile of patients with type 2 diabetes mellitus (T2DM) based on the stages of the change model, and( 2) to explore the perceived facilitators and barriers of self-management (SM) in a sample of Iranian patients with T2DM. METHODS: This was a mixed method study, accomplished in two phases. In the quantitative phase, 246 subjects with T2DM participated. They were classified according to items such as regular use of blood-glucose-lowering drugs, having a healthy diet and performing physical activity to pre-action and action groups. Socio-demographic and anthropometric information were collected, and a phenomenological qualitative study was conducted, and data collection continued until saturation achieved by 10 subjects in pre-action and 12 subjects in action groups. Four focus group discussions in the field of SM were accomplished. Analysis of quantitative and qualitative data was conducted by the SPSS and MAXQDA software, respectively. RESULTS: The mean age and duration of illness among the subjects were 53.9±7.1 and 6.9±4.9 years, respectively. The barriers of SM in action and pre-action stages were as follows: lower socio-economic status, poor performance of treatment team, physical-intellectual factors and lack of planning to change. The facilitators stated in the pre-action and action stage in the field of SM were satisfaction from treatment, planning, belief in diabetes, treatment team's support, nutritional knowledge, and religious beliefs. CONCLUSION: This study indicated facilitator and barrier factors in SM based on TTM in action and pre-action groups. Healthcare professionals should consider these findings to improve the patients' outcomes.

Evaluating the Factor Structure of the Persian Version of Posttraumatic Growth Inventory in Cancer Patients.

PURPOSE: This study aimed to assess the factor structure of the Persian version of posttraumatic growth inventory (P-PTGI). METHODS: Participants included 272 Iranian people of Azari ethnicity (111 women and 161 men), aged between 21 and 91 years (mean 52.65 years), who were diagnosed with cancer and were referred to the oncology department of the university hospital. The P-PTGI was assessed to determine the construct validity, using various indices of confirmatory factor analysis and standardized lambda coefficient, followed by further assessment of the discriminant and convergent validities by using the structural equation model. LISREL 8.8 for Windows and SPSS were used for data analysis. RESULTS: The calculated values of comparative fit index, incremental fit index, normed fit index, and non-normed fit index > .90 and the values of standardized root-mean-square residual < .08 indicate an acceptable fit for the original PTGI. Considering that the values of average variance extracted (.52-.74) were greater than the square of correlation coefficients between the five dimensions of P-PTGI, discriminant validity was approved. Convergent validity was confirmed through a high value of standardized lambda coefficient (.52-.92) between the items and their related factors. CONCLUSIONS: This study revealed that P-PTGI has an acceptable validity and reliability for posttraumatic growth assessment in Iranian cancer patients and its factor structure is similar to that of the original form developed by Tedeschi and Calhoun.

A Survey of Adherence to Guidelines to Prevent Healthcare-Associated Infections in Iranian Intensive Care Units.

BACKGROUND: Healthcare-associated infections (HAIs) are acquired by patients while receiving care. The highest incidence of HAIs has been documented in admissions to intensive care units. Adherence to evidence-based practices is the most important step for preventing HAIs. OBJECTIVES: To determine the rate of adherence to evidence-based post-insertion recommended care practices after admission into the intensive care unit for the following devices: central line catheter, indwelling urinary catheter, and mechanical ventilator. PATIENTS AND METHODS: A structured observational cross-sectional research design was used. Data were collected using a checklist and a self-report questionnaire. The minimum sample size required for this study was 276 post-insertion care episodes, and 332 episodes were observed. The ANOVA test was used to identify any significant differences among the mean scores of the three devices. RESULTS: Overall observed adherence rates were 18.3%, 59.1%, and 43.1% for central line catheters, indwelling urinary catheter, and mechanical ventilator, respectively. Of the observed episodes of device care, only in 9.4% of the episodes was regular oral care performed for patients on mechanical ventilators and only in 19.3% of the episodes were indwelling urinary catheters properly secure after insertion. More so, in none (0.0%) of the episodes was the central line catheter hub disinfected before being accessed. CONCLUSIONS: Evidence-based post-insertion recommended care practices were not consistently and uniformly implemented in the intensive care units. Establishment of a program for the surveillance of adherence to recommended guidelines is required for improving compliance by health professionals and the quality of preventive care.

The status of social well-being in Iranian nurses: a cross- sectional study.

INTRODUCTION: Social well-being is one of the important aspects of individual's health. However, the social aspect of health, or social well-being, has not been attended to as equally as the other aspects. Social well-being is people's perceptions and experiences in social circumstances as well as the degree of successful responses to social challenges. The aim of the study was to investigate the social well-being of a sample of Iranian nurses. METHODS: This study was a cross- sectional conducted in 2013. The study population consisted of all 1200 staff nurses working in all hospitals located in Ardabil, Iran. We invited a random sample of 281 practicing nurses to respond to the 33-item Keyes's Social Well-Being Questionnaire and the possible range of the total score is 33-165. Higher score reflect better SWB. The quantitative analysis of this study used the Statistical Package for Social Science SPSS version 13.0. RESULTS: The results showed that Participants' mean score of social well-being was 105.45 (15.87). Social well-being was significantly related to participants' age, gender, work experience, satisfaction with working in hospital and with income, familiarity with nursing prior to entering it, official position, and type of employment. However, there was no significant relationship between nurses' social well-being and their marital status, their parents and spouses' educational status, as well as the type of hospital. CONCLUSION: Nurses' social well-being deserves special attention. Effective well-being promotion strategies should be executed for promoting their social well-being particularly in areas of social integration and social acceptance. Moreover, nurses, particularly female nurses, need strong financial, emotional, informational, and social support for ensuring their social well-being.

Disciplined care for disciplined patients: experience of hospitalized blind patients.

Blindness is a permanent condition that alters daily life of blind people. Interpretive phenomenology was used to understand lived experiences of the hospitalized blind people. "Disciplined care for disciplined patients" was one of the themes that emerged from the data. Provision of disciplined care can help health care professionals provide a holistic and comprehensive competent care for blind patients.

Effect of distraction on children's pain during intravenous catheter insertion.

PURPOSE: This study examined the effect of pressing a soft ball during intravenous catheter insertion (IVCI) on the intensity of pain in children ages 4-6 years. DESIGN AND METHODS: In this quasi-experimental study, children in the intervention group were asked to press a soft ball with the opposite hand during IVCI and to immediately mark the Wong-Baker FACES Pain Rating Scale. RESULTS: There was a significant difference in the intensity of pain between the control group (n = 30) and the intervention group (n = 30; p =.012). PRACTICE IMPLICATIONS: Pressing a soft ball during IVCI may be an easily accessed, inexpensive, and effective technique to control or reduce pain in young children.