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Background & Aim: Number of patients with bloodborn disease is increased. Because of degenerative effects of the disease on body&aposs organs, and patient&aposs need to hospitalization, contamination risk for nurses and other patients is also increased. So investigation of the performance the principals of the safety injection by nurses are necessary.

Methods & Materials: This study is a descriptive research. Sample of the study were 85 nurses employed in emergency units of the selected hospitals. The research data gathering tools were a questionnaire included 7 question about demographic data and 3 checklists included 29, 20, 15 objects about performance of the safety injection in three steps (pre, during, and after injection). The statistical tests included t-test, Pearson correlation. Data analysis performed by SPSS software.

Results: This study showed that the majority of subjects were 23-30 years old (60%), female (70.6%), have BS (97.6%) in nursing and clinical experience under 5 years in hospital (55.3%) and emergency unit (80%) and didn’t participant in infection control course (75.3%) and work in rotation shift (82.4%). About half of the nurses (49.4%, 51.8%, 55.3%), had desirable performance in three steps of injection. Performance of safety injection had a significant correlation with sex (p=0.002), and preinjection step with during injection step and after injection (p=0.000), (p=0.001) respectively.

Conclusion: According to the results of this study, the half of nurses had desirable performance in injection process, but the half of them had undesirable performance. It is suggested that nurses and managers pay more attention and try to performance standard and world precautions and principals of safety injection to prevent convection of bloodborn diseases.

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Background & Objective: According to Iranian national statistics, every year 400 to 500 thousand unwanted pregnancies occur in Iran. The emergency contraceptive methods are easily accessible and affordable for the women of this region. Regarding the important role of health care providers in representing these methods, this study is to determine the knowledge and attitudes of these staff toward required contraceptive methods.

Methods & Materials: In this semi-experimental study, 216 health personnel working in south of Tehran health centers were randomly selected. Two 30- minute educational sessions were presented to the staff. The methods of education included face to face, and group discussion. At the end of each session a pamphlet was given to the staff. Data were gathered using a questionnaire before and 2-6 weeks after the education. Statistical analysis was carried out using statistical package for social sciences (SPSS).

Results: The results showed that there were significant statistical differences between the knowledge and attitudes (P<0.001) of personnel about the emergency contraceptive methods before and after education. There was no significant relationship between demographic characteristics and attitudes of personnel. There was a significant relationship between sex (P<0.001), educational level (P<0.003), educational major (P<0.001), with knowledge after intervention.

Conclusion: Knowledge and attitudes toward emergency contraceptive methods increased significantly after education. This finding reveals the importance of continuous education for health care staff such as midwives and physicians to facilitate successful guidance of their patients towards effective family planning.

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  Background & Aim: Access to quality care is important in delivering health services. Patients' safety and satisfaction are indicators of quality of care evaluation. Competent nurses may deliver quality care . This study aimed to investigate the impact of using competent nurses on patients’ safety and satisfaction .

  Methods & Materials: In t his interventional study with non-equivalent control group, we selected 120 patients admitted to the emergency department of Imam Khomeini hospital in 2012 using convenience sampling method . Nursing care for the experimental group (n=40 ) was provided by nurses who had high competency scores and in the control group ( n=80), nursing care was provided by usual emergency department nurses . Data were collected using the patient satisfaction with nursing care quality (PSNCQ), and patient safety inventory. Data were analyzed in the SPSS v.16 using descriptive and inferential statistics . The significance level for all statistical tests was considered at P<0.05 .

  Results: Mean age of the intervention and control groups were 48.1 ( ±12.5) and 40.5 ( ±16.7), respectively (P<0.018). There was a significant difference between the two groups in terms of employment (P<0.009). The two groups were similar in terms of other variables such as gender, marital status, level of education, having health insurance , and the reasons for seeking admission . The results showed that there were significant differences between the two groups in patients’ safety and satisfaction with nursing care (P<0.001). Regression test was used to eliminate the effects of age and job satisfaction the results showed effect of intervention on the patients’ safety and satisfaction with nursing care .

  Conclusion: These findings indicated that using competent nurses in providing nursing care promotes patients’ safety and satisfaction with nursing care. Training nurses focusing on the level of competency is required in scheduling, staffing, and implementing nursing care to enhance safety, patient satisfaction , and quality of care.

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  Background & Aim: H ospital emergency departments in Iran are prone to crisis for different reasons. Understanding nurses’ perspectives about these crises help in crisis management. The purpose of this study was to explain the nature, causes and consequences of crisis in emergency departments from nurses’ points of views .

  Methods & Materials: This was a qualitative study with content analysis approach. Data were collected using semi-structured interviews with 12 nurses working in emergency departments of general and trauma hospital. Participants were selected through purposive sampling method. Interviews lasted between 45 minutes to an hour. The data were recorded and transcribed. The accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged. Data were analyzed using qualitative content analysis with conventional approach . 

  Results: Five themes were emerged through data analysis including: 1) unexpected imbalance 2) events 3) defect in service provider factors 4) positive consequences and 5) negative consequences .

  Conclusion: The results of this study revealed that every factor that can affect balance and daily tasks can make a crisis in emergency departments. Causes of the crisis can be divided into internal or external factors. Several measures should be planned to decrease the crisis in emergency departments from high rank decision making in the ministry of health and medical education to planning appropriate programs in hospitals .

  

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Background & Aim: Error always occurs in the health system and it can lead to irreparable consequences. Therefore, error prevention must be taken into account by the health systems. Detection of factors contributing to error is a key factor for the prevention of error. Hence, the aim of this study was to explore factors contributing to nursing error in emergency department.

Methods & Materials: This study was conducted using a qualitative approach. 17 emergency nurses participated in this study. Semi-structured interview was used to collect the data. Sampling was started as the purposive sampling and continued until the saturation of data was reached. Data were analyzed using the Elo & Kyngas (2008) qualitative content analysis approach. To achieve trustworthiness, participants were selected with maximum variation in terms of age, gender, work experience, and educational background.

Results: The analysis of data led to the emergence of 500 open codes and four categories including the predisposing factors of nurse-related error, predisposing factors of organization-related error, predisposing factors of error related to the culture of emergency department and predisposing factors of patient-related error.

Conclusion: Factors contributing to nursing errors in emergency department were very wide and multifactorial. Identifying the factors contributing to error is a first step to prevent errors. For reducing nursing error, nursing managers should pay special attention to the contributing factors of error identified by this study and implement interventions to reduce and mitigate these factors.

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Background & Aim: Improving clinical decision-making is one of the challenges of the pre-hospital emergency system. Therefore, the aim of this study was to determine the effect of pre-hospital trauma management training program on the capability of clinical decision- making in emergency medical technicians.
Methods & Materials: In a randomized controlled field trial study, 64 pre-hospital emergency technicians from Gonabad University of Medical Sciences, were randomly assigned to either intervention or control groups by the stratified sampling method in 2018. For the intervention group, a pre-hospital trauma management training program was administered based on existing domestic and global standards in a two-day crash course with a combination of learning techniques including lecture and simulation. The research instruments were a demographic questionnaire and a researcher-made questionnaire on clinical decision-making, completed before the course, immediately and one month after the completion of the course. Data were analyzed by the SPSS software version 19 using independent t-test, the repeated analysis of variance and Bonferroni's post-test.
Results: The mean changes in clinical decision-making scores before and immediately after the intervention (9.31 vs. 0.3), before and one month after the intervention (7.86 vs. 1.1) and immediately after the intervention and follow-up one month after the intervention (1.62 in. vs. 1.39) were significantly higher in the intervention group than in the control group (P<0.001).
Conclusion: The pre-hospital trauma management training program can improve clinical decision-making in pre-hospital emergency medical technicians. Therefore, this program can be integrated into the technicians’ training programs.
Clinical trial registry: IRCT20180802040677N1
 

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Background & Aim: Due to repeat emergency patients, the high quality obstetrics and gynecology triage is essential in the obstetrics and gynecology department. Given the importance of improving the healthcare quality, clarifying the aspects and features of the concept of obstetric triage quality would be helpful for determining criteria and standardization of obstetric triage quality. Therefore, the aim of the study was to explain the quality index of obstetric triage.
Methods & Materials: This qualitative study was conducted using a directed content analysis method on 15 participants. Participants included obstetric triage service providers and key specialists in obstetric triage. The data were collected through in-depth, semi-structured interviews. Data analysis was performed using the MAXQDA software version 10.
Results: At this stage of the study, conducted with in-depth, semi-structured interviews, 824 initial codes and 97 merged codes were extracted. The quality of obstetric triage was explained by three main themes, including process quality, structure quality and outcome. The concept of process quality included 35 codes in two sub-categories: actions and care, interactions and communications. Structure quality included 51 codes in five sub-categories: routine and process of triage, pattern and standard, equipment, physical space, and manpower. Outcome included eleven codes in five sub-categories: waiting time, satisfaction, physical implication, psychological implication, and cost.
Conclusion: The index of obstetric triage quality is influenced by the quality of the process (actions and care, communications), the quality of the structure (routine and process of triage, pattern and standard, equipment, physical space, manpower), and outcome (waiting time, satisfaction, physical implication, psychological implication and cost).
 

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Background & Aim: Pre-hospital emergency staff, as the first responder group at the scene of emergencies and disasters, should be able to cope with, and maintain their physical and mental health. The aim of this study was to investigate the relationship between resilience and self-efficacy of pre-hospital emergency staff with their professional quality of life.
Methods & Materials: The present study is a cross-sectional, descriptive study that was conducted in 2019. A total of 200 pre-hospital emergency operational staff from Alborz province participated in the study using proportional and convenience sampling. Data collection tools were a demographic form and three standardized questionnaires including the emergency medical services resilience scale, the Schwartz and Jerusalem self-efficacy scale, and the Stamm professional quality of life scale. Data were analyzed through the SPSS software version 20 using descriptive statistics (mean and standard deviation) and analytical statistics (Spearman correlation, one-way ANOVA and linear regression) at the significance level of P less than 0.05.
Results: The mean and standard deviation of self-efficacy (29.67±5.82), resilience (123.14±17.07), compassion satisfaction (39.81±8.09), burnout (12.06±4.76), and secondary traumatic stress (23.61±7.27). There was a significant correlation between self-efficacy and three components of professional quality of life (P<0.05). Self-efficacy was positively related to compassion satisfaction and negatively related to burnout and secondary traumatic stress. Self-efficacy and resilience were also predictors of compassion satisfaction and burnout (P<0.05). The effect of self-efficacy and resilience on compassion satisfaction was positive. The results of stepwise multiple linear regression analysis showed that five components of resilience including self-management, stress outcomes, communication challenges, maintaining peace of mind and job motivation had an effect on compassion satisfaction (P<0.05). The effect of all resilience components on compassion satisfaction was positive.
Conclusion: Alborz pre-hospital emergency operational staff were at an acceptable level in terms of resilience, self-efficacy and professional quality of life.
 

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Background & Aim: Pre-hospital emergencies are one of the most stressful medical professions. Stressful jobs affect employees’ resilience and their ability to control anger. The aim of this study is to determine the effect of psycho-education on the level of anger and resilience among pre-hospital emergency staff.
Methods & Materials: In this quasi-experimental study, 120 people employed in urban and road centers in Zahedan were included through the convenience sampling method. To determine the intervention and control group, out of 24 available centers, 12 centers were randomly assigned to the intervention group and 12 centers to the control group. First, a demographic information form and the self-reported anger and resilience questionnaires were completed by both groups. Then, the intervention group participated in five sessions of psycho-education in groups of 8-12 people. The questionnaires were completed again by both groups two months after the intervention. Data was analyzed by the SPSS software version 16 using descriptive (mean and standard deviation) and inferential statistics (Chi-square test, independent t-test and paired t-test).
Results: The results of independent t-test showed no significant difference in the mean and standard deviation of resilience score among pre-hospital emergency staff between the intervention and control groups before the intervention (P=0.492), but after the intervention the difference was significant (P=0.009). Also, the results of independent t-test showed no significant difference in the mean and standard deviation of anger control score among pre-hospital emergency staff between the intervention and control groups before the intervention (P=0.672), but after the intervention, mean and standard deviation of anger control score in the intervention group were significantly higher than those of in the control group (P<0.001).
Conclusion: The present study showed that psycho-education improved the resilience of emergency workers, and the employees were able to control their anger by enhancing resilience. It is suggested that in-service training programs for pre-hospital emergency staff include a psycho-education program to enhance resilience and control anger in those who face many stressful situations.
 

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Background & Aim: Given the importance of the emergency department in providing prompt and high-quality services, the emphasis on lean management has increased to minimize non-value-added and wasteful activities within a process. The aim of the study was to determine the process of patient flow and identify opportunities for its improvement using the Six Sigma method as one of the most important subsystems of lean management, in the emergency department of the selected teaching hospital in Kerman.
Methods & Materials: The current research is a sequential mixed-method study conducted in 2022 within the cardiovascular and neurological emergency department in Kerman. The Six Sigma method, specifically the DMAIC approach consisting of four steps, was employed in conjunction with spaghetti charts to implement lean management principles. The research population included 180 patients referred to the cardiovascular and neurological emergency department. The data were collected using researcher-developed forms, and Excel software version 2013 was used to analyze the data.
Results: By examining the processes and using the spaghetti chart, the main problems contributing to prolonged patient admission time in the cardiology and neurology emergency department were identified. The implementation of a strategy involving the presence of admission staff during triage for level 1 to 3 patients will eliminate the additional distance and time required for patient admission.
Conclusion: The use of lean thinking principles in the emergency department with the implementation of Lean Six Sigma and Spaghetti Chart by streamlining the service process, will result in improving patient flow, providing timely quality services, reducing service delivery time, and ultimately increasing patient satisfaction.