---

This study is a quasi-experimental research with aim of evaluation the effect of respiratory exercise in acute respiratory complication and the length of time patient hospitalization undergoing coronary artery bypass surgery in Kermanshah Emam Ali hospital in year 2000 The study subject consisted of 60 patients (42 male and 18 Femal), with age rang between 30-70 years old, who were eligible for this study. The subjects were selected with convenience sampeling and randomly allocated to two groups (Experimental and control). Experimental group received education in two sessions of videoteaching and control group recived routin cares. Tools of data collection consist of demographic questionnaire, clinical records, check list and respiratory exercise. Results revealed: The incidence rate of atelectasis in experimental group was (26.7%), less than contral group (%56.7), test showed significant difference between incidence rate of atelectasis (P = 0.01). Therefore the length of hospitalization in experimental group was less than control group (P=0.02). Accomplishment of post operative respiratory exercises in all samples were lower than doing exercise pre-operatively, and the highest score for effective exercise and coughing were in two and three days after surgery (P=0.000). The result of this research reveales, videoteaching is effective in promoting nursing care and self care in clients.

---

Background & Aim: Pulse Oximeter monitoring technology has become so common in intensive health care settings over the last decade that blood oxygen level is now considered as the fifth vital sign. However, it seems that medical and nursing staffs are not specially educated to operate with the devices. The aim of the study was to investigate the knowledge of medical assistants (residents), nurses and anesthesia technicians of pediatric intensive care units regarding Pulse Oximetery.

Methods & Materials: This is a cross-sectional study. The study population consisted of all nurses, first year to third year medical assistants, and anesthesia technicians who working in intensive care units in Pediatric Center. A questionnaire was used for data gathering that had three sections: the first section as demographic data (occupational condition, record of service in pediatric unit, having the experience of using Pulse Oximetery, having enough knowledge about Pulse Oximetery, and its educational program type) the second section (eighteen short answer questions) in order to determine the participants knowledge about Pulse Oximetery and the third section (four imaginary clinical scenarios) evaluating the participants interpretation on Pulse Oximetery reports and its changes in patients. The collected data were analyzed through descriptive and inferential statistics (Fisher exact test) by SPSS v.15 and EPI6 computer softwares.

Results: The analyses showed that 77.4% of the participants did not pass any educational course regarding Pulse Oximetery, also 67.9% of them correctly identified what Pulse Oximeter measures, and 47.2% of the subjects correctly identified how a Pulse Oximeter works, and 13.2% identified its normal range, but only 26.4% had a correct understanding of the Oxhemoglobin dissociation curve and explained it completely true. It was found that the majority of the participants were wrong in their answers about Pulse Oximeter monitoring. They made mistakes in interpretation of the imaginary clinical scenarios.

Conclusion: The results of the study showed that the majority of pediatric intensive care unit staffs have little knowledge regarding Pulse Oximeter monitoring, then with attention to the vast usage of the technology the necessity of formal educational programs in colleges and retraining courses during employment about the device for health care providers is apparent.

 

---

Background & Aim: Due to the fact that family centered care have a crucial role in pediatric nursing, it seems compatibility of nurses&apos and parents&apos perception about parents&apos needs can lead to deliver higher quality care. The aim of this study was to compare parents&apos and nurses&apos perceptions about needs of hospitalized children&aposs parents.

Methods & Materials: This is a cross-sectional survey. One hundred and fifty parents and 80 nurses were selected using convenient sampling method. Data was gathered using Kristjánsdóttir&aposs "parental needs of hospitalized children" questionnaire. Data were analyzed using descriptive and analytical (Chi-squared & Mann-Whitney U tests) methods.

Results: Research findings showed that there was significant difference between both parents&apos and nurses&apos perceptions about parents&apos needs (P=0.012). Both groups believed that parents&apos needs are met partially in hospitals. There was not meaningful difference between the parents&apos and nurses&apos perceptions concerning meeting parental needs (P=0.666). Based on their perceptions, understanding of parents&apos needs help them to meet their requirements in health care facilities. There was a significant difference between parents&apos and nurses&apos perceptions regarding parents&apos need (P=0.018).

Conclusion: Parents and nurses recognized all of the parents&apos needs to be important there were also deficits in meeting these needs. Therefore, parents&apos cooperation with health care team is necessary to facilitate the recovery of sick children as well as meeting parents&apos needs.

---

Background & Aim: Patient satisfaction has been recognized as a key indicator of health care quality which is used by accreditation agencies to monitor quality of care in hospitals. A high proportion of health caregivers are nurses. The services provided by nurses are significantly influential in satisfaction of patients. The aim of this study was to assess patients&apos satisfaction from nursing care in hospitals of Iran University of Medical Sciences in 2010.

Methods & Materials: In this cross-sectional study, we recruited 200 patients from different wards (except for special wards, Emergency department, Pediatric and Psychiatric wards) at the time of discharge from hospital through multistage sampling method. Data were collected using Patient Satisfaction Instrument (PSI). Data analysis was performed using descriptive statistics, chi-square and regression analysis.

Results: Majority of patients (72%) were moderately satisfied. Patient satisfaction had a significant relationship with the type of ward (P≤0.001), and type of hospital (P≤0.001). Of demographic variables, only patients&apos level of education was significantly associated with patient satisfaction (P≤0.019).

Conclusion: In this study, patients were moderately satisfied from nursing care services. Educating hospital staff, especially nurses and encouraging them to actively participate in activities to promote patient satisfaction should be a priority for hospital management. We should also consider that in a competitive market of health and treatment care giving, institutions that put patient satisfaction as their main goal are more successful.

---

Background & Aim: The aim of this study was to investigate the relationship between nurses&apos knowledge about pain and satisfaction from pain relieving procedures among postoperative CABG patients in selected Tehran medical university hospitals.

Methods & Materials: In this cross-sectional study, 100 nurses were recruited from the ICU Open heart. Also, 200 patients were selected from whom underwent CABG in 24 hours after surgery and were extubated using a simple random sampling method. Data were gathered using two questionnaires including 17 question about demographic characteristics of patients and their satisfaction, and 36 questions about demographic characteristics and nurses&apos knowledge about pain and pain control after the CABG. Data were analyzed using descriptive and inferential methods using SPSS-11.5.

Results: There was not significant relationship between the nurses&apos pain knowledge and the patients&apos satisfaction. However, there were a significant relationship between the knowledge of the nurses about pain control after the CABG and the patients satisfactions (r=0.209, P=0.037).

Conclusion: According to the findings of the study, there were some significant relationships between the nurses demographic and pain knowledge with the pain control after the CABG. There was also significant relationship between patients&apos satisfaction and some of them demographic characteristics.

---

  Background & Aim: The quality of clinical services is a major concern for healthcare systems throughout the world. Clinical Governance, a relatively new approach to improve quality of healthcare systems, plays a fundamental role in the establishment of primary healthcare strategies to provide high quality services. Moreover, regarding the importance of organizational culture as a powerful lever to improve organizational behavior, success of organizations in implementing strategies largely depends on the support receiving from organization. Accordingly the aim of this study was to examine the correlation between organizational culture with establishment of clinical governance in public hospitals in Rasht .

  Methods & Materials: A cross-sectional correlation study with structural equation modeling was used. All 152 nurses working in managerial positions participated in the study. Data were collected using Denison Organizational Culture questionnaire, and research-made questionnaire on clinical governance. Validity and reliability of questionnaire were confirmed. Data were analyzed using the Pearson correlation coefficient test and confirmatory factor analysis in the SPSS and LISREL . 

  Results: There was a significant positive relationship between clinical governance and all components of organizational culture (P< 120.01' type="#_x0000_t75"> ). Factor analysis showed the impactof organizational culture on successful establishment of clinical governance .

  Conclusion: Improvement of organizational culture leads to sustainable establishment of clinical governance through which quality of healthcare services improves. Managers of hospitals should pay attention to instituting appropriate organizational culture in order to establish clinical governance .

  

---

World’s health systems have entered a critical period of human resource shortage. The shortage of qualified nurses has been suggested as one of the most important barriers to achieve effective healthcare systems (1). According to the WHO (2014), there is currently a shortage of 7.2 million health care providers at the international level. This shortage is estimated to reach 12.9 million by 2035 (2). In other words, in order to develop healthcare systems, achieve positive outcomes and ensure patient’s safety, recruiting well-qualified nurses is a global concern (3). Nursing shortage in Iran has also become a concern for managers and a major challenge to the healthcare system. The nursing deputy of the Iran Ministry of Health and Medical Education reported that the number of nurses working in health care settings is estimated to be 140,000, but there is a need for 2,60,000 nurses to deliver ideal levels of health care (4). While, qualified nurses adequacy is one of the essential components of the nursing professional practice environment (5). Poor nursing work environment, inadequate resources, imbalanced workload, disproportionate nurse-patient ratio, high bureaucracy (5), lack of supportive management, low salaries, and reduction in employment are major challenges that have caused Iran’s healthcare system to face a serious crisis of nursing shortage despite a large number of young nursing graduates (6). Evidence suggests that the nursing practice environment has a significant role in the retention of expert nurses, the quality of care and, safety of patients (7). Poor nursing work environments are related to adverse patient outcomes, including an increase in mortality rate, patient falls, and medication errors (8, 9). In addition, unhealthy workplaces are important causes of turnover, efficient nurses’ intention to leave, early retirement, job dissatisfaction and burnout (10, 11). Therefore, efforts to create environments that attract and retain nurses are worthwhile. Different strategies have been proposed to improve the nurses’ work environment. In this regard, making workplace attractive is a basis for increasing the quality of nursing practice environment (12).
Today, there are hospitals called "Magnet Hospital" that are renowned for attracting and retaining expert nurses. The Magnet hospital was first used in the United States. In the early 1980s, concurrent with nursing shortage crisis in the United States, extensive studies were begun to examine the organizational structures of Magnet hospitals. In a study, the American Academy of Nursing (AAN) identified 41 hospitals that were known to attract and retain qualified nurses, and used the term "Magnet" as a gold standard for nursing practice in these hospitals (13). Magnet hospitals are evaluated in terms of achieving goals in five areas including transformational leadership, structural empowerment, new knowledge, innovation, and empirical outcomes and development (14). Magnet hospitals with a more different organizational structure than non-Magnet ones play an important role in nurses’ job satisfaction and retention (15). One of the main reasons for the attractiveness of these hospitals is the existence of work environments focusing on decentralized decision-making, autonomy, control over practice, resource adequacy, supportive management, effective inter-professional communication, and career development (16). In other words, the organizational attributes of Magnet hospitals lead to the nurses’ empowerment by increasing autonomy and authority, and subsequently improving job satisfaction. These hospitals have designed a set of work environment standards to support professional nursing practice (17). Many studies have shown that Magnet hospitals provide a healthier environment with higher job satisfaction for nurses and better outcomes for patients, compared to non-Magnet ones (18, 19). In recent years, the development of Magnet hospitals has rapidly grown in various countries. Considering the complexity of nursing shortage phenomenon, paying attention to the factors influencing the nurses’ attraction, retention and productivity is important to overcome the challenge of nursing shortage (20).
Conclusion
The nurses’ dissatisfaction with the work environment and consequently, the shortage of competent and educated nurses, is a major challenge to Iran’s health system. Therefore, solving this crisis is vital to prevent adverse health consequences. In this regard, nursing managers and health policy-makers can create a quality work environment using the features of Magnet hospitals to increase the attraction and retention of health care professionals, especially nurses. This will not only result in the nurses’ job satisfaction but will also increase the quality of care and ensure the patients’ safety.
 

---

Background & Aim: A desirable level of happiness among nurses is related to the quality of nursing care services. This study aimed to evaluate the level of happiness among nurses and its’ relation to some demographic factors in Zanjan province- 2017.
Methods & Materials: In this cross sectional study, 371 nurses employed in the hospitals affiliated to Zanjan University of medical sciences were participated. The Oxford happiness inventory was used to collect data. The data were analyzed using descriptive statistics and Chi-square test through the SPSS software version 16. A P<0.05 was considered statistically significant.
Results: The mean and standard deviation of age of samples were 32.2±7.08. Most nurses were female (86.79%) and married (68.46%). Most nurses had a bachelor’s degree (94.88%) and the rest of them had a master’s degree. The mean score of happiness in nurses was 43.1±13.3 (the range 0-87). Concerning the demographic and occupational variables, a statistically significant relationship was found between job satisfaction and happiness level (P=0.049).
Conclusion: According to the findings of the study, the level of happiness in the nurses was at an acceptable level. Considering the relationship between happiness and job satisfaction, and given the importance of job satisfaction in the motivation and retention of nurses in the profession, it is necessary to pay attention to this matter.
 

---

Background & Aim: Creating and maintaining a safe environment is an important part of care in psychiatric wards. The results of previous studies indicated that some features of the physical environment facilitate the ward’s safety. The experiences of people who are most likely to be present in these environments can be the best source for identifying these features. Therefore, this study was conducted to explain patients’ and employees’ perceptions toward the features of a safe physical environment in psychiatric wards.
Methods & Materials: In this exploratory qualitative descriptive study, seven patients at discharge time and nineteen employees working in psychiatric wards were interviewed about their experiences in psychiatric wards and 84 hours of field observation was done. The data were analyzed using a qualitative content analysis approach according to the method proposed by Graneheim and Lundman.
Results: The results showed a safe physical environment in psychiatric wards meant “having an accident-free environment”. This theme was abstracted from two main categories included “Accidents prevention through design” and “having a natural life environment”, which, according to the experience of the staff, is required to balance the two. The subcategories of “having the design of accidents prevention” were “eliminating or modifying accident-causing objects”, “wards based on the characteristics of the patients” and “conditions for facilitating staff performance” and the subcategories of “having a natural life environment were “meaningful activities", “healthy and pleasant conditions” and “preserved privacy”.
Conclusion: According to the results of the study, it is necessary to create a physical environment free of accidents and at the same time to meet the daily needs of patients in order to prevent physical and psychological damage to patients and staff in psychiatric wards.
 

---

Background & Aim: Cesarean section (CS) rate was 56% in 2012 in Iran, which was considerably higher than the WHO recommended rate (10-15%). Thus, the Normal Delivery Promotion (NDP) program as a part of Iran’s Health Transformation Plan (HTP) was implemented in 2014 to reduce unnecessary cesarean deliveries and promote maternal and neonatal health. The aim of the study was to evaluate the effect of the NDP plan on the CS rates.
Methods & Materials: This quasi-experimental and longitudinal study analyzed the immediate and long- term effects of the NDP program on the CS trend in Iran using an interrupted time series analysis. Monthly CS rates in the hospitals of the country were extracted from April 2013 to September 2018.
Results: Overall CS rate in Iran decreased by 6% immediately after the implementation of the NDP program and then remained at the same level. The NDP program reduced the CS rate in teaching (9.5%), non-teaching (11.7%), private (18.1%), and charity (27.1%) hospitals. But the CS rate increased in social security (7%) and other hospitals (15.7%). The CS rate would have reached 58.5% by September 2018 if the NDP program had not been implemented.
Conclusion: The NDP program was somewhat effective in reducing the CS rate in Iran. Promoting this program by formulating a strategic plan and comprehensive action plans addressing various underlying causes of CS at meta (ministry of health), macro (universities of medical sciences), meso (hospitals) and micro (obstetricians, midwives, and mothers) levels and considering effective solutions in the areas of governance and leadership, financing, human resources, equipment, information and service delivery is critical to achieve the determined national goals.
 

---

Background & Aim: Designing healthcare spaces and physical facilities requires the identification of the patient's family needs, and it is considered an important component of nursing theories. The aim of this study was to explain the needs of family caregivers of patients undergoing gynecological surgery for physical facilities and equipment in hospital.
Methods & Materials: This study is based on the results of the qualitative part of a large hybrid study on the development and implementation of a need-based service delivery program for the caregivers of patients undergoing gynecological surgery in 2017. The selection of participants was purposefully done with maximum variation. The study data were collected using 31 (16 caregivers, 6 nurses, 4 doctors, 3 patients and 2 service workers) in-depth interviews and observations and analyzed by the conventional qualitative content analysis using the Zhang and Wildemuth approach.
Results: Data analysis led to the development of the theme "need for physical facilities", which fell into two categories "need for proper physical structure in the hospital" with the following subcategories: "need for care facilities behind the operating room door", "need to provide welfare facilities in the hospital for caregivers", "need for welfare facilities in the surgical ward", "necessity of allocating rooms to the similar patients", and category "need for appropriate hospital facilities and equipment" with subcategories "caregiver’s need for facilities and amenities", and "caregiver’s need for facilities and amenities for the comfort of the patient".
Conclusion: The results show the importance of having a physical structure tailored to the needs of family caregivers as well as the availability of appropriate facilities and equipment in hospital. One of the limitations of the study was preventing men from visiting patients in the women’s hospital. It is recommended that the needs of male companions and the necessity of their presence according to the cultural context be studied. Also, a new architectural design is suggested to create a suitable therapeutic environment and positive effect on patients’ improvement and increase patient and family satisfaction.
 

---

Background & Aim: In recent years, women's experience of disrespect and misconduct during childbirth has been raised as a significant problem around the world. This study aimed to determine the prevalence of disrespectful maternity care and its associated factors.
Methods & Materials: This is a cross-sectional study conducted in 2019 on 357 mothers who gave birth at hospitals affiliated to TUMS. The data collection tool included socio-demographic characteristics form, and the disrespectful maternity care questionnaire, measuring various domains of abuse. The questionnaire was completed by interviewing mothers. Data was analyzed using descriptive tests, Chi-square test and multivariate logistic regression through the SPSS software version 24.
Results: All participants reported at least one form of disrespect, of which “not allowing for mobility, fluid and companion” was the most prevalent (99.7%) and “stigma and discrimination” was the least prevalent (4.5%). Statistical analysis showed a significant relationship between older age, ethnic minority, primiparity, higher socioeconomic status, delivery time (night, day) and a history of illness with more experience of different forms of disrespect.
Conclusion: This study confirmed a relatively high prevalence of disrespectful maternity care in hospitals based on international standards, which requires serious and prompt attention of top-level managers to take action to eliminate or limit this type of behavior.
 

---

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.