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In an international project in 1987, the world health organization (WHO), UNICEF, UNFPA and the world bank suggested the maternal safety program and the following objectives were considered:1. Reducing maternal mortality from 1990 to 2000 to the half of thepresent rate throughout the prenatal care2. Availability of the whole pregnant women to the prenatal care,qualified personnel during the delivery and required facilities fortransferring women in high risk pregnancies and midwifery emergencies.3. Availability of appropriate services and information to prevent low ageand high age pregnancies ,short interval pregnancies and multiparous.Since 1987, an international cooperation has been established to support the maternal safety program.Relating to this program, essential changes in the structure of the health services system, in laws and policies and also in training programs of medical doctors ,midwives and other related professions have been made.The international confederation of midwifery (ICM), a professional organization of midwifery, and also midwifery societies in the developed countries are the most active organizations involved in providing maternal safety program. Some researches relating to this program was performed in some undeveloped and developing countries such as Africa, Asia and latin America. Some confernces and congresses were also held.Researchers have indicated that traditional midwifery can not be successed in reducing the rate of maternal mortality unless be supervised by qualified midwives.Since in our country and some other developing countries, the rate of maternal mortality and morbidity is high, therefore the maternal safety program should be perfectly performed and midwives should do their best in applying this program.WHO declared midwives are responsible for the maternal safety program performance, and they will be supported by WHO in different ways, WHO also announced the year 1998 as the maternal safety year.Thus, as midwives, we should recognize our essential role in this program and in other national and international reproductive health programs.

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This is a double - blind clinical trial to evaluate the safety and efficacy of topical nitroglycerin ointment on venous catheterization in patients referred to emergency ward of Baghiyatollah hospital in 1997.The units under investigation consisting of 70 patients, 40 women and 30 men ranging in age from 20 to 69.The samples were randomly assigned into two equal groups, 35 patients in case group and 35 patients in experimental group. The experimental group received 2% nitroglycerin ointment and the case group received the placebo ointment that was applied prior to venus catheterization on the skin of the dorsum of the hand, wrist or front part of forearm.To collect data, an observational checklist was used in which demographic characteristics, and efficacy and immunity of the ointment were recorded.The findings revealed that the vein diameter in case group was not increased after applying the ointment, while it was considerably increased in experimental group from 4 mm to 6.6 mm. Although the method of catheterization in two groups was the same, catheterization in case group was more difficult than experimental group. Using T.test, the findings revealed that there was statistically significant relationship between vein diameter before and after applying the ointment in experimental group and after applying it in case and experimental groups (PO.001). Moreover, tachycardia and hypotension was not observed in both groups during 15, 30, 45 minutes and one and two hours immediately after applying the ointment, however in both groups, a sort of mild headache was observed. The findings also showed that there was significant relationship in observing the vein after catheterization in two groups (P<0.2). However, before applying the ointment, there was significant relationship in observing the vein in the experimental group. Furthermore, after applying the ointment, arhythmia appeared, but it was not significant.The results showed that applying nitroglycerin ointment was a useful method in expanding the peripheral veins, therefore, it resulted in easy venous catheterization.

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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 & 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: Governing organizational culture in hospitals can affect patients’ safety through establishment of behavioral norms among nurses. This study aimed to determine the relationship between nurses’ perception of organizational culture and their performance about patients’ safety .

  Methods & Materials: In this cross sectional, descriptive-correlation study, we used stratified sampling method to recruit 250 nurses working in general wards and emergency departments of general hospitals in Babol, 2013. Data were collected through questionnaires and were analyzed using the descriptive and inferential statistic tests including the Pearson test, ANOVA test and T-test in the SPSS . 

  Results: Nurses' perception of organizational culture was "fairly desirable" (54.5%). Performance of the nurses in the field of patients' safety was "desirable" (88%). The Pearson test showed that there was a positive and statistically significant correlation between nurses’ perception of organizational culture and their performance in the field of patients’ safety (P<0.01) .

  Conclusion: It seems that improving organizational culture in hospitals can enhance nurses’ performance in the field of patients' safety .

  

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Background & Aim: Patient falling is one of the most important indicator of patient safety. Nurses have an important role in the prevention of patient falls and the improvement of patient safety standards. The current study aimed to determine the relationship between the incidence of patient falls and nurses’ professional commitment.

Methods & Materials: In this cross-sectional study,300 nurses employed in hospitals affiliated to Tehran University of Medical Sciences, were selected through a proportional stratified sampling method. Data were collected by a three-part questionnaire consisted of the demographic data, the Nurses’ Professional Commitment Scale and the reports on the number of patient falls in the past three months. Data were analyzed on SPSS software using statistical tests including Pearson's correlation coefficient, Kruskal-wallis and independent-t test.

Results: The mean score of patient falls in the past 3 months was 6±1.61(moderate) for each nurse and the mean score of nurses' professional commitment was 86±8.61 (committed).A significant and reverse relationship was observed between the incidence of patient falls and nurses’ professional commitment (R= -0.51; p<0.018).There is no relationship between nurses’ demographic characteristics and patient falls.

Conclusion: Despite the lower incidence of falls in the patient under the supervision of the committed nurses, its prevention entails taking into account all factors that influence this phenomenon besides improving professional commitment.

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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: 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.
 

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Background & Aim: The success of the surgical safety checklist in reducing surgical mortality and morbidity largely depends on the degree of compliance with the checklist and correct implementation of its components by the staff. The aim of this review is to determine the challenges of effective implementation of the surgical safety checklist and to provide solutions for its more effective implementation.
Methods & Materials: In the present systematic review, all the relevant qualitative papers published from 2010 to October 2018, were examined. A  literature search was done in databases SID, Iran Medex, Iran doc, Magiran, Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar, Cochran Library with keywords patient safety, surgical procedures, operative, checklist, World Health Organization, implementation science, qualitative research and their equivalent terms in Persian. Inclusion criteria were articles written in English or Persian, qualitative studies and relevant to the objectives of the study. Exclusion criteria were review articles, posters, presentations, letters to editor and quantitative studies.
Results: The findings of the review of 14 qualitative studies showed that the most important challenges in effective implementation of the surgical safety checklist were unpredictable priorities, lack of collaboration and coordination of the surgical team members, mismatch between the checklist and hospital setting, lack of patient’s cooperation and lack of a planned approach towards implementing the checklist. The strategies to improve the implementation of the surgical safety checklist included checklist localization, improving the collaboration and coordination of all the team members, training and practicing, patient participation, and active organizational leadership.
Conclusion: The introduction of the surgical safety checklist to the health care setting is a permanent challenge and requires ongoing evaluations and its integration into the workflow in the hospital, active and effective leadership, explanation of why and how to use it by managers and receiving support from the organization. Continuous education, performance evaluation and the participation of all the surgical team members in the implementation of the checklist are key factors for effective implementation of the surgical safety checklist.