Hospital

Proper site selection of urban hospital using combined techniques of MCDM and Spatial analysis of GIS (Case study: region 7 in Tehran city)

Seyed A Alavi

Background: In Iran, the rapid growth of urbanization is in a way that it fits into the appropriate location for urban spaces are not switching. The main consequence of this is failure of service delivery and service system to citizens. One of the most important public services that hospitals provide most of the citizens' health. The purpose of this study, “Optimal locating of hospitals in region 7 in Tehran city”.

Material and methods: This research is descriptive - analytical study has been done. For collecting information and data is used field studies and According to information obtained, To review the study area in terms of access to communication road, green space, away from industrial centers, military, and the fault, as well as for weighting the criteria, is used the AHP model. Then, using a decision model of TOPSIS in GIS software, valuation of criteria has been studied and appropriate maps is prepared, finally map that represents the best location for the construction of hospitals in this area is extracted.

Results: with combination and overlaying of data layers, the final map was obtained and determined that the northeastern section (Cross Resalat Street and cabli), central (martyr Motahari streets and Miremad) and southeast (Bakhshi fard and part of Damavand street) in district 7 are have priority and more points to construct hospitals.

Conclusion : System of Multi Criteria Decision Making (MCDM) with GIS can be used as effective tool in site selection of hospitals. Being located of hospitals, near to green spaces and comunication road and its distance from the industrial and military areas as well as the fault, capability of this model in this study is prove.

Surveying the Factors Affecting Patient`s Discharge against Medicine Advice from Emergency Ward of AmirAlam Treatment-Teaching Hospital in Tehran: 2012

M Arab

Background: Patient`s self-discharge from the hospital is a process in which a patient leaves the hospital before completing his or her determined treatment period by his own will. This study is aimed to survey the factors affecting patient`s self-discharge from the hospital in emergency ward of a referred hospital. Materials and Methods: This is a case-control study. The 280 selected samples were divided to two groups, each with 140 members. The data were gathered using a questionnaire evaluating the scale of patients and their companions` satisfaction of the hospital services. Chi-square test was used for analyzing the relationship between independent variables and the patient discharge type. Moreover logistic regression was used in order to identify the effect of significant independent variables on own will-discharge possibility. Results: Results indicate that there is a meaningful relationship between variables such as age, having supplementary insurance, residency, income rate, reference shift, reference day, satisfaction of the physicians, satisfaction of the physical environment and welfare facilities, the patient`s satisfaction, the waiting time, satisfaction of the instructions given by nurses and physicians and total satisfaction with discharge type(p<0.05). Conclusion: The matter of patient`s self-discharge is a multi-dimensional phenomenon and depends on patient’s characteristics and structural and medical factors. Therefore predicting its scale and determining factors might play an effective role in controlling this phenomenon.

Surveying Kerman’s Afazalipour Hospital clinical and educational staff`s points of view about the clinical decision support system designed for reducing the possibility of pulmonary embolism and deep vein thrombosis

K Bahaadinbeigi

Background: This research aims to design and implement a software with the ability to identify patients who are facing the risk of pulmonary embolism and deep venous thrombosis instantly as well as the ability to send timely reminders for any prophylactic action. The main target is introduce a clinical decision- support system which could finally lead to preventing mortality and handicap cases caused by embolism and thromboses in patients who are confined to bed in hospitals. Materials and Methods: The software was designed using the Visual Basic.Net and SQL Server database. Afterwards the software was installed in the largest educational hospital of Kerman and a survey was conducted amongst the physicians using multiple questionnaires and interviews. Finally, the data were analyzed using the SPSS software. Results: The average score was 21.16 for the physicians and 20.76 for the nurses. T-Test results show that there is no significant difference between the total average score of the physicians and that of the nurses. Conclusion: The results have shown that both groups (physicians and nurses) have a positive viewpoint about the software therefore using the clinical decision support system can be effective in reducing the occurrence of pulmonary embolism and deep venous thrombosis through sending timely electronic alerts to the medical staff.

Measuring the Exposure of Households to Catastrophic Healthcare Expenditures in Iran in 2001: the World Health Organization and the World Bank's Approach

A Rashidian

Background: Achieving equitable financial contribution and removing the risk of households' exposure to catastrophic expenditures are the most important challenges for health systems all over the world. This study aimes to measure Iranian households' exposure to catastrophic health care expenditures and surveying the factors affecting this expenditure, based on the World Health Organization and the World Bank approach.
Materials & Methods: Sectional data of the World Health Survey in Iran in 2001 has been analyzed. This survey covered 10300 urban and rural households across the country. The catastrophic expenditure has been calculated based on the ability to pay in the thresholds of 40, 50, and 60 percent and the income at the threshold of 20 percent. Logistic regression model was used to examine factors influencing catastrophic health expenditures.
Results: The proportion of families confronting catastrophic health expenditures was estimated at 9-15 per cent. Facing catastrophic expenditures showed a statistically significant relationship with variables such as having a family member suffering from a chronic disease, family`s financial condition, and living in rural areas regardless of the thresholds used. The insurance coverage showed a statistically significant relationship with exposure of catastrophic health expenditure just in case it was measured using the 40% threshold.
Conclusion: Political interventions and policies of the government such as implementing fee exemptions for certain target groups, designing benefits packages, extending population coverage through prepayment mechanisms and protecting the poor and disadvantaged groups can protect households from experiencing catastrophic health expenditures.

Surveying the effect of demographic specification on organizational citizenship behavior of staff of selected educatioanl hospitals of Tehran Universities of Medical Sciences

A Pourreza

Background: One of the behaviors taken into consideration in organizations such as hospitals is organizational citizenship behavior. Recent studies have shown that organization employees show interest in organizational citizenship behavior and this subject may be influenced by demographic specifications.This study aims to determine the relationship between organizational citizenship behavior and demographic specification (gender, age, marital status, educational qualifications, salary&wage ,ethnicity,employment type, work type, organizational post, place of employment and work experience) among selected hospitals employees of selected hospitals of Tehran and Shahid Beheshti Medical Sciencesis Universities. Materials and Methods: This research has been implemented in six selected Hospitals of Tehran and Shahid Beheshti Medical Sciencesis Universities and data was collected by distributing a questionnaire among 429 employees of these hospitals using a two-stages random sampling method.The research methodology has been cross-sectional- descriptive using field study. In order to accept or reject the research hypothesis kruskal-wallis and mann-whitneyU tests have been used. Results: Results showed that, the most studied demographic characteristics have an effect on organizational citizenship behavior of the staff of selected hospitals employees in Tehran and Shahid Beheshti Universities of Medical Sciences. Conclusion: Findings of this research indicated that men have shown more organizational citizenship behavior compared to women, Married people have shown higher organizational citizenship behavior compared to single and divorced people and people in the age class of 50 to 54 years have been the highest organizational citizenship behavior average. In addition to, people with master degree, have been the highest organizational citizenship behavior. Also our findings show that Ethnicity does not have effect on the incidence of organizational citizenship behavior.

Assessment the Level of Patient Safety Observance in the Intravenous Injection of Contrast Media in Radiology Departments of Urmia University Hospitals

B Rahimi

Background: Today using contrast media in order to diagnose different tissues in radiology section has found a vast range of applications. Thus application of safe procedures and protocols in usage of contrast media to prevent dangerous reactions seems to be of great necessity. That is why in this study we aimed to evaluate the safety of intravenous administration of contrast media in the radiology sections of medical-educational Centers of Urmia. Materials & Methods: This is a descriptive and cross sectional study. Data were gathered using questionnaires derived from articles and international standard guidelines such as (ESURE, RCR) in three areas including: drugs, protocols and facilities. Results: Results indicated that the level of compliance with safety protocols, facilities and drugs were 91.3% and 69.4% and 100% respectively. The average safety observance was 80.9% totally. The results showed that there were some deficiencies in some equipment such as pulse Oximeter and ECG. Moreover, it was found that a unique protocol is not used in all surveyed sections. Conclusion: Regarding the importance of this issue it is necessary to publish and implement a unique protocol for contrast media administrating and to provide all required equipment for improving patient safety process. Meanwhile a wide supervision should have been done by related authorities in or out of the organization.

Relationship Between Managers Communication Skill and Staff Motivation in Modarres Hospital of Tehran

Seyed J Tabibi

Background: It is a long time that the matter of manager`s Communication skills and staff motivation have come up in Iranian hospitals. This study determined the relationship between manager`s communication skills and staff motivation to identify the present situation and provide managers with appropriate strategies to enhance the motivation level of employees in the Modares hospital.

Materials and Methods: This study was conducted using a descriptive-correlative method. The statistical society consisted of 66 individuals including 11 top and mid-level managers and 55 of their affiliated staff which were selected using a clustered model from the medical and administration sections. Data were collected using a 3- part questionnaire. Demographic data were measured in the first part while communication skills and motivation were measured in the second and third parts separately. Manager`s communication skills were measured using the Ardeshirzadeh(2005) questionnaire while Mokhbery questionnaire (2008) was used to measure staff motivation.The data were analyzed by the SPSS software using statistical indicators, relative frequency, mean and standard deviation, nonparametric tests and Pearson correlation factor.

Results: The average of the three dimensions of manager`s communication skills were (3.57± 0.57) for non-verbal skills, (3.24 ± 0.62) for the underlying communication skills and (3.23 ± 0.88) for verbal communication skills in a descending order while the average score of staff motivation was (2.57 ± 055). Meanwhile results from the Pearson correlation factor showed that there is only a significant positive relationship between the underlying communication skills and staff motivation with the correlation coefficient of r=0.25 and p-value = 0.042.

Conclusion: Since there is a significant relationship between the underlying management communication skills (empathy, effective listening and self-efflorescence) and staff motivation, improving this dimension can increase the motivation of employees.

Oppression in Nursing Profession and The Way of its Management

MR Dinmohammadi

Background: Oppression as a phenomenon experienced by most of nurses might have a background in the historical, social, cultural, political and economic structures of a country. This study aimed to criticize and explore the phenomenon of oppression in nursing literature in order to find an explanation to manage the problem.

Materials & Methods: A literature review was conducted by performing a search on scientific databases (Pub Med, CINAHL & Ovid) using the key terms such as ―nurse/ nursing‖, and ―oppression‖ systematically. Eventually 31 articles published during recent two decades were selected to get reviewed.

Results: In this study, there has been an effort to define the terminology of oppression`s concepts and its historical background, attributes, and consequences. Furthermore, this study considered introducing available models and theories and preventive approaches and managing this phenomenon in nursing profession.

Conclusion: Hierarchal structures in hospital environment provide conducive conditions for the oppression to emerge. Presence and consistency of the phenomenon and its consequences have irreparable effects on nurses as well as their organization, patients and care quality. Adopting practical and effective strategies in a framework of supportive, informative, and educational actions and managerial policies from authorities and related organizations could create an effective environment, which will result in unity, empowerment and self-confidence of nurses.