Hospital

Assessment of outcome of patients admitted to 2 academic Emergency Departments with non-specific complaints (weakness)

Mohammad Hosseinikasnavieh

Background and aim: Having weakness and lethargy and feeling the need for hospital emergency services is one of the most important reasons for patients to go to hospital emergency rooms. The aim of the present study was to investigate the relationship between morbidity and mortality of patients with weakness and lethargy.
Method: The present study was conducted in an observational and prospective manner in the emergency department of Rasool Akram and Firouzgar hospitals. The patients were divided into 5 groups by the evaluation team in the emergency triage unit using the international valid triage tool "Emergency Severity Index (ESI)". The patients were followed up for 2 months after the time of discharge and the patient's condition was examined in terms of illness, health or death.
Result: Between levels 1 and 2 (patients with high severity conditions) and 3 (patient needs two or more emergency facilities in case of no disturbance in vital signs), level 3 had the highest frequency of referrals (61.9%). 90.7% had an underlying disease and 66.1% of the patients were taking medication at the time of visit. 11% of patients died in the first visit. In the initial follow-up, 23.7% of people were still sick, 40.7% had recovered and 17.8% had died.
Conclusion: According to results in the final follow-up, 3.9% of people were still sick; the rate of recovered patients in the final follow-up was 44.1% and the percentage of deaths in the final follow-up was 24.6%. The high mortality rate indicates that the patients' concern was not due to weakness and lethargy, but due to a dangerous underlying disease that forced them to go to the hospital.

Investigating the relationship between resilience and spiritual health of medical staff in hospitals admitting patients with Ccoronavirus

Morteza Abdolvand

Background: Since the health and treatment staff are constantly exposed to critical and stressful situations during the outbreak of the Covid-19 pandemic, the present study aims to investigate the relationship between spiritual health and resilience in the personnel of hospitals accepting patients with the corona virus affiliated to Tehran University of medical Sciences.
Materials and Methods: The current study is a descriptive and analytical study that was conducted cross-sectionally in 2019. The study population included medical staff, including doctors, nurses, paramedics, and service personnel who participated in the fight against Covid-19. In order to measure resilience, Connor and Davidson's questionnaire was used, and Polotzin and Ellison's spiritual health questionnaire was used to measure spiritual health. 145 questionnaires were included in the study. Statistical tests of mean, standard deviation, Pearson correlation coefficient, analysis of variance and independent t were used to analyze the data.
Results: The average resilience score among the subjects was 64.3. The results showed that resilience in the field of spiritual effects with an average of 3.07 was the highest and in the field of tolerance of negative effects and strength against stress with an average of 2.33 had the lowest average. Spiritual health in 55.9% of the studied units was at a moderate level and none of them had a low level of spiritual health. Resilience and all its domains had a statistically significant positive correlation with spiritual health and its domains.
Conclusion: Managers' attention to the spiritual health of health center staff can reduce stress and pressures caused by work in critical situations and be an effective step towards greater productivity of human resources.

Designing a model for developing brand citizenship behavior in medical tourism

Mohammad Ghafari

Background: Brand citizenship behavior is one of the new concepts in branding with emphasis on the role of employees. This study aims to provide a model for development of brand citizenship behavior in a way that is compatible with the local environment of medical tourism in Iran.
Materials & Methods: The present qualitative research is based on the systematic database method. The required data were collected through semi-structured interviews with 16 experts in medical tourism and academic experts using judgmental, snowball, and accessible sampling methods, following the saturation rule. Data analysis was done using the Strauss and Corbin model and in three stages of open, central and selective coding.
Results: Brand citizenship behavior is created as a result of causal conditions, including factors related to employees, organizations, and tourists, and through human resource support strategies and comprehensive marketing and branding planning with the influence of intervening factors, including organizational structure, management performance, characteristics of the treatment industry, Environmental factors, career history and personal quality of life are implemented in the framework of the social capital of the organization, organizational justice, quality of work life, competitive atmosphere of the work environment and social responsibility of the organization and lead to consequences related to tourists, organizations, employees and extra-organizations.
Conclusion: The model obtained from this research shows the influence of several factors in the formation of brand citizenship behavior of medical staff, which, if paid attention to by managers, will lead to the satisfaction and attraction of tourists and gain a competitive advantage.

Identification of the main components in the implementation of the referral system in the health and treatment system of Bojnord city

Esmaeil Moshiri

Introduction: The present study qualitatively investigated the main components that should be considered for the implementation of the referral system in Bojnord city.
Methods: In this study, data were collected through doing interviews with experts, and finally, the importance of all the extracted components was evaluated using a researcher-made questionnaire. Also, the exploratory factor analysis method was used to classify the components in main sets. Kolmogorov-Smirnov, one-sample t-test, performed in Excel and SPSS software, was used for statistical analysis.
Results: The most frequent noted components by the experts included "empowerment (knowledge, skill, psychological) of human resources involved in the referral system", "paying attention to the motivation of human resources involved in the referral system", and "developing suitable processes for the referral system and re-engineering the processes to meet the conditions". Finally, the main requirements in the referral system of Bojnord city were divided into three categories included organizational and management, manpower, and technology-based requirements.
Conclusion: Briefly, some components may lead to improvement of the referral system, which can be categorized into organizational and management, manpower, and technology-based requirements. Detailed planning to improve the referral system can lead to the improvement of the health system.

Original Research Article Identification of barriers and bottlenecks in health medical tourism in the context of the outbreak of COVID-19; a mixed approach Running Title: Identification of barriers to health medical tourism

Ahad Norouzzadeh

Background: Global statistics shows that health tourism grew significantly before the outbreak of Covid-19, but with the beginning of the pandemic and the closure of countries' borders to immigrants, this trend has declined significantly. The present study aimed to identify the bottlenecks of health medical tourism in the context of the outbreak of Covid-19 and to present scientific solutions for its development using two stages of content analysis and surveying.
Materials & Methods: This research is exploratory in terms of purpose and descriptive in terms of type, which was conducted by field method. Study population was selected in two stages; the first stage consisted of 20 physicians with more than 15 years of experience in Ardabil province who were chosen by snowball sampling method and the second stage consisted of 200 employees of the province's University of Medical Sciences who were randomly selected. In order to analyze the data in the first stage, the content analysis was used in 6 stages and in the second stage, the first and second order confirmatory factor analysis test was used.
Results: The research findings showed that 9 main themes and 29 sub-themes were identified as barriers and bottlenecks in health medical tourism and 23 scientific solutions were presented to reduce barriers and bottlenecks in health medical tourism in the event of COVID-19 outbreak.
Conclusion: The adaptive fit indices are good and the RMSEA value is 0.047 which indicates that the model has a good fit.

Comparing the effectiveness and durability of the treatment based on acceptance and commitment and the time schedule of the paradoxical recovery of emergency department nurses

Ahmad GHazanfari

Purpose: Considering the problems of nursing profession, it is very important to find the best method to improve the resilience of nurses. The purpose the present study was to compare the effectiveness and durability of treatment based on acceptance and commitment and paradoxical time schedule of resilience of emergency department nurses.

Methodology: To perform this quasi-experimental research, which was carried out with a pre-test-post-test design with a control group and a follow-up stage, 45 nurses working in the 5 emergency departments of Isfahan hospitals in the second half of 2019 were selected using convenience sampling method. They were randomly divided into three groups of 15 subjects: treatment based on acceptance and commitment, paradoxical schedule treatment and control. Subjects in the acceptance and commitment treatment experimental group participated in 8 sessions and the paradoxical schedule treatment group in 6 90-minute sessions but for the control group, there was no intervention. Participants completed the resilience scale by Connor and Davidson (2003) in three steps. The research data were analyzed using the variance analysis method with repeated measurements in SPSS-26 software.

Results:The results showed that there is a significant difference between the resilience score in three stages of pre-test, post-test and follow-up measurements. It was also found that there was a significant difference between scores of two experimental groups and control group, but there was no significant difference between the scores of the two experimental groups.

 Conclusion: According to the results, it is recommended that the authorities use these two types of treatment programs under expert supervision to improve the resilience of nurses.

Designing an assessment framework based on educational standards required for internship in HealthCare Management Assessment of the HealthCare Management students according to educational standards

Roohollah Askari

Background: It is expected that graduates of healthcare management have the necessary skills to perform various managerial and administrative positions. This study was carried out with the aim of designing and compiling an evaluation framework for students based on educational standards in the internship period.

Materials &Methods: The current study was conducted in four phases: In the first phase, in order to identify the problem and assess the needs, the existing curriculum and topics were examined, as well as the studies conducted in this field. In the second phase, the perspective of the stakeholders was used to complete and modify the initial framework. In the third phase, worksheets for registering internship learning activities were prepared for students and a checklist of educational and learning objectives, personal and management skills, and skills for developing professional qualifications was compiled. Finally, a specialized panel was used to determine the type of formative and final exams.
Results: The problems and challenges of internships can be investigated in 4 areas: inappropriate planning of the course, faculty, group - professors and hospital. In designing the evaluation tool, 9 criteria were taken into consideration. Also, tests designed in a compilation framework were used as formative tests and reasoning tests were used as final tests.
Conclusion: The compiled framework can be used as a valid and comprehensive tool to evaluate the practical competence and capabilities of healthcare management students during the internship period.

Why and How to Establish A Scientific Approach for Management in Health Sector: Myth to Reality

Maryam Babaei Aghbolagh

Management is a key pillar in order to achieve the goals of health systems. An efficient structure for identifying, recruiting, training, promoting, monitoring and evaluating the performance of managers is highly likely to help the specialization of management, prevent non-specialized selection processes and possible deviations. Given the managerial level in which they play a role, health managers ought to have the required competencies and characteristics. The leading countries generally thrive to have structures where proper candidates are systematically placed in the position of management and promoted to the higher positions. Therefore, the experiences of these countries should be solicited in line with the local social, political, economic and cultural factors in order to achieve the health system goals.