Hospital

Workplace Violence and its Impact on Job Satisfaction among Healthcare Workers in Ardabil, Iran

Mohammad Panahi Tosanloo

Background and purpose: Workplace Violence (WPV) is a significant occupational hazard and is increasingly recognized as a critical crisis within the healthcare sector. Due to the inherent nature of their services, healthcare organizations are more susceptible to this phenomenon than other sectors. This study aimed to investigate the prevalence of workplace violence and its role in predicting the job satisfaction of healthcare workers in Ardabil.
Methods: This descriptive-analytical cross-sectional study was conducted in 2024. A total of 300 employees working under the auspices of the Ardabil Health Center were selected using stratified random sampling. Data collection utilized two standardized instruments: the Minnesota Satisfaction Questionnaire (MSQ) and the Workplace Violence in the Health Sector Questionnaire. Data were analyzed using SPSS software (version 20) via descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and linear regression analysis.
Results: The overall job satisfaction rate was calculated at 58.75%. In terms of prevalence, 63.8% of the participants reported experiencing workplace violence at least once during the past year. The mean score of experienced violence was 27.35%. Psychological violence was the most frequent form (51.5%), while physical violence was the least frequent (9.4%). Significant statistical relationships were observed between demographic characteristics, workplace violence, and job satisfaction (P<0.05). Linear regression analysis identified workplace violence (β = 0.181) as the third most influential predictor of job satisfaction, following the payment system (β = 0.482) and advancement opportunities (β = 0.312).
Conclusion: The findings suggest that healthcare workers may have normalized workplace violence as an inherent part of their professional environment. Consequently, their job satisfaction appears to be more heavily influenced by economic factors—specifically the compensation and payment system—than by the adverse effects of occupational violence.

Challenges Facing Pre-Hospital Emergency Medical Services in Iran: A Meta-Synthesis Study

Alireza Rahimi

Background and purpose: Pre-hospital Emergency Medical Services (EMS) play a pivotal role in managing life-threatening conditions. However, evidence suggests that the Iranian EMS system faces multifaceted challenges across human, managerial, and infrastructural dimensions. This study aimed to conduct a comprehensive meta-synthesis to identify and analyze the challenges characterizing pre-hospital EMS in Iran, based on research evidence published between 2014 and 2025.
Methods: This study employed a meta-synthesis approach utilizing the seven-step framework by Sandelowski and Barroso (2006). A systematic search of major domestic and international databases using relevant keywords yielded 414 initial records. Following a rigorous screening process based on inclusion/exclusion criteria and quality appraisal, 25 articles were selected for the final analysis. Data were synthesized and categorized using thematic analysis.
Results: The findings revealed that the challenges facing the Iranian pre-hospital EMS can be categorized into six main themes: human resources, logistics and infrastructure, organizational and managerial barriers, socio-cultural issues, and educational deficits. A deeper analysis highlighted the multifaceted and intertwined nature of these obstacles. The results indicate that these challenges do not exist in isolation but are interconnected within a complex network of cause-and-effect relationships.
Conclusion: The findings confirm that the challenges within Iran's emergency system mirror global trends and overlap significantly with issues reported in other low- and middle-income countries (LMICs). Addressing these problems requires a holistic and systemic approach that simultaneously targets human, logistical, organizational, and socio-cultural dimensions, while ensuring system preparedness for potential accidents and disasters.

Evaluating the Resilience of Service Delivery to Hypertensive Patients in Primary Healthcare Centers during Pandemics and Crises

Farzad Faraji-Khiavi

Background and purpose: Ensuring continuous access to healthcare services is critical for patients with hypertension, particularly during pandemics and public health crises. This study aimed to evaluate the resilience of service delivery by Primary Healthcare Centers (PHCs) to hypertensive patients during such emergencies.
Methods: This descriptive cross-sectional study was conducted in 2023 across 10 PHCs in Markazi Province, Iran. A total of 250 patients with hypertension were recruited using a systematic random sampling method. Data were collected using a researcher-designed questionnaire assessing four dimensions of resilience: quality, accessibility, continuity, and coordination. Data were analyzed using descriptive statistics and multiple linear regression in SPSS software (version 24).
Results: The overall service resilience score was 2.95 (±0.32), indicating a "relatively weak" level of resilience. The mean scores for the dimensions were: Accessibility 3.08 (±0.28), Coordination 3.03 (±0.76), Quality 2.93 (±0.41), and Continuity 2.88 (±0.35). Multiple regression analysis revealed that these four dimensions collectively explained 96.1% of the variance in service resilience. Accessibility (β = 0.478) was the strongest predictor, followed by Quality (β = 0.379), Continuity (β = 0.352), and Coordination (β = 0.178).
Conclusion: The resilience of services provided by PHCs to hypertensive patients during pandemics was assessed as suboptimal. These findings highlight an urgent need for strategic operational planning by health policymakers. Developing protocols to ensure service continuity and expanding infrastructure for remote care (telemedicine) are recommended as key priorities to enhance system resilience.

Identifying Factors Affecting Hospital Accreditation: A Hekmat-Based Hospital Approach

Elham Ghazanchaei

Background and purpose: Hekmat (Wisdom) implies deep knowledge, understanding, and sagacity. Hospital services are uniquely dependent on human resources; therefore, beyond technical expertise, staff commitment is essential for maximizing efficiency and effectiveness. A "Hekmat-based hospital" is defined as an institution delivering care founded on three pillars: human dignity, medical knowledge/wisdom, and Islamic ethics. This study aims to identify the key factors influencing hospital accreditation through the lens of the Hekmat-based hospital approach.
Methods: This qualitative study employed conventional content analysis based on the Graneheim and Lundman approach. Data were collected through purposive sampling and semi-structured interviews with 62 participants (32 physicians and 30 patients) from various departments until data saturation was reached. Additionally, a comprehensive review of 20 upstream documents related to health, medicine, education, and culture within the Iranian health system (post-1979 Revolution) was conducted to supplement the field data.
Results: The analysis of interviews yielded 10 main categories representing the components of accreditation in a Hekmat-based context. These categories included: social, cultural, and religious issues; facilities, equipment, and human resources; communication skills; patients' financial and livelihood challenges; knowledge and education; tangible environmental factors; economic factors; cultural dynamics; patients' psychological resilience; and service reliability.
Conclusion: The findings suggest that mutual understanding of emotions and beliefs, patience, reciprocal respect, and effective knowledge exchange are core expectations shared by both physicians and patients. Addressing these primary and secondary needs is a prerequisite for achieving a standardized hospital model aligned with the vision of Hekmat-based medicine.

Modeling of the mediating role of health literacy in the relationship between early maladaptive schemas and health-related quality of life in cancer patients

Javad Siahmoshtei

Background and purpose: Early Maladaptive Schemas (EMSs) are pervasive cognitive patterns that can detrimentally affect the well-being of individuals with chronic illnesses. This study aimed to investigate the structural relationship between EMSs and Health-Related Quality of Life (HRQoL) in cancer patients, with a specific focus on the mediating role of health literacy.
Methods: This descriptive-analytical study utilized a correlational design based on Structural Equation Modeling (SEM). The statistical population comprised all cancer patients aged 20 to 60 years referring to private oncology centers in [City Name] in 2025. A total of 665 participants were recruited using convenience sampling. Data were collected using the Young Schema Questionnaire (YSQ), the Health Literacy for Iranian Adults (HELIA) questionnaire, and the Health-Related Quality of Life questionnaire. Data analysis was performed using SPSS (v.25) and AMOS (v.24) software, with the significance level set at 0.05.
Results: The path analysis revealed that EMSs had a significant direct negative effect on both health literacy (β =-0.85, P< 0.001) and HRQoL (β= -0.56, P<0.001). Conversely, health literacy showed a significant positive effect on HRQoL (β=0.51, P<0.001). Furthermore, health literacy significantly mediated the relationship between EMSs and HRQoL (β=0.26,P<0.001). The goodness-of-fit indices confirmed the model's optimal fit (X²/Df = 3.94, GFI = 0.913, IFI = 0.903, CFI = 0.901, RMSEA = 0.067)
Conclusion: The findings suggest that Early Maladaptive Schemas significantly compromise the quality of life in cancer patients. However, health literacy acts as a protective buffer, mediating this negative impact. Therefore, interventions aimed at enhancing health literacy could be an effective strategy to mitigate the adverse effects of maladaptive schemas and improve the HRQoL of cancer patients.