Journal of

---

Background: Multiple environmental factors have roles in producing anxiety. Individualized differences and environmental conditions can affect the anxiety level. So, hospital environment and especially cardiac surgery ward have a great importance because they can save the patient's life.

Material & Methods: The present study is a descriptive- analytical one which has been conducted upon studying the level of anxiety pre and post coronary artery bypass graft surgery in the hospitals of Tehran University of Medical Sciences and preparing an educational program for such patients, was the other goal of the study.

Study population consists of 150 patients under examination that at the time of the study have been voluntaries to coronary artery bypass graft surgery. The sample was studied 24 hours before and weeks after surgery. The sample was selected randomly and data collected through a questionnaire with two separate parts. For the purpose of data analysis, SPSS software was employed.

Results: The result of the study shows that the level of anxiety before coronary artery bypass graft have been more than the level of anxiety after  the operation. The difference between of the levels of anxiety have had significant relations with some of independent variables of the study such as sex, age, number of children and marital status, but there were not significant relations between occupation, educational level, non cardiac disease background, background of MI, non cardiac surgery background, the period of suffering from coronary disease background of hospitalization.

Conclusion: It seems that the men's ability to return to pre-operation socio-economic condition reduces their post operation anxiety. When people become older, they will be more fearful regarding the future's events but people older than 46 years old will obtain more life expectancy after surgery due to more extended familial relationship.

Married people experience less anxiety due to post operation, familial responsibilities and relief of cardiac symptoms. It can be concluded that anxiety reduction in these patients can result from cultural, socio-economic and demographic variables. Believes as cultural factors in the life have a great role in appearance and the level of anxiety.

 

---

Background: Reporting of  medication errors  leads to saving Patients &apossafety and also is counted as a valuable information source for further prevention of mistake in future.  The aim of this study was to determine the reasons for refusing to report medication errors from the viewpoints of nurses.

Material and Methods:In this descriptive study, 140 of 200 nurses who were employees of Baharlo hospital of Tehran participated in the study (response rate = 70%). Data were collected through a questionnaire. Test- retest analysis conducted for measuring reliability of the questionnaire and content and face validity of the instrument confirmed by key statisticians and methodologists. . SPSS software and descriptive statistics were used for analyzing the collected data. 

Results:Our findings indicate that the reasons of not reporting medication errors were Management factors (3.68 ± 1.12), Fear of reporting outcomes (3.09 ± 1.68) and Process related to reporting (2.73± 1.26). Management factors domain was the major cause of refuse of reporting medication errors. 

Conclusion:Since medication errors seem to be unavoidable, suppression, decreasing medication error depends on using a systematic approach with emphasis on management and nursing care. 

---

Background: Health literacy is the degree to which individuals have the capacity to obtain, process, and understanding basic health information and services needed to make appropriate health decisions. The aim of this study was to assess relationship between health literacy and knowledge of women with type 2 diabetes.
Materials & Methods: In this cross sectional survey, 160 women with type 2 diabetes were selected by convenience sampling method. Data collected by using a STOHFLA standard questionnaire and knowledge was measured by self-administrated questionnaire. Obtained data analyzed by SPSS16 software in two categories of descriptive and inferential statistics (Chi-square and Pearson coefficient).
Results: The mean age of studied population was 52.73±8.56 years old. The means of health literacy and knowledge was 40.57±15.87 and 21.52±2.94, respectively. There was a relation between occupation, education and family history with knowledge and health literacy score, and also between incomes with knowledge. There was reverse significant relation between age and disease duration with knowledge and health literacy.
Conclusion: Results indicated that patients did not have the appropriate knowledge in type 2 diabetes, as well as health literacy which was also moderate. These results confirmed the need to develop of education for improving and increasing the appropriate knowledge and health literacy among studied women.

---

Background: Establishing an effective communication between health team professionals and diabetic patients is an important issue in living with type 2 diabetes. This study was conducted to assess communication between health workers as an obstacle in living with diabetes among type 2 diabetic patients referring to affiliated hospitals of Tehran University of Medical Sciences.
Materials and Methods: This survey was a descriptive, analytic cross-sectional with 600 patients selected by a simple random method. Data were collected using a two part questionnaire including demographic information, health and disease related variables and HbA1C index (containing 10 questions) and communication of health workers with diabetic patients (containing 18 questions) which was measured by a five-level Likert scale [absolutely agree (5) to absolutely disagree (1)]. Validity and reliability of the questionnaire was verified. Questionnaires was filled by interview. SPSS software version 11.5 and descriptive statistical tests (mean and standard deviation) and inferential tests (chisquared, logistic regression model) were used for data analysis. Level of significance was assumed to be less than 0.05.
Results: Mean and standard deviation of communication between health workers and patients as an obstacle were 56.78± 7.17. Study results indicated that there were statistically significant relationships between sex(p<0.001), disease duration (p<0.001) , level of education (p<0.001) , type of treatment (p<0.001), occupation status (p<0.001), age categories (p<0.001), income status (p<0.001), marital status (p<0.001) and HbA1C index (p<0.001) and communication with health care as an obstacle. In addition results of the logistic regression model showed that the ratio of intensity of health worker communication as an obstacle was 0.38 times in 5-10 years and 1.32 times in more than 10 years diabetic patients compared to patients with less than 5 years disease duration. This ratio was significant in the group of diabetic patients with 5-10 years disease duration (p=0.004) and was effectively significant in intensity of health worker communication as an obstacle.
Conclusion: Study results indicated that several factors affect communication between health workers and patients and the factor of years diabetic duration is related to ratio of the intensity of communication as an obstacle which can be helpful due to the planning health improvement interventions.

---

Background:  hospital is one of the most key institutions in the modern health care system and accountability is the most essential organizational functions. Accountability strengthens the main factors to responsibility regarding functions by pushing them up. This study aimed at assessing the situation analysis of  performance accountability in teaching hospitals affiliated to Tehran University of Medical Sciences

Materials and Methods: This descriptive and analytical study performed at 12 teaching hospitals of Tehran University of Medical Sciences in 2013. Data collection performed by performance accountability checklist. Analysis was done by SPSS software version 19 using descriptive and analytical statistics test (Pearson correlation coefficient).

Results: In general, the condition of accountability for hospitals' performance (Mean =1.5 from 2) measured "good"(moderate to high). Strategic planning dimension achieved the highest score (Mean±SD:1.85±0.21) and Stakeholder Participation had the lowest score (Mean±SD: 1.12±0.46). There was a positive significant correlation between all variables (except Motivation) and performance accountability.

Conclusion: Weakness in any part of performance can affect other parts and have negative impact on total hospital performance. Mentioning the current situation of accountability for hospitals' performance and its importance, reinforcing weak dimensions and addressing deficiencies in  performance accountability should be consider as managers' top priority.

---

Background: Nowadays, it is essential to employ medical and clinical librarians to provide the required information for healthcare professionals and enhance accessibility to evidence based information in hospital libraries. Thus, this study aimed at assessing the medical librarians' employment status in hospital libraries in Tehran city in 2013.

Materials and Methods: This was a descriptive and cross-sectional study. Study population considered from all 152 hospitals in Tehran city. Data collected using a questionnaire and analyzed by SPSS version 18 using descriptive statistics.

Results: only thirteen participants had medical librarianship and information science degree. While 28 persons graduated in librarianship and information science from universities affiliated to Ministry of Science, Research and Technology and others had degree in non relevant fields. The majority of participants (51.3 %) with non-related degree were educated empirically and others had learned librarianship skills with other methods. Most of participants were employed based on hiring official process and friends and relatives recommendation.

Conclusions: There is a real lack of medical librarians in the hospital libraries in Tehran city. Thus, these libraries are not able to perform their professional duties such preparing information and omitting healthcare professionals' needs in hospitals. It is necessary that hospitals’ managers attempt to hire medical librarians' and overcome employment barriers.

---

Background:Nosocomial infections due to mortality and economic costs are one of the main challenges in current century. Gram-negative bacilli infections acquired in hospitals and hospital environment is one of the most important places of residence and publication of these types of bacteria. This study aimed to investigate the prevalence of gram-negative bacilli from the equipment of hospital in Western region of Golestan province in 2015.
Materials and Methods: During this descriptive study, 1210 devices were examined with sterile swab of environment and equipments which used in various wards of seven teaching hospitals of Golestan province using census sampling. After identification of the isolated colonies based on biochemical standard tests, results analyzed using SPSS version 22.
Results:Based of isolated samples, 352 positive microbial cultures (29.1%) contaminated with gram-negative bacilli which the highest bacterial contamination was related to Enterobacter (10.7%). among different hospital wards the highest bacterial contamination observed in ICU_s (19.32%) and among assessed equipment, the highest contamination was related to laryngoscope blades (10.51%), phone (7.1%) , ECG sensor device and  monitoring interface (6.25%).
Conclusion:The study findings confirmed that microbial contamination with gram-negative bacilli of hospitals equipment is highly considerable in West of Golestan province. Periodic assessments can be effective in nosocomial infections prevention.

---

Introduction: Medication process to patients is one of the most important tasks of nurses and doing in correct way can play a significant role in patient safety. This issue is the most significant part of quality care which consisted of patient safety as the impotant element. Medication errors are the main threatening factors of patients' safety. This study aimed at assessing the causes of medication errors from the nurses' viewpoints

Materials and Methods: This study was a descriptive-sectional-analytical one which was done in 2013. The study population consisted of 232 nursing staff of Abadan hospitals(Imam khomeini,Taleghani,Shahidbeheshti ,17shahrivar) which were covered by Ahvaz University of Medical Sciences,Oil Company and Social Security Organization ,respectively. Study instrument was a two part questionnaire including demographic - occupational information and causes of medication errors in 28 items in four fields (nurse, ward, nursing management and pharmaceutical causes).Content validity of questionnaire provided by review of related papers and experts'openion and required correction was performed.reliability of questionnaire was estimated 0.91 using Cronbach's alpha method.

Results: the most important causes of medication errors included shortage of nurses in propration to patient(%44),compression of work in ward(%36.2),fatigue due to over work(%35.8),illegible physician oder(%24.5),anxiety and stress due to work(%25),noise in ward(%22.4),nurse dissatisfaction of salary(%29.7) and similarity in medicine shape(%14.7) respectively.

Conclusion: Management causes such as nursing shortage, organizational factors such as compression of work in ward and some factors like nurses' fatigue had the most effect on occurance of medication errors among nurses. Thus, organizational processes reform and hospital organization to improve service quality and patient safety in order to resolve nurses' problems.

---

Background: Demographic prediction indicates that Iran population move towards an aged society until 2025, Hence, the need for medical care will be increased.  The study aimed at predicting geriatric specialists based on dynamic system approach for the Iranian elderly.

Materials and Methods: After an exploratory study, data gathering and building similar structured in order to determine geriatrics number prediction by considering the important factors. Causal loop diagram to show relationship between variables, stock-flow diagrams for quantitative analysis of system dynamic behavior was conducted and model equations in Vensim software version 5 used.

Results: After simulation, intake students' simulated model revealed increased trend then a sharp decline and finally the pattern had fixed trend from 2009 to 2012. Pattern of physician who was still in study and also graduated physician was in growing trend. Employed physician had growing trend and then it fixed, and retired physician had fixed trend at first and then had an incremental trend. Finally, the various behavior of workforce assessed in three level.

Conclusion: According to increasing  growth of the elderly population until 2025,  we will encounter  with shortage  more than 2500  geriatrics which can be  compensate by 50% graduated admissions of the major annually. 

---

Background: health-oriented lifestyle in today’s world is the best way for preventing illness and healthy life. This study conducted to determine the predictor ofhealth-orientedlifestyle in health workers of Amol city.

Materials and Methods: This study was a cross-sectional research conducted on 222 persons of health workers of Amol city. Instrument was a questionnaire including two parts; demographic information was extracted through 15 questionsand the data collected fromthe reliable and valid questionnaire of lifestyle .Data collection. Health workers filled questionnaires in a self-declaration way. To data analyze,t-tests, Mann-Whitney, ANOVA or Kruskal-Wallis and logistic regression used. Data were analyzed statically using SPSS.

Results: This study showed that there is a significant relationship between living place of Prairie village with dimensions of sport , malnutrition , self-care ; and malnutrition dimension in persons below 35, below diploma degree, suffering a chronic disease , suffering high blood pressure ;and tobacco and alcohol consumption dimension in individuals less than35 years;men with medical advice,sport,Malnutrition,tobacco and alcohol consumption ,Health of buying,daily mobility,proper nutrition and owning a personal car with the consumption of tobacco and alcohol dimension ,safety in driving,Health of buying .

Conclusion: Considering that most of the health workers especially men do not behave based on the health-orientedlifestyle, some actions should be taken to change thebehaviorof these individuals, professional educationalworkshops or workshops that do not need to basic information shouldbe activated, because these individuals have health knowledge but do not behave according to this knowledge.

---

Background: Considering the importance of standard precautions to prevent needle stick injuries and health care staff, this study aimed to determine the effectiveness of educational interventions to improve adherence to standard precautions, health belief model based on professional clinical staff needle stick two hospital "yaftabad" and "Ghiyasi" done.

Materials and Methods: This study was an experimental study of two group. The study population was 90 persons of professional clinical staff Shohada Hospital Yaftabad as the intervention group and 90 patients from the hospital Ghiyasi as compared to randomly selected and three part questionnaire including demographic, structures, health belief model , and practice questions were completed. In analyzing the data, descriptive and inferential statistical methods were used.

Results: At baseline, the two groups regarding demographic variables, health belief model structures and functional do not different between them. After intervention structures perceived severity, perceived susceptibility, perceived barriers, self-efficacy and performance of the experimental group showed statistically significant change (p< 0.05) that the effect of education based on health belief model.

Conclusion: education based on health belief model, you can increase the level of knowledge and capacity building and efficacy in clinical staff needs people to observe standard precautions

---

Background: Iranian health system transformation plan has been implemented since 2014 with the aim of financial protection of people, equity establishment in access to health services and quality improvement of hospital services. Hospital performance evaluation is essential in order to monitor the health system transformation plan. One of the tools for evaluating hospital performance is the dynamic multi-attribute decision-making method. The purpose of this study was to use the dynamic multi-attribute decision-making method to evaluate the performance of the hospital before and after the implementation of the health system transformation plan.
Materials and Methods: In this cross-sectional study, the performance of Shariati Hospital in Tehran was evaluated for 48 consecutive months (24 months before and 24 months after the Health System Transformation plan, 2012-2016). Each month was addressed as an option in the decision-making matrix and ,with considering six important health indicators, the hospital performance was dynamically assessed  using the weighted aggregated sum product assessment and through EXCEL software 2010. 
Results: Hospital performance scores had some fluctuations over time; however, in general, it had an increasing trend over forty-eight months. The highest and lowest values were for months 42 and 13 (0.4932 and 0.9408, respectively). In addition, in the first month of the solar year, the hospital performance score declined significantly for each year.
Conclusion: Changes in hospital performance scores during the study period show improvement in hospital performance. Nevertheless, this incremental process cannot be considered as a positive outcome of the health system transformation plan. Therefore, while improving the current process, continuing the hospital performance evaluation can lead to the hospital's performance promotion.
 

---