Journal of

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Background: Nowadays, health care section is one of the most important parts of sustained development in human societies because of having relationship with human health. Achieving this goal needs to have healthy and motivational staff, including nurses. We see nurses in all hospital wards who have been interested in their works when entering the hospital, but feel fatigue after several years and may give up their jobs. This survey has been conducted to study of effective factors on nurses' job motivation in Kerman University of Medical Sciences hospitals.

Material and Methods: This is a cross-sectional survey that studies 232 nurses occupied in Kerman university of medical sciences' hospital inpatient wards who were selected by stratified random sampling using a questionnaire which had 31 questions in 5 area: psychological, educational, financial, administrative and welfare factors. For determining the reliability of questionnaire, we conducted a pilot study and its _Krunbakh was 0.92. we used spss11.5 and Kruskal-Wallis and Mann-Whitney tests to analyze data.

Results: The results show the statistical relationships between welfare factor and hospital type (P=0.012), between psychological factor with sex, job experience and marital status (respectively, p=0/002, p=0/043 and p=0/011). But there weren't any statistical relationships between nurses' age and educational status and the studied area of motivation.

Conclusion: In this study, nurses who have following characteristics, have also better motivation status: occupying in hospital B, being married, being man, having master of science degree, having more than 10 years job experience and being between 30-40 years old.

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Background: As in many countries, Medical Education (ME) is offered in three levels including Undergraduate ME, Graduate ME, and Continuing ME. Information theology development has provided a suitable chance for ME. E-learning in ME is growing more and more. The present study seeks to determine the key success factors (KSF) in E-learning in medical fields.
Material and Methods: KSF has been scrutinized in the literature following of which, and due to similarity, a clas­sification with seven groupings was established including institutional factor, technology, interested parties, information knowledge, methods and approaches educational resources, and environmental factors. Through a questionnaire, the data were gathered from the information technology (IT) direc­tors in all medical universities throughout the country. The data collected were subjected to facto­rial analysis. Data from heads of educational groups were obtained through focus group discussion. Cronbach reliability coefficient was calculated for questionnaire used. Factorial analysis was used to identify meaningful KSF. T-Test, and one-way variance analysis as well as Pearson's correlation were used. The analysis was conducted with SPSS software.
Results: The preparedness factors were analyzed through group discussions with the heads of the academic departments under the study. By factorial analyses, five factors were found. Fisher Exeact Test was used to compare the obtained ratios in 5% curve whose results showed that among the three factors including legal and technical environ­ment, specialized hardware and software, and high speed internet, performance interest and potentials showed a significant difference (p=0.002). A p=0.011 was found for the authorities' interest and finan­cial and non-financial rewards. No other significant differences were found anywhere else.
Conclusion: Appropriate strategies to coordinate and aligned with the conditions that must be taken, including some of them can be cited : Document Perspective drawn by the Ministry of Health, Content production (medical, etc.) to the appropriate shape, Develop technical and communications infrastructure, First e-learning development in the field of basic science And then as a complementary training in Clinical Science, Develop and build information literacy skills among teachers and students And encourage them in this area, Platforms and create the appropriate structures and interactions necessary, Despite the virtual library, Drawing rules for the protection of creators and owners of content rights education, Culture correct and appropriate, Private sector participation in developing e-learning and ..so on

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Background: The different effective factors on out of pocket payment (OOP)have been introduced as follows: low salary of the employee's, low governmental tariff, chronic disease, gifts to personnel, physician and other cadre's requests, fear of bad or no services. In addition OOP has negative effects on the accessibility of services .This article studies the distribution of effective factors on OOP (formal and informal) through cardiac patients and its side effects.
Materials & Methods: This is a descriptive-exploratory study. The data were collected byinterviews and questionnaires reliability of which was approved by specialists and their validity were approved by simulation-in Shahid Madani hospital in Tabriz in the winter of 2010.
Results: all the persons studied had an experience of OOP. Formal payments included the free cost of the services with no insurance cover and the margin between the tariff and the rate that the physician or the hospital declares (83% of OOP). In addition 10% of persons encountered informal payments 80% of which was due to the physician's request and 20%as a gift. The results describes the OOP`s side effects so that 52% of patients faced a postpone in getting services because of the OOP and 72% pointed that OOP has had an enormous effect on providing the necessary needs of the families.
Conclusion: The high rate of OOP and the weak performance of insurance system will result in injustice and intensifies the unfavorable effects of OOP on the health system and society.

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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.

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Abstract Background: Several factors have an impact on hospitals` crisis preparedness including the status of “internal factor ”. This study is aimed to investigate the relationship between the status of hospitals `internal factors and their level of preparedness in crisis. Materials and Methods: This correlative, applied, and cross-sectional study was conducted in 12 hospitals of Kurdistan University of Medical Science in 2008. The data were collected using the standard Weisbord questionnaire and hospital preparedness checklist to measure the status of internal factors and the hospitals` level of crisis preparedness ,respectively. The data were analyzed using descriptive and analytical statistical methods. Results: Changing internal factors would result in 74% of the changes in level of hospital preparedness in crisis in all studied hospitals . The preparedness level and the organizational structure of the hospital had strongest relationship and preparedness level and personnel’s attitude to changes had the weakest respectively . Conclusions: Hospitals should analyze their internal factors status in order to improve their preparedness level in crisis. Concentrating on different aspects of internal factors, reviewing objectives, improving increasing teamwork, involving personnel in decision-making, using performance-based rewards, forming communication committee, improving leadership styles, training organization `s managers and leaders, and facilitating internal and external coordination could be effective .

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Abstract Background: Human resource management has a critical role in organizations and organization culture is an outcome of human resource management performance. One of the dimensions of the organizational culture is power distance. This study aims to investigate the attitude of employees of selected hospitals of Tehran University of medical sciences towards the power distance in the organization and its consequences. Materials and Method: This is a cross sectional study with a descriptive research design conducted in a sample of 306 employees and managers from Tehran University of Medical Sciences hospitals located in Tehran, Iran. A distinctive questionnaire for each group was developed, distributed and collected as a main procedure to gather data. Data were analyzed using SPSS 16. Results: Study results indicates that there is a positive and significant relationship between power distance and employee participation, organizational commitment, job satisfaction, perception of justice and readiness to accept job responsibilities in the level of 95%(p value<0.05). The moderated multiple regression results also supported the hypothesis that managers’ attitude towards power distance had a significant relationship with their manner with the employees, noticing their qualifications and abilities, giving them independence and responsibility and supporting them in their role. Conclusion: A limited power distance in an organization will result in more committed and satisfied employees with positive perception toward justice in the organizational interactions and ready to accept job responsibilities and movement toward the organization objectives.

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Background: Educating patients and improving their self-care skills are main factors to achieve maintaining and improving health as health care organizations prime priorities all over the world. This study is aimed to assess nurses and doctors viewpoints on obstacles and facilitators of educating patients. Materials and Methods :This quasi experimental research were undertaken in Kermanshah Razi hospital.85 nurses and doctors were selected by Simple Random Sampling method. The data were collected by a questionnaire based on Likert scale consisted 32 questions in 3 parts. Validity and reliability of the questionnaire were confirmed by Content validity and Test-Retest methods respectively. Results : Shortage of nurses and lack of sufficient financial resources among inhibiting factors and holding seminars on teaching and learning strategies and also considering educating patients as a annual evaluation determinant among enhancing factors were the most important ones . Conclusion: Providing efficient resources and facilities and running personnel`s training courses seems necessary to overcome current obstacles.

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Background: Managers can provide manpower motivations activity contexts and real efficiency through identifying and anticipating according to organizational goals. Since, today’s working motivations have not been realized in hospitals, this study aimed at determining and comparing the importance of hygiene-motivational factors in both Kosar and Faghihi hospitals in Shiraz. Materials and Methods: In this cross-sectional survey, study populations included all staffs of Kosar and Faghihi hospitals in Shiraz. One hundred fifty selected by stratified randomly sampling participated in the study.The study questionnaire was designed based on Herzberg theory. Questionnaire validity proved by available experts and Cronbach alpha calculated 0.95. Statistical analysis was done using SPSS software and independent t-test. Results:The most important hygiene factors were "job security" and "supervision" and the most significant motivational factors were "success" and "appreciation". Hygiene factors are more important than motivational ones in both hospitals. Hygiene and motivational factors had more mean score in Kosar hospital compare to Faghihi hospital. Conclusion: In the Kosar charity hospital hygiene-motivational factors were significant more than faghihi governmental hospital from the staff viewpoints. Hence, the directors of the hospitals should organize appropriate incentive actions owing to differences in terms of ownership toward quality improvement and efficiency of hospitals.

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Background: Recently, considerable attention has been paid to medical errors in health care system. Taking into account that nurses spend more time with patients in comparison with other staff, they are more prone to human errors. The present research conducted to investigate nurses' errors in delivery emergency ward in a hospital affiliated to Tehran University of Medical Sciences.

Material and Methods: In the present coss-sectional study,at first, task analysis was conducted  to nursing proffession using Hierarchical Task Analysis (HTA) technique by FGD. In next step, the Human Error Probability (HEP) was determined utilizing SPAR-H method and dependences of performance-shaping factors (PSFs) and action and diagnosis activities were identified. Finally, after determinig dependency level, the final diagnosis HEP was calculated and risk assessment level was carried out  using the risks' probability and intensity tables.

Results: According to the results, four groups of studied tasks, the lowest errors were belonged to "working with serum pumping machine'' subtask with the error level of 0.055 and the highest error probability related to '' transfusion of blood products'' subtask with the error rate of 0.78. Moreover, special responsibilities of the wards had the highest level of undesirable risks.

Conclusion: In the present study, the analysis of identified errors reveals due to high work demand, insufficient time and the need for accurate administrative monitoring and providing required arrangements, the main causes of errors can be attributed to high level of stress and complexity in the tasks of delivery emergency ward. 

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Background: Using vein by Peripheral Catheter is one of the important ways to provid water, electrolytes, medications and nutrients to patients in hospitals and other therapeutic centers. Phlebitis is an important complication of using peripheral cannula. This study performed to determine the incidence of phlebitis related to peripheral cannulae, and its effecting factors.

Materials and Methods: This prospective and analytical study was conducted in adult's medical- surgical units of Shahid Sadoughi Yazd. Two hundred ninety seven cannulae of 297 patients were assessed. Phlebitis was identified by the presence of at least two following symptoms including local pain, redness, swelling, warmth and palpable venous cord.

Results: The mean of patients' age was 40.82±19.48 (12-91 yrs.). The phlebitis incidence rate was 14.1%. Some factors such as smoking (P=0.007), diabetes (P=0.001) had positive and significant association with phlebitis incidence rate. Odd Ratio for smoking and diabetes were 3.107(CI=1.310-7.372, 95%) and 3.736(CI=1.736-8.039, 95%) respectively.

Conclusion: Study findings revealed that overall incidence rate of phlebitis compare with other similar studies was low. Study results indicated high phlebitis incidence in smokers, diabetic patients, and elder patients which can be prevented by considering phlebitis incidence in impatiens.  

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Background: Although the role of Spirituality has been acknowledged in the social entrepreneurship literature, we know of no research that has empirically investigated relationships between spiritual intelligence and health and care benefactors. Thus, this paper aims to propose and empirically test a theoretical model positing relationships among spiritual intelligence and intentions of hospital-makers benefactors. Materials & Methods: This study is descriptive which is conducted with total number of 164 hospital-makers benefactors, and is tested by path analysis. For measuring spiritual intelligence, three questionnaires distributed between every subject and two of his/her acquaintances. Results: The results suggest that spiritual intelligence and other related variables explained 41 per cent of the variance in the rate of hospital-makers benefactors intentions (R2=0/41) that is a sizable amount in behavioral studies. Results provide strong support for the proposition that social mission and social responsibility fully mediate the positive effect of spiritual intelligence on intentions of hospital-makers benefactor. Conclusion: With existence of opportunities for merely finical investments, hospital-makers benefactors should have high levels of spiritual intelligence to gain motivation for social wealth creation. Policy-makers of health system, to increase charitable activities, should focus on heightening spiritual intelligence in health and care sector.

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Background: Physical and verbal violence against hospital personnel is very critical problems that could influence the quality of clinical and nursing cares. Today, problem prevention and identification of related factors with domestic violence against women have been considered as a health priority in many countries. Therefore, due to the importance of this issue, this study aimed to determine related factors with domestic violence against women in educational hospitals affiliated to Isfahan University of Medical Sciences.
 
Materials and Methods: This cross-sectional study was a descriptive-analytical one which conducted on 836 female employees using census method. Data collection performed using a researcher-made questionnaire. This questionnaire consisted of 34 items in four dimensions (physical, verbal and mental, sexual) and violence experienced by the husband. Data were analyzed using SPSS version 16 with descriptive statistics and analytic statistics such as Kolmogorov–Smirnov, ANOVA, independent t test, and Pearson correlation coefficient and multivariate regression.
 
Results: Study results revealed that verbal and mental (55.33%), physical (36.16%), and sexual (6.66%) violence were the most common type of violence against women, respectively. There was a significant statistically association between age gap, forced marriage, husband’s addiction, income and precedent violence Experience and violence against women.
 
Conclusion: This study presented prevalence and related factors of demotic violence among women. Therefore, it is imperative that health authorities, especially hospital managers, pay attention to this phenomenon assessing further investigation of factors related to violence against women in order to take the necessary steps to mitigate and reduce related factors using life skills workshop, training and counseling for couples.

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Introduction: change and innovation for gaining competitive advantage in health system will lead to the continuation of activities in health care. Therefore, managers ' entrepreneurial orientation to promote organizational goals in the turbulent health industry is one of the requirements of human capital managers. Materials and Methods: In this study , semi-structured interviews were conducted to identify promoting and obstacles in the organizational entrepreneurship factor to design entrepreneurial human resource management model and were analyzed by content analysis method . The population of the study consisted of operational and middle managers in the field of health, among which 20 were selected by non-probability and snowball sampling methods .
Results: The results showed that organizations in health care areas are influenced by three factors of managers , employees and environment of the organization and have an impact on the organizational entrepreneurship variable in human capital management. In the case of obstacles and promoting factors, employees and managers had the highest number of codes (meaning unit) respectively.
Conclusion : Human capital managers in the field of health by creating the necessary ground in strengthening the driving factors and overcoming the confounding factors of corporate entrepreneurship in their management strategies and processes promote the performance of the staff and personnel  and consequently play a significant role in the health of the entire society .

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Introduction: Health tourism is a new form of tourism industry that aims to maintain recovery and regain physical and mental health and has grown in recent years. Therefore, the present study was conducted to investigate the factors affecting the marketing of health tourism in hospitals affiliated to Iran University of Medical Sciences.
Methods: The present study is descriptive-analytical and was conducted on 270 individuals at some point in 2021. The study population consisted of all heads, managers, matrons, quality managers and heads of international patients of public and private hospitals affiliated to Iran University of Medical Sciences. The data collection tool was a researcher-made questionnaire. Data were analyzed by using SPSS software version 23.
Results: The results of study showed a significant difference between the components of price, place, promotion and people in the two types of hospitals (P-value <0.05). While no significant difference was observed between other components (product, physical evidence and process) (P-value <0.05).
Conclusion: Providing the needs of medical tourists will increase their satisfaction. Therefore, paying attention to the effective factors in marketing and trying to solve the shortcomings of this field can be very effective in attracting health tourists and turning Iran into a medical tourist destination.

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Context: The intention to quit is a step before the actual leaving the job. The complex conditions of treating covid 19 patients, nurses physical pressures and mental tensions during the covid-19 pandemic, encourage them to quit their jobs. The present study was conducted to determine the factors related to the willingness of nurses to quit during the covid-19 pandemic in the hospitals of Isfahan city.
Method: 416 nurses working in the hospitals of Isfahan participated in this cross-sectional descriptive-analytical research in the form of quota sampling and systematic random stratification. The data collection tool was a researcher-made questionnaire with high validity and reliability (0.95) that measured the intention to quit of nurses during the covid-19 pandemic in 4 dimensions of individual, occupational, organizational and transorganizational factors. SPSS version 25 software was used for data analysis.
Findings The average score of nurses' willingness to leave during the corona pandemic in Isfahan hospitals was 2.98 out of 5. The average of Transorganizational factors (3.30) was higher than the average of organizational factors (3.05) in driving the intention to leave of nurses. A relation was seen between demographic information such as; received compensation, secondary job and total income and intention to quit.
Conclusion: During the covid-19 pandemic, several factors lead to the quit in the group of nurses. Since the willingness to leave the job in public hospitals is higher than in private hospitals, managers of these organizations should pay more attention to evaluating factors, determining their impact and making effective decisions.

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Background and purpose: The physical environment of the hospital includes elements and components that improve the quality of the treatment environment and also reduce the stress of the patients. Therefore, this research aims to improve the environmental quality of treatment spaces with the approach of reducing patients' stress.
Materials and methods: Based on the research approach, descriptive-analytical has been done. The selection of the research sample in the General Surgery Department (Imam Reza Birjand Hospital) is considered. To collect data, a questionnaire (patient, patient's companion, doctor and staff) was used to prioritize the variables. The validity of the questionnaire was checked by 3Smart PLS software, and the reliability was measured by Cronbach's alpha. Then the collected data was analyzed in SPSS 26 software.
Results: The results of this study showed that the prioritization of different criteria from the physical factors of the indoor environment of therapeutic spaces including: convenience, flexibility, nature, light, color, fresh air, sound, texture, furniture arrangement, works of art, and scent are different. It is meaningful. Based on the Kruskal-Wallis test, the most significant difference in the patient's stress reduction priority is the criteria of color, material and texture, fresh air, scent. Based on the Yeoman-Whitney test, gender has a significant difference in the variables of scent, color and fresh air.
Conclusion: The results of the research identified that flexibility, convenience, nature, according to the descriptive statistics, have the most influence in reducing the stress of the patients from the perspective of all the participant. Design solutions with the approach of reducing patient stress in medical centers are presented based on the significance of most variables.

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Background: The rise in healthcare expenditures, particularly drug costs, has posed a significant challenge to the healthcare system. This issue is particularly critical for chronic diseases such as diabetes, as various factors influence patients' access to these medications and their financial ability to pay for them. Thus, this study aimed to investigate the access and purchasing power for anti-diabetic drugs in pharmacies and hospitals in Khorramabad city in 2022.
Materials and Methods: This descriptive-analytical study included patients and visitors to private pharmacies and hospitals in Khorramabad. The required information was collected through patient prescriptions, pharmacy records, interviews, and checklists based on the World Health Organization protocol. Data analysis was performed using t-test, chi-square, ANOVA, and logistic regression, utilizing SPSS version 21 software.
Results: The findings revealed that among the socio-economic factors affecting the financial ability to pay for diabetes medications, income level is identified as a significant factor, particularly in patients with underlying conditions, where their income is adversely impacted. Additionally, the results indicated that, unlike the free market, in the healthcare and pharmaceutical market, no socio-economic factor from the demand side (i.e., patients) influences pharmacies as drug suppliers in terms of the accessibility index.
Conclusion: Despite the good availability of medications in pharmacies, the financial constraints faced by patients in covering medication costs suggest that government intervention through measures such as enhanced insurance coverage and medication subsidies could support economically disadvantaged groups.