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Abstract Aim This study aimed to comprehensively examine the factors influencing healthcare providers’ decision-making for initiation of resuscitation (IOR). Background In-hospital resuscitation survival hinges on timely and effective interventions. Despite guidelines, decision-making during resuscitation remains challenging, impacted by both clinical and non-clinical factors. Methods A mixed-methods systematic review (MMSR) was conducted, searching PubMed, Web of Science, Scopus, and Embase in May 2024. Twenty peer-reviewed studies of adult in-hospital resuscitation decision-making (≥ 18 years) were included. Data were extracted and synthesized using the Joanna Briggs Institute (JBI) convergent integrated approach. Results A database search yielded 4398 studies, of which 1216 were duplicates. After screening 3182 unique studies, 20 articles (five qualitative, 12 quantitative, three mixed methods) were included. Data synthesis identified three overarching themes: patient, provider, and system factors. These themes encompassed barriers and facilitators to IOR. Conclusion This review underscores the importance of understanding patient-related, provider-related, and system-related factors influencing IOR. By addressing these factors, healthcare organizations can improve resuscitation practices and outcomes. Future research should focus on enhancing collaboration, communication, and resource availability while considering non-medical factors in decision-making for IOR. Relevance to clinical practice Understanding the multifaceted barriers and facilitators identified in this study can enhance the effectiveness of resuscitation protocols and ultimately improve patient outcomes during critical care situations.

Background: Prehospital paramedics played a critical role in the COVID-19 pandemic crisis. Objectives: This study aimed to evaluate paramedic performance and background factors in the outbreak of this emerging disease. Methods: This cross-sectional study recruited 335 paramedics selected from 49 emergency medical services stations in Urmia and Tabriz cities, Iran. Data was collected using a questionnaire to assess the demographics and performance of paramedics in caring for COVID-19 patients. The response rate for the questionnaires was 90%. Data were analyzed using descriptive statistics and regression analysis in SPSS version 21. The level of statistical significance was considered less than 0.05. Results: The average age of the paramedics was 32.81 years (71.3% were 35 years old or younger). Results showed that assessing patients' vital signs, checking for COVID-19 symptoms/signs, administering oxygen and IV fluids, recommending home care, and transporting patients to the emergency department were the most common actions taken by paramedics. Invasive procedures performed by paramedics included cardiopulmonary resuscitation (60.9%), intubation (53.1%), and suctioning (38.8%). However, 15.5% of paramedics reported not performing physical exams on patients due to fear of COVID-19. A statistically significant correlation was observed between paramedics' performance and their education level, educational qualifications, and history of COVID-19 disease (p< 0.001). Conclusion: Study results provide insight into paramedic performance during the COVID-19 pandemic. During emerging disease outbreaks, further training and the provision of necessary personal protective equipment could help paramedics perform all tasks without undue concern for personal safety.

Background: Oral health is a central aspect of overall health and well-being. However, people with psychiatric disorders are more vulnerable to oral health problems due to illness-related factors, limited access to dental care, and lifestyle habits. Objectives: This study aimed to evaluate the dental health status in patients with psychiatric disorders. Methods: This cross-sectional study included all 80 patients with psychiatric disorders hospitalized at Razi Hospital in Tabriz, Iran in 2020. Sampling was done by census method. Data were collected using a researcher-developed questionnaire covering demographics, oral health behavior, and the Decayed, Missing, and Filled Teeth Index (DMFT). Information was obtained through interviews, a review of medical records, and dental examinations. Data were analyzed using descriptive statistics, independent t-test and ANOVA in SPSS v.24 software. Results: 52.6% of participants were male. The mean (SD) age of the participants was 39.16 (9.42) years. Over half (53.8%) had low socioeconomic status and half were married. The mean (SD) DMFT was 10.96 (9.77). The results showed significant relationships between the frequency of dental visits, smoking, and the DMFT index (p < 0.05). Conclusion: The DMFT index in patients with psychiatric disorders was unfavorable. Support programs to promote self-care, oral health, smoking cessation, and regular dental visits are needed in this population.

Abstract Aim The aim of the study was to examine the experiences of nursing students in internship during the COVID‐19 pandemic. Design A qualitative study. Methods Purposeful sampling was conducted among undergraduate nursing students at Tabriz School of Nursing in November 2021. Students participated in 14 in‐depth open‐ended interviews and stated their experiences and opinions on internships during the COVID epidemic until full data saturation. Data analysis was performed using the conventional content analysis method. This study followed the Standards for Reporting Qualitative Research (SRQR) checklist. Results Findings were extracted and classified into five main categories, including a lack of facilities and equipment, psychological disturbances, physical risk, disturbances in education and learning activities and movement to continue clinical learning in the situation. Conclusion Nursing students in clinical training during the COVID epidemic have experienced physical and mental health issues, as well as educational challenges. During an infectious disease epidemic period, education administrators should adopt appropriate strategies to protect students' health and facilitate their educational and learning activities.

Background. Effective triage is a viable solution to improve performance indicators in the emergency department. This study aimed to compare the effect of conventional triage and team triage methods on the performance indicators of emergency department. Methods. In this descriptive cross-sectional research, all 749 patients referred to the emergency department of Tabriz Sina Hospital were triaged using conventional and team methods for two consecutive weeks in July 2020. A researcher-made checklist was used to collect emergency performance indicators. The data were extracted from patient records and recorded in the checklist. Data analysis was performed using descriptive statistics, Chi-square and Mann-Whitney tests in the SPSS.19 software. Results. Among the patients, 86.9% in the triage group using the conventional method (52.7% female) and 86.7% in the group using the team method (52% female) were older than 40 years. The results showed that in the team triage group, the number of temporarily hospitalized patients was significantly higher and the frequency of self-responsible exit was lower compared to the conventional method. In addition, the waiting time for patients triaged with the team method was shorter, and the difference in values was significant for all three triage levels. Conclusion. According to our results, team triage had a more positive effect on improving emergency performance indicators compared to the conventional method. Therefore, it is recommended to consider this method in hospital emergency departments to provide better services and increase patient satisfaction.

Background: Personnel working in emergency departments are exposed to a lot of burnout due to their nature and occupational factors; therefore, it is very important to pay attention to the factors that cause and aggravate burnout. In the meantime, the existence of organizational justice is an important principle in employee efficiency that can also affect the quality of employee services. Therefore, this study was conducted to investigate the relationship between organizational justice and burnout in emergency department personnel of Tabriz hospitals in 2019. Materials and Methods: The present study is a descriptive cross-sectional correlational study that was performed on 140 pre-hospital emergency personnel in Tabriz, Iran in 2021. The sampling method was census. Data were collected using a three-part questionnaire including participants’ personal demographic information form, Niehoff and Moorman organizational justice questionnaire, and Maslach burnout inventory (MBI). For data analysis, SPSS software, version 22 was used through descriptive statistics and analytical statistics. The significance level was considered at 0.05. Results: The results showed that the level of organizational justice and job burnout of participants was in the moderate range. Also, the results of the correlation statistical test showed that there was a significant reverse relationship between organizational justice and job burnout of pre-hospital emergency personnel (P

Background: The emergency medical services system has a vital role in the timely treatment of victims and the reduction of injury and mortality rates. Ambulance response time is an essential variable in evaluating the quality of its services. The aim of this study was to determine the ambulance response time and to compare it according to background variables. Materials & Methods: This descriptive study was conducted on ambulance emergency missions in Tabriz Emergency Medical Center. The data file related to the eligible missions in the server of the center was read and listened and ambulance response time and background variables were extracted and analyzed using descriptive statistics. Results: The average ambulance response time was 11.58 (5.69) minutes and was long. The results showed there is a statistically significant relationship between ambulance response time and ambulance technical readiness, traffic conditions, accident time, and the educational level of ambulance personnel. Conclusion: Compared to the standard value, the average ambulance response time in Tabriz Emergency Medical Center was longer. By recognizing the effective variables and taking the required actions, one can improve the ambulance response time and facilitate the medical services providing process in emergency conditions.

Abstract Aim To investigate the association between the nurses’ perception of the public image (PI) of nursing and the quality of nursing work life (QNWL). Design A descriptive correlational study. Methods 250 nurses of 12 hospitals affiliated with Tabriz University of Medical Sciences were sampled using a proportionate stratified sampling technique. Porter Nursing Image Scale and Brooks QNWL Scale were used for collecting data. Results There was a significant positive correlation between nurses’ perception of their public image and QNWL (r = .158, p = .012). Nurses’ perception of their PI along with other significant predictors including gender, age, position, work shifts, residency, financial status, level of family support, spouse's education and spouse's job significantly explained 15.2% of the predictability of QNWL (F(10,175) = 3.017, p = .001). Findings imply that enhancement of nurses' psychological status (nurses' perception of the public image of their profession) may improve their functional status (quality of nursing work life).

Introduction: Diabetes is a disease whose control requires effective self-care and patient education. Multimedia Messaging Service-based (MMS) education is one of the new methods for education. The purpose of this study was to investigate the effect of two types of in-person and MMS-based education in the Telegram application on self-care and weekly fasting blood sugar levels in patients with insulin-dependent diabetes. Methods: In this clinical trial, a sample of 66 patients with diabetes who referred to the Sina hospital in Tabriz, were randomly assigned into two groups: in person and MMSM-based education. Data gathering tools included a demographic form, Toobert’s self-care activities questionnaire (as primary outcome), and a checklist to record fasting blood sugar weekly measured by a glucometer. Data were analyzed using independent and paired sample t-tests, chi-square, and repeated measures ANOVA. Results: After the education the mean scores of self-care in terms of diet, exercise, foot care, and blood sugar testing activity significantly increased in both groups (P0.05). Reduction in the fasting weekly blood sugar levels over a 12-week period were statistically significant in both groups (P 0.05). Conclusion: MMS-based education same as in-person, improves self-care in patients with diabetes. Given the disadvantages of in-person education, this new educational strategy can be used to facilitate the patient education process and improve its quality.

Background: Considering the advancement of information technology, the use of new educational methods, such as e-learning, is undeniable. The purpose of the present study was to design and evaluate drug dose calculation multimedia software to nursing students. Methods: After providing educational content, the software was prepared based on research findings in the field of e-learning, including Mayer’s multimedia design principles, educational evaluation criteria and an educational materials checklist. Software evaluation was done by a number of multi-disciplinary experts (n=15) and students (n=32) and by polling forms that included the characteristics of electronic resources. SPSS 20 was used to analyze the data. Independent t tests, analysis of variance (ANOVA) and Pearson correlation were used to assess the relationship. Also, the data are presented using mean (standard deviation) and frequency (percentages) for numeric and categorical variables. Results: Software evaluation by students resulted in a mean score of 57.73 (SD=10.964) (range: 14 to 70) of the maximum possible score of 70, indicating that software evaluation was excellent. There was a significant difference between the mean total score provided by female (mean=61.8, SD=6.03) compared to male (mean=52.5, SD=9.02) students (P

Objective: The complex process of taking care of patients with cancer can affect various aspects of the needs and health of their family caregivers. The present study aims to determine the unmet needs of the family caregivers of patients with cancer and to compare it according to background variables. Methods: The present descriptive study recruited 200 family caregivers of patients with cancer visiting a referral hospital in Iran. Sampling was carried out through the convenience method. Data were collected using Shin's comprehensive needs assessment tool in seven domains (health and psychological problems, family/social support, healthcare staff, information, religious/spiritual support, hospital facilities/services, and practical support). Results: The mean (±standard deviation) of the total scores of the unmet needs of the family caregivers was 81.73 (±16.82), with a possible range of 0–123. A significant percentage of the family caregivers of patients with cancer had unmet needs in all of the seven domains with different severities. The mean scores were higher in the information, healthcare staff (physicians and nurses), and health and psychological problems domains as compared to the other domains. Conclusions: The results showed that the majority of the family caregivers of patients with cancer have many unmet needs, which should be addressed by professional care providers through the development of holistic care programs targeting family caregivers by focusing on information needs and a proper communication process.

Background & Aim: Exposure to high stress in the work environment among the intensive care unit nurses results in leaving the profession and their unwillingness to continue their activities. This is one of the major challenges in the nursing profession and has a great effect on the effectiveness of health systems. Despite the importance of resilience, there is few studies on the intensive care unit nurses’ resilience. The aim of this study was to determine resilience and its association with the intensive care unit nurses’ intention to leave their profession. Methods & Materials: This is a cross-sectional, descriptive analytical study on 400 nurses working in the intensive care units of teaching hospitals affiliated to Tabriz University of Medical Sciences in 2016. Data were collected through a modified form of Anticipated Turnover Scale designed by liou and a summarized form of Connor-Davidson’s resilience scale". Descriptive and inferential statistics (Mann-Whitney, and Kruskal-Wallis) were used for data analysis through SPSS version 13. Results: The mean rank for intention to leave and resilience was 2.83 (IQR: 0.67) and 25.50 (IQR: 8) respectively. Also, there was a negative, significant correlation between resilience and intention to leave (P