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The present study was conducted to determine the extent of observation of patients' privacy by physicians and nurses and its relationship with patient satisfaction. This descriptive correlational study was conducted on 600 patients selected by convenience sampling. Based on the patients' points of view, the level of observation of patients' privacy and its dimensions, especially the psychosocial dimension, were reported to be higher in nurses than in physicians. Pearson's correlation coefficient showed a direct and significant relationship between the observation of privacy by the nurses and physicians and different dimensions of patient satisfaction.

PURPOSE: The aim of this semi-experimental study was the determination of collaborative care model training on diabetic foot ulcer patients’ quality of life. METHODS: Demographic characteristics and life’s quality questionnaires were used, and to implement the collaborative model that included (including four steps of motivation, preparation, engagement, and evaluation), 60 patients divided into two “experiment” and “control” groups. For the experimental group, the program was done by face to face education and pamphlet through one hour in seven sessions. Data were analyzed by descriptive and inferential statistical methods. SPSS 24 was used for data analysis. RESULTS: Findings showed the differences of the scores of life’s quality dimensions (except the economic situation), which was significant between both groups after the implementation of the collaborative care model (p

Background Healthcare providers involved in an unexpected adverse patient safety event are affected by negative outcomes of the event and are called 'second victims'. The Second Victim Experience and Support Tool has been introduced as a reliable and valid measure to assess the second victim responses and to support recourses of healthcare professionals. Aim The core objective of this survey was to assess the psychometric attributes of the scale within Iranian nurse. Methods Having translated the scale based on the WHO guidelines and assessing its face validity, a board of 8 specialists assessed the content validity of the measure. In order to assess the psychometric characteristics of the questionnaire, a survey was conducted in 5 university-affiliated hospitals of Urmia. Confirmatory factor analysis is adopted to assess the construct validity. The internal consistency and test-retest reliability of the scale were determined. Results The Persian version of the scale consists of 29 items and 9 subscales. Confirmatory factor analysis illustrated that the scale reflects a foolproof construct validity. Cronbach α coefficients revealed the reliability of the scale (0.68-0.88). Conclusions The survey proves to be a reliable and valid measure to evaluate the second victim responses and conceivable support resources of Iranian nurses or other Persian-speaking healthcare professionals of the region. Implications for health policy and practice Health policymakers ought to build up large-scale surveys to determine the degree of second victimization of healthcare professionals so as to offer suitable support systems. Taking the scale into account would improve evaluation of the benefits of second victim support initiatives in nursing practice.

Background and Aim: Medication overuse headache (MOH) is the second leading cause of chronic headaches. This study aimed to compare the efficacy of three medication regimens in the treatment of MOH in the patients referring to the neurology clinic of Imam Khomeini Hospital in Urmia in 2018. Material and Methods: This was a randomized clinical trial. Participants in this study selected from MOH patients referring to neurology clinic of Imam Khomeini Hospital in Urmia from Feb to Aug 2018. Our study included 60 patients. Patients were randomly assigned to one of the following 3 groups; prednisolone, celecoxib or a combination of both medications. The duration of treatment was 15 days for all the patients. At the end of the study period, the patients provided the information in regard to the severity, duration, and the number of headache days. Results: The mean duration of headache was 3.55 ± 1.58 months. Gender had no significant relationship with age and the duration of headache. The mean values for severity of headache were 8.2 ±0.71, 2.33 ± 0.84 and 2.3 ±0.95 at the first, second and third visits respectively. The mean values for severity of headache at first visit was higher in the patients receiving celecoxib compared to those in the other two treatment groups. At the second and third visits, the mean values for severity of headache were lower in the patients receiving combination therapy. Difference between the scores of severity of headache at the first visit was higher than those at the second and third visits in the combination group which indicated greater effect of this treatment regimen on reducing the severity of the headache compared to the other treatment groups. Conclusion: All three-treatment regimens were effective in reducing headaches, but the combination regimen was more effective. Both celecoxib and prednisolone had beneficial effects on reducing the severity of headache, but celecoxib was more effective. © 2018 the Author (s).

Self-care and quality of life challenges significantly affect post-stroke life. Stroke patients look for strategies to improve their performance and cope with their new situation. The aim of this study was to explore spirituality in self-care from the perspective of stroke survivors in the northwest of Iran. Purposive sampling is done on 15 participants through Semi-structured interviews of obtained data through conventional content analysis approach. Two categories of "spiritual self-care" as the main theme included "supplication" comprising subcategories of "worship and prayer", "resort" and "trust" and "religious beliefs" with subcategories of "divine providence" and "divine blessing". Based on results of this study, Spirituality increases motivation for self-care and adaptation, reduces stress and helps patiently manage diseases as realities.

Background: Patient safety is a major concern for health care professionals. Medication errors have been considered a major indicator of health care quality. The lack of pharmacological knowledge is a cause of medication error among nurses. Objectives: The purpose of this study was to investigate the relationship between pharmacological knowledge and the probability of medical errors in nurses working in Urmia hospitals in 2020. Methods: This cross-sectional study included 490 nurses randomly selected from among those working in hospitals of Urmia in 2020. The data collection tool was a multiple-choice questionnaire about knowledge and pharmacological skills consisting of 3 sections: demographic information, nurses’ drug knowledge, and the confidence level of response in nurses. To analyze questions and hypotheses via SPSS version 21, the t-test and analysis of variance (ANOVA) were employed. Results: The highest pharmaceutical knowledge scores of nurses were related to methods of administration (2.9 ± 1.01 [72.56%]), and the lowest score was related to drug management (1.05 ± 0.63 [52.84%]). The mean of error probability was very low in 28.81% of nurses, low in 37.66%, high in 11.34%, and very high in 22.85%. Pharmaceutical knowledge had a significant relationship with gender, wards, type of hospital, and number of children (P < 0.05 for all). Conclusions: Since the nurses’ level of pharmaceutical knowledge has an important role in the correct prescription of medicine, we suggest that nurse managers and educational supervisors in the field of nursing use in-service training programs and prepare training booklets and posters to promote nurses’ pharmaceutical knowledge in this field.

BackgroundOrganizational commitment is of considerable importance to nurses working to maintain, restore, and promote human health. One of the factors associated with organizational commitment is the quality of services offered to nurses by hospitals. The present study aims to determine the relationship between organizational commitment and the quality of services offered to nurses by hospitals.Materials & MethodsThis descriptive-correlational study was conducted in 2017. A total of 150 nurses working at Seyed al-Shohada Heart Center in Urmia were enrolled in this study using a census. Data collection was conducted using a demographic questionnaire, Allen and Meyer's Organizational Commitment Scale, and Ashill's Scale of Service Delivery Performance. In addition, data were analyzed by descriptive statistics and the Pearson’s correlation coefficient using SPSS V.16.0, Chicago, Illinois.ResultsThe results indicated that organizational commitment was at a moderate level among 67.3% of the nurses, and the quality of services offered by the hospital to 72% of the nurses was determined as relatively high. Moreover, the overall score of organizational commitment was found out to be linearly and significantly correlated with the overall score of the quality of services offered to nurses by the hospital as well as all of its dimensions (r=0.474, p=0.05).ConclusionsThere appeared to be a significant positive correlation between the quality of services offered to nurses by the hospital and organizational commitment. Therefore, hospital authorities could improve the quality of services provided to nurses, thereby promoting their organizational commitment. This will in turn lead to an improvement in patient care.

Purpose This study was conducted to explain the psychological reactions of COVID‐19 patients to the stress caused by the disease crisis from the perspective of the survivors. Design and Methods A phenomenological approach was adopted to the qualitative study of 14 COVID‐19 survivors selected through purposive sampling. Findings Two themes extracted as the psychological reactions of the patients to the COVID‐19‐induced stress included “self‐moderating effect of stress” and “psychological maladaptation.” Practice Implications The present findings appear effective in laying the foundations for performing interventions to improve constructive psychological reactions such as using self‐moderating mechanisms of the COVID‐19‐induced stress and reducing or eliminating maladaptive psychological reactions such as depression, anger, self‐blaming, and regret.

Aim To explore the challenges experienced by ICU nurses throughout the provision of care for COVID-19 patients. Background The intensive care unit nurses, who are at the frontline of fighting against COVID-19 and defusing this crisis, are faced with various challenges throughout the provision of care for COVID-19 patients. Methods In this qualitative descriptive study, a total of 17 nurses working in intensive care units were selected using purposive sampling. Data were collected using semi-structured face-to-face interviews. After recording and transcribing interviews, the concepts were extracted using the content analysis method. Findings The nurses reported the four following challenges throughout the provision of care for COVID-19 patients: 'organization's inefficiency in supporting nurses', 'physical exhaustion', 'living with uncertainty' and 'psychological burden of the disease'. Conclusion The present study portrayed a clear understanding of the challenges faced by nurses working in intensive care units during the crisis of the COVID-19 pandemic based on their lived experiences. Implications for nursing management A profound understanding of these challenges in the current critical situation can help health care authorities adopt appropriate measures to resolve these challenges, provide health care facilities, support the health workforce, give accurate and evidence-based information and perform psychological interventions on how to handle the current crisis.

Background In addition to physical problems, patients with COVID-19 suffer from considerable stress throughout the disease crisis. It is important to address mental health needs and not to ignore the psychological dimension in this group of patients. In this regard, the first practical step is to have a clear understanding of patients’ psychological issues. Therefore, this study aimed to explore the psychological disturbances of COVID-19 survivors throughout the disease crisis. Method This qualitative study was conducted using a phenomenological approach through 14 individual semi-structured in-depth interviews with patients recovered from COVID-19. Data were analyzed using Colaizzi’s seven-step method. Results Three themes of “living in limbo”, “psychological distress behind the wall” and “psychological burden of being a carrier” were extracted as the psychological disturbances of COVID-19 survivors throughout the disease crisis. Conclusion This study portrayed a better understanding of psychological disturbances of COVID-19 survivors throughout the disease crisis based on their lived experiences. Given the ambiguity in the time of the disease eradication and its continuing course, a deep understanding of these experiences in the current critical situation can help healthcare officials to make appropriate decisions and take measures to assess and identify psychological traumas and perform interventions to improve the mental state of these patients.

Background End-Stage Renal Disease (ESRD) is the final and permanent stage of Chronic Kidney Disease (CKD). Hemodialysis (HD) is the most common treatment for CKD. To have desirable therapeutic outcomes, patients have to adhere to a specific therapeutic regimen that reduces the hospitalization rate and side-effects of HD. The present study aimed to determine the effects of the patient education program and nurse-led telephone follow-up on adherence to the treatment in hemodialysis patients. Methods This is a randomized controlled trial in which a total of 66 patients were recruited using convenience sampling and then randomly assigned to two groups of control (n = 33) and intervention (n = 33). Data were collected using a demographic questionnaire, the laboratory results record sheet, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which included four dimensions of HD attendance, medication use, fluid restrictions, and diet recommendations. The intervention group received a patient education program and nurse-led follow-up services through telephone communication and the Short Message Service (SMS) for 3 months. All participants filled in the questionnaire before and after the intervention. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Results The results showed a significant difference in the mean scores of HD attendance, medication use, fluid restrictions, and diet recommendations between the two groups immediately, 1 month, and 3 months after the intervention (p P P = 0.130). Conclusion Implementation of the patient education program and nurse-led follow-up can lead to better adherence to hemodialysis in four dimensions of HD attendance, medication use, fluid restrictions, and dietary recommendations in HD patients. Trial registration IRCT registration number: IRCT20190127042512N1; Registration date: 2020-09-12; Registration timing: retrospectively registered: Last update: 2020-09-12.

Background: Suicide-attempts have increased across the world and have become more higher among females. In Iran, there has been a high prevalence of self-immolation mostly young married women admitted in the burn centers. This study aimed to explore the factors and experiences of self-immolation in Iranian married women to develop prevention strategies to prevent the personal, social and economic impacts of suicide and suicide attempts. Methods: A qualitative descriptive approach using open-ended in-depth face to face interviews was conducted in a purposive sample of 16 married Iranian women aged 16 to 40 years in the burn centers in Urmia city located in northwest Iran. Conventional content analysis was used to analyze the data.Results: Four themes emerged from the data including: (1) antecedents of self-immolation, (2) suicidal ideation method, (3) defeat and humiliation, and (4) pathway to recovery. Each of these themes are supported by sub-themes.Conclusions: The study highlights the need for health professionals to focus in helping and supporting self-immolation survivors to continue a normal life. A comprehensive supportive program based on survivors’ needs to support their pathways to recovery in all its complexities is recommended. Health professional should also not forget that the family of the survivors also will need help to overcome this trauma. Family counselling program may also be provided.

Background : Pregnant women’s participation in safe delivery is associated with safety assurance and improvement. Safety and care quality improvement in developed countries has so far been based on research and clinical evidence. Nonetheless, stakeholders’ preferences and expectations were not much taken into account. This study aimed to explore midwives’ expectations from pregnant women regarding their participation in safe delivery. Methods : This qualitative study was conducted in 2019 in three public hospitals in Urmia, Iran. Data were collected through 24 in-depth semi-structured interviews with 24 midwives. Sampling was done purposively and continued up to data saturation. Data were analyzed through Graneheim and Lundman’s qualitative content analysis. Results: Midwives’ expectations from pregnant women regarding their participation in safe delivery were grouped into the two main themes of effective communication (with two main categories) and empowerment of pregnant women (with three categories). The five main categories of these two themes were client’s interaction with midwife, confidence in midwife, readiness for delivery, health literacy improvement, and participation in safe behaviors, respectively. Conclusions : Understanding midwives’ expectations regarding pregnant women participation in safe delivery is important to the development of policies for care quality and safety improvement in perinatal care. Keywords : Patient participation, Safe delivery, Qualitative study

Background: Moral distress and workplace bullying are important issues in the nursing workplace that appear to affect nurse’s burnout. Aim: To investigate the relationship between moral distress and burnout in Iranian nurses, as mediated by their perceptions of workplace bullying. Ethical considerations: The research was approved by the committee of ethics in research of the Urmia University of Medical Sciences. Method: This is a correlation study using a cross-sectional design with anonymous questionnaires as study instruments (i.e. Moral Distress Scale-Revised, Maslach Burnout Inventory and The Negative Acts Questionnaire-Revised). Data were collected from 278 nurses from five teaching hospitals in Urmia, the capital of Western Azerbaijan, northwest of Iran. Structural equation modeling and bootstrapping procedures were employed to recognize the mediating role of their perceptions of workplace bullying. Results: The mean score of moral distress, burnout, and the Negative Acts Questionnaire-Revised Scale among the participants were 91.02 ± 35.26, 79.9 ± 18.27, and 45.4 ± 15.39, respectively. The results confirmed our hypothesized model. All the latent variables of study were significantly correlated in the predicted directions. The moral distress and bullying were significant predictors of burnout. Perception of bullying partially mediated the relationship between moral distress and burnout. The mediating role of the bullying suggests that moral distress increases burnout, directly and indirectly. Conclusion: Nursing administrators should be conscious of the role of moral distress and bullying in the nursing workplace in increasing burnout.

Anemia is regarded as one of the most common findings in ICU, resulting in extensive blood transfusions in this unit. Several factors are involved in increased patients’ hospitalization in hospital and increased mortality. Thus, the current research was carried out to evaluate the anemia and blood transfusion in ICU and its impact on the mortality of patients in educational hospitals of Urmia University of Medical Sciences. The present study has been conducted based on prospective observations in intensive care units of educational hospitals of Urmia University of Medical Sciences .Demographic information of the100 patients, blood transfusion, and hemoglobin level of patients were recorded at admission time since the seventh day to the 30th day of hospitalization in the intensive care units. Logrank test was used to determine the survival time. Among the patients who had more than one week of hospitalization, 100 patients met the inclusion criteria of study, and 54 (54%) were male and 46 (46%) were female. The mean age of patients was 64.24 ± 16.69. The mean survival time was 27.5 days for males and 26 days for females. The survival time for people received blood was reported to be 26.83 days, and for those did not receive blood, it was reported to be 26.81 days. It was reported to be 29.44 days for patients with anemia at the time of admission and 25.11 days for those without anemia. The survival time for two groups was not significantly different in terms of sex (male and female) and receiving the blood (received or not), and the hemoglobin of admission time of patients between two anemia and non-anemia groups were among the variables, which had a significant difference (p

Patient satisfaction is known as a quality outcome measure of quality of care provided by the staff of the emergency department (ED). Many factors effect on the patient satisfaction. Since accompanied patients (AP) play a vital role in providing psycho-social support to patients, their satisfaction can effect on patient satisfaction. However little is known about AP expectations, prospects and satisfaction. The aim of this study is to assessment of accompanying persons’ satisfaction from services provided at emergency departments in hospitals of Urmia University of medical sciences. A descriptive- cross-sectional study was conducted in three ED of hospitals affiliated to Urmia university of medical sciences, Iran in 2010. The study population consisted of 400 accompanied patients who were randomly selected from study settings. Data were collected through a selfstructured questionnaire that reliability of which had been measured by specialists and validity evaluated by internal consistency method. Collected data analyzed by SPSS software descriptive statistics (SPSS 16.0). The study findings indicated that in the case of services provided at ED of hospitals affiliated to Urmia University 11.69% of AP was dissatisfied and 67.75% was satisfied. Also it has revealed, the greatest satisfaction factors of ED characteristics among AP was meaningful communication with 79,67% followed by accountability with 75.94% ,and nurse and staff care with 75.33%. The most dissatisfaction factors were from facilities with 16.76%, costs with 16% and accountability with 13.26%. To achieve maximum quality of health care services, increasing customer (patient and AP) satisfaction based on customer – centered plan can be helpful. Attention to human factors such as communication, right accountability and proper care play a major role for increasing customer satisfaction. Consideration of facilities and cost of treatment are also important in customer satisfaction.

AIM: The study examined the mediating effect of the second victim experience between safety culture and burnout in Iranian nurses. METHODS: A convenience sample of 298 nurses from five teaching hospitals of Urmia participated in the study. Hospital Survey on Patient Safety Culture, Maslach Burnout Inventory and The Second Victim Experience and Support Tool were used to measure the major variables. We adopted structural equation modelling to examine the hypotheses. RESULTS: Safety culture was significantly associated with second victim experience and burnout (p

We aimed to determine the effect of training of new guideline on Pressure ulcer (PU) prevention in the intensive care units (ICUs). PU is the third costly disorder with high mortality and morbidity. Thus reduction of PU incidence is very important and effective step for health systems. PU is one of the most common medical conditions, occurring in both hospital and community settings, in all age groups, but mostly among the elderly, the immobile, and patients with severe acute and chronic illnesses or neurological deficits. This semi-experimental study was conducted on high-risk patients with a Norton scale score of 16, while they had daily care for PU prevention. Patients were randomly divided into two equal groups of intervention and control patients in each. The control group was assessed with routine care o PU prevention in the first three months of the study. Then the nurses were trained with the new guideline and after that the data were collected again in the second three months period. The data were analyzed through the SPSS statistical software (version 13). results showed that new guideline training program was associated with decreased risk of PU. Education of the new guideline on PU is an effective way to decrease the rate of PU in (ICUs). Training the new care guideline of the PU prevention for the involved nurses probably can reduce the incidence rate of pressure ulcer.

Background and Aim: Medication errors are one the most common causes of preventable health care errors. Since nurses are the main controllers of the hospital’s wards and play a major role in looking after patients, the incidence of medication errors is one of the serious threats to the health and safety of the patients and nursing profession.This study aimed to determine the factors affecting the incidence of medication errors among nurses. Materials and Methods: In this cross-sectional study, 100 nurses working in Besat hospital in Sanandaj city participated. The data collection tool was a two section questionnaire. The first section includes demographic data and the second part contains questions about medication errors in 5 areas. Data analysis was conducted by statistical software SPSS 16. Findings: The results showed that all participants had a history of drug error in the last year. Age, gender and workload had a significant relationship with medication errors. The most common medication errors included wrong patient (26%), kind of drugs (19%), drug administration (9%), and the dosage and timing of drug (23%). Conclusion: Human and organizational factors play a bigger role than other factors in the incidence of medication errors. Therefore, identifying these factors will help the health system and nurses in responding to obviate the causes and reduction of medication errors, improving patient safety and the quality of care. &nbsp

Background: Road accidents is a particular public health problem that is endangering the lives of many people every year in the world. Iran is one the most dangerous countries in terms of road accidents. Human factors and driving performance are the most important causes of this car accidents. This qualitative study was conducted to determine perceptions of 12 drivers in Shiraz city about road accidents, hoping to lead to effective interventions to inform and reduce the incidence of them. Methods: 12 drivers aged 24–60 years from Shiraz participated in qualitative, semi-structured, interviews about their perceptions of road accidents. The social ecological model informed interview question development, and data were examined using thematic analysis. Then the early categories formed. All interviews were recorded, categorized and analyzed. Results: The results of the study in five main themes included the sense of responsibility for driving regulations, the causes of driving hazardous behaviors, participation in modifying these behaviors, the requirements for preventive performance and the best practices for modifying behavior were emerged. Participants also believed that with more education, incentive behaviors would be more effective than punishment, accountability to their lives, occupants and people. They all opposed the increase in fines and noted that the authorities should be more concerned with measures, such as foundation of highways, the construction of parking sites, the construction of equipped centers for repair of vehicles and rest for the prevention of road accidents. Conclusions: According to the results of this study, the best and most cost-effective method is to reduce the incidence of injuries and improve the performance of drivers by using participatory and cooperative behaviors and avoiding of violence in law cases. More studies are recommended in this regard. Keywords: Qualitative research, Drivers, Road accidents

Rahim Baghaei,1 Elham Sharifian,1 Aziz Kamran2 1Inpatient Safety Research Center, Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia, 2Public Health Department, Khalkhal Faculty of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, IranBackground: Hand washing is the best strategy to prevent known nosocomial infections but the nurses' hand hygiene is estimated to be poor in Iran.Objective: This study aimed to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors) model on hand hygiene adherence education.Methods: This controlled quasi-experimental study was conducted on 70 hemodialysis unit nurses (35 case and 35 control) in the health and educational centers of the University of Medical Sciences of Urmia, Iran. To collect the data, a six-part validated and reliable questionnaire was used. The data were analyzed using SPSS version18, using Wilcoxon, Mann–Whitney, chi-square, and Fisher's exact tests. The significance level was considered P

Background: There are many factors associated with medication errors. These errors are mainly related to nursing care, including error in medication administration and omission. Nurses make up the largest group of health workers. Hence, quality of health care depends to a great extent to nurses. Nurses who work in hospitals with inadequate human resources and have more working hours are more likely to commit errors. This study aimed at determining the incidence of medication errors and factors affecting it according to nurses’ self-report. Methods: This is a descriptive analytical study in which 100 nurses in beast hospital in Sanandaj, Iran were selected randomly from different shifts. The questionnaire consisted of 2 sections. The first section consisted of 17 questions on demographic information including age, sex, type of activity, duration of service, hospital ward and location, error during the years of service, reporting or non-reporting of mistakes and type of mistake. The second part of the tool consisted of 25 items rated to 1-to-5 likert scale, which checked out medical errors in 5 domains. For ethical issues, anonymous questionnaires were distributed with bar codes. Then the data were entered into SPSS version 16 and analyzed. Results: All the participants in this study had a history of medication error in the previous year. In 12% of the cases, association between workload and medication error were too high, 22% was high, 54% was average and 6% was low. Conclusions: The results of this study showed that the most important factors affecting the incidence of errors include workplace stress, working in the intensive care units, tiredness due to work load, and inappropriate nurse physician relationship. Hence, identification of these factors helps nurses to reduce errors and helps reduce other medical consequences and improve in the quality of patient care and patient safety. Regarding the importance of patient safety it is necessary to improve positive relationship between nurse managers and nursing staff. Therefore, an environment of close collaboration, in-service training for new nurses regarding medication errors, and creating a reporting system is necessary.