Journal Of Patient safety and quality improvement
Volume:6 Issue: 1, Winter 2018

Prevalence of diabetes has increased around the world, such that 4.5% in 1980 grew to 8.5% in 2014 (1). The aim of controlling diabetes is to achieve an HbA1C of lower than 7%. However, around 50% of the diabetic patients cannot achieve this target. Poor blood glucose control is a risk factor for the complications associated with diabetes (2,3).
To control this disease, typically oral hypoglycemic drugs are used. In case of failure in achieving normal blood glucose level, another oral drug or insulin may be required (4(. According to the research, only one fifth of patients are interested in insulin initiation. Further, insulin initiation in these patients is challenging for the health care providers as well (5).
The barriers related to the insulin initiation can be categorized into the health care providers and patient. According to the previous studies, the barriers related to the health care providers include fear of hypoglycemia, lack of sufficient time to educate the patients, low socioeconomic status of patients, lack of sufficient knowledge and experience, absence of a common language with the patients, and poor relationship. Furthermore, the barriers related to the patients include inconvenience and limitation in lifestyle, losing independence, social embarrassment, poor self-efficacy, needle phobia, depression, failure to receive convincing answers from the health care providers about the benefits and risk of insulin, incomplete understanding of diabetes, use of traditional herbal treatments and fear from weight gain due to use of insulin (3,4,6,7,8,9).
Based on the above mentioned reasons, delay in insulin initiation is common. Research has shown that around 50% of the patients with poor diabetes control, havent initiated insulin therapy timely, and even its initiation has been delayed by around 3 to 5 years after failure to receiving response from oral hypoglycemic drugs. Therefore, a special attention should be directed to this matter. From among the mentioned barriers, a few of them including low socioeconomic status cannot be modified, while in most cases, these barriers can be altered which should be resolved by the health care providers(8).
Nurses are among the most important members of the health care providers, who are in relation with patients and should provide their knowledge and specialized skills to educate and create motivation in diabetic patients to take insulin. In this way, they can contribute to fulfilling treatment objectives which include reducing the complications and achieving a suitable HbA1c level (10). Accordingly, along this way, evidence-based scientific documents are required, so that the essential education is given to the patients based on them. In order to achieve this evidence, electronic search in international database including web of science(ISI), Pubmed, Scopus, and Google Scholar was performed with the keywords of “initiate or starting”, type 2 diabetes”, and “insulin”. The search results indicated that the number of interventional articles in the field of nursing and “insulin initiation” is very limited. Among Persian electronic databases such as SID(Scientific Information Database) and Magiran, only one “descriptive- cross-sectional” study was found (11).
Indeed, across various studies, the barriers in insulin initiation have been listed and investigated. Only a few nursing interventions have been performed to overcome these barriers. It appears that considering the importance of insulin initiation and the significant role of nurses as facilitators of this process, a gap is felt regarding interventional studies to guide nurses in the clinical practice. Thus, it is suggested that researchers pay more attention to this dimension of treating diabetes and take more effective and practical steps to overcome the barriers insulin initiation in type 2 diabetic patients.

Patient safety is a universal problem, has still many gaps needing to research. Nurses are the hospitals largest workforce; play a vital role in hospitals profitability and patient safety indices. This study aimed to evaluate the perception of nurses regarding the patient safety culture and nursing work environment. This cross- sectional design study was carried out with 100 nurses. We used “Hospital Survey on Patient Safety Culture” questionnaire for data collection. Survey forms were distributed to the nurses during July 1st- 30st July of 2017. Data were analyzed using SPSS 19. The positive response rates varied between 7-82% for the 42 items of the questionnaire. The item "When one area in this ward gets really busy, others help out" had the highest positive response rate (82%), whereas the item "We have enough staff to handle the workload" had the lowest positive response rate (7%). The domain with the lowest positive response rate was “Staffing “(21%), while the highest positive response rate belonged to “Teamwork within wards“(76%). Our study indicated that nurses had a positive perception about the teamwork in their works; however, they believed that the number of staff to manage the workload was insufficient and this sometimes causes the poor relationships between staffs. Accreditation as an external quality evaluation tool, can help to the creation of patient safety culture. To research the influence of hospital accreditation on patient safety culture in Iran, further studies could be done.

Evidence from the literature shows that safety HUDDLES (Healthcare Utilizing Deliberate Discussion Linking Events) can enhance inter-professional relationships through improved communication, and consequently increases situational awareness among health care professionals. However, very few studies have explored staff perception of these huddles. Our aim was to assess the perspective of front line staff on the impact of safety huddles and explore further strategies to improve their delivery, enhancing situational awareness to improve patient safety. Safety huddles were implemented on two inpatient wards of a tertiary children’s hospital [Great Ormond Street Hospital (GOSH), London, UK]. A staff survey was conducted at two time points post initiation of the huddles (18 months and 30 months) using a questionnaire to evaluate the perception of staff regarding these huddles. The questionnaire was devised and scored via Likert scales and free text responses. Staff felt that safety huddles played a crucial part in highlighting patient problems and identifying clinical deterioration. It also improved communication amongst the team reducing anxiety and enhanced team cohesiveness Safety huddles had an extremely positive influence on front line staff. They can be easily implemented in health care setting to increase situational awareness. They also improve team work and communication, thus enhancing patient safety. Considering their positive impact, safety huddles have been introduced to other wards and specialities across the hospital (GOSH). Huddles have also been included in the RCPCH S.A.F.E programme as one of the most important and core interventions to improve situational awareness.

The mission of health promoting hospitals is to change the treatment-based attitude to health-based and health promoting attitude to patients, personnel, clients and all groups of the society. The present study was conducted to investigate the awareness and attitude of the managers of teaching hospitals in Tabriz City towards health promoting hospitals. The present study was descriptive-analytic research. The study population included all the bosses and managers at different levels of teaching hospitals in Tabriz City. A researcher-made questionnaire was used to data collection. Data were analyzed using SPSS19 Software, descriptive statistics, t-test, analysis of variance (ANOVA) and Spearman’s correlation coefficient test. In the studied teaching hospitals, awareness and attitude of managers were significantly higher than mean. In addition, there was significant relationship between managers’ awareness and their attitudes (P The results of present study showed that the awareness and attitude of managers towards health promoting hospitals were at desirable level. This could be a basis for informing other personnel and establishing health promoting policy in hospitals. Regarding the readiness of hospitals, it seems necessary to determine a given and specific framework and policy in the Ministry of Health in order to establish health promoting hospitals.

DAMA indicates the existence of serious problems in the quality of hospital services, which can exacerbate the disease and increase the risk of readmission to the hospital. In this study we examined Reasons for the DAMA of Patients in Ghaem hospital of Mashhad in 2015. In this cross-sectional, descriptive study, 6645 patients who had been discharged from Ghaem Hospital of Mashhad with their own personal desire in the first 9 months of 2015 were selected as the respondents. For data collection, the information contained in the health information system of the hospital and then the required information which was not available in this system were obtained via telephone call with respondents. The data were statistically analyzed descriptive statistics in SPSS-22. All patients admitted to Gheam Hospital of Mashhad in the first nine months of 2012 was equal to 53558, 6645 of whom (12.4%) were discharged with their own desire. About the reasons of DAMA, 13.1% of patients had called for DAMA for reasons related to the hospital and 86.7% of them had called for DAMA for reasons related to themselves. The main reasons for AMA were: patient- related reasons(The patient's personal and family reasons 41.8%) ¡hospital- related reason (Overcrowding of wards 6.6%)¡ Improved communication between physician and patient, patient’s increased awareness of probable complications of early discharge, improved quality of hospital services, using clinical aids and designing green space and a pleasant environment are the recommended strategies to reduce the rate of discharge against medical advice.

Human resource is an important assets for any organization and it is necessary to preserve their health for achieving the organizational goals. Therefore, the present study aimed to investigate the relationship between the quality of work life with depression, anxiety and stress on employees in healthcare system of Islam Abad e Gharb Healthcare Network. This is a descriptive-analytic study in which 158 employees of Health Network were studied by cross-sectional and census method. Data were collected by questionnaires of Walton’s quality of work life and DASS. Data were analyzed using descriptive statistics and Spearman correlation coefficient, Mann Whitney U and Kruskal-Wallis tests. Mean and median (Standard deviation) was 80.45 (17.70) for quality of work life, 4.9 (4.1) for depression, 6.34 (4.2) for stress and 3.7 (3) for anxiety. There was a negative and significant relationship between quality of work life and depression(r=-0.255, p=0.001), anxiety (r= -0.260, p= 0.001) and stress (r= -0.242, p= 0.002). Regarding the results, it can be concluded that improving the quality of work life is essential to mitigate the rate of depression, anxiety and stress.

Skin cancer screening clinics form a major component of a general dermatologist’s workload. Historically patient preference regarding the communication of histological results following skin biopsy have not been explored in great depth. Primary care physicians locally report an increased workload with patients seeking results directly from them. We sought to ascertain patient preferences in relation to notification of skin biopsy results among patients attending our department and explored the process from the patient’s perspective. We undertook a interviews with departmental clinical staff to assess what they believed would be important to investigate in relation to the patients’ biopsy experience as well as discussing it with patients in general. Following this we undertook a retrospective study involving a postal questionnaire sent to 100 consecutive patients. We then analysed this data. Our findings suggest the need for greater involvement by the patient at the outset in selecting the most appropriate method of result notification. We also discovered that a proportion of patients may benefit from anxiety assessment at the outset to identify those who will experience most anxiety post-operatively. These changes may facilitate a more patient-centred approach to what is a potentially anxiety-provoking and life-changing process. Further studies carried out post-operatively exploring the patients’ psychological state prior to receipt of results would be interesting to compare with the above findings.

Stigma is a set of attitudes, beliefs, and negative thoughts toward a certain situation, such as mental disorders. Mental illnesses are among the most stigmatizing conditions throughout the world. The stigma attached to mental illness in general is the principle of stigma toward physical health problems in this group of patients.
Case: We present a 28-year-old single man with paranoid schizophrenia and neuroleptic malignant syndrome. Stigma was a serious barrier in the Emergency Ward in both psychiatric hospital and general hospital. there is a need to revise the curriculum of people who are educated in the fields of health, both in undergraduate and postgraduate levels.