مدیریت بحران

Frost and related climatic changes pose serious threats to public health, food security, and economic stability. In this regard, artificial intelligence (AI) serves as an innovative tool playing a crucial role in predicting, managing, and mitigating the impacts of these phenomena. Machine learning models analyze diverse datasets to provide early warnings, while intelligent systems facilitate energy consumption optimization and healthcare services. However, challenges such as limited access to high-quality data, high costs, and privacy concerns remain significant barriers. To maximize the benefits of AI in combating frost, it is essential to develop models resilient to data scarcity, expand international collaborations, and conduct cost-benefit analyses of this technology. Investing in AI not only helps reduce the adverse effects of frost but also serves as a model for managing other climate crises.

In recent years, the use of chemical agents has increased, both in war and terrorist operations and in peacetime. Considering that nurses are one of the first responders in the management of victims of chemical accidents, this study was conducted with the aim of investigating the role of nurses in the hospital incident command system in chemical accidents.

This review article compiled by searching reputable library resources and databases with the keywords “Crisis management”, “Incident Command System (ICS)”, “Chemical accidents”, “Training” and “Nurse” between 2002 and 2017 .

Hospital staff should be aware of the importance and management of victims affected by chemical weapons. International studies have shown that 80% of volunteer nurses in crisis have no previous experience and knowledge in dealing with crisis. Therefore, their training in this area is needed.

The deliberate use of chemical weapons has posed a significant threat, especially in recent decades. Therefore, in addition to civilian government hospitals, military hospitals must be aware and prepared to manage victims affected by chemical weapons. Therefore, the knowledge of medical staff, especially nurses, is very important. Aware nurses in this field can play an effective role in reducing human losses and helping crisis management in the event of an accident.

 Applying efficient management of hospitals and healthcare centers during a crisis has a significant effect on the optimal performance of these institutions. Therefore, the purpose of this study is to clarify the concept of hospital crisis management: concept analysis with Rogers approach.

In this study, Rogers' evolutionary approach was used to clarify the concept of hospital crisis management. For this purpose, Web of Sciences, Science direct, Proquest, Scopus, Pubmed, Magiran, Iran Medex and SID databases were searched using the keywords. Finally, after reviewing 11 articles, they were selected for study.

In this study, the characteristics of the concept of hospital crisis management were identified in the dimensions of hospital management readiness, national management, infrastructure and resource management. Antecedents include strengths, weaknesses, numerous opportunities and threats, sufficient knowledge of managers, mobilization of organizations, provision of physical and human resources, existence of general and special plans, existence of processes, preparation plans, political commitment, communication And the suffixes also include such things as designing and implementing programs and policies, necessary support and training, developing methods to strengthen management and acquiring resources, establishing monitoring programs, approaches based on multi-departmental and people-centered systems, operational formulation of hospital programs, guidelines and accreditation standards to increase readiness. 

The concept of hospital crisis management has a multifaceted, dynamic and permanent nature. Prioritizing needs and determining short-term, medium-term and long-term goals and developing necessary plans for preparation and response are considered essential requirements of hospital crisis management.

Clinical care changes in emergency departments have occurred due to technological advancements and emerging crises, and nurses are at the forefront of these changes, facing numerous challenges. Therefore, this study aimed to identify emerging challenges and provide innovative solutions to improve the performance of emergency nurses in crisis management.

The study was conducted as a scoping review based on the Joanna Briggs Institute guidelines and structured around three axes: population (emergency nurses), concept (emerging challenges and innovative solutions to improve performance), and context (crisis management). The study's design was based on the Omeli, Askay framework, considering four main reasons for the study:1) scope, 2) necessity, 3) dissemination of results, and 4) research gap. A comprehensive search was performed in Embase, Scopus, CINHAL, Web of Science, Cochrane, PubMed, ProQuest, and Google Scholar databases using MeSH keywords from 2014 to 2024, resulting in 60 articles. After applying inclusion and exclusion criteria, 32 articles were selected.

A comprehensive analysis of dynamic changes, emerging trends, challenges, and the impact of new technologies on the role of emergency nurses led to the identification of innovative and operational solutions to improve their performance in crisis management.

Addressing emerging challenges requires innovative solutions, such as advanced training and learning from new global crises, to enable nurses to master crisis situations. By leveraging new technologies, such as artificial intelligence, wearable health devices, and remote nursing systems, nurses' resilience and adaptability can be increased, allowing them to play a key role in crisis management in emergency departments.

With the outbreak of the coronavirus and the disruption of the normal state of human life and death, the most social, economic, political, and especially educational activities changed to virtual communications.

The present study was planned with the aim of assessing the effectiveness rate of adopting Learning Management System (LMS) among students. A questionnaire method was used to obtain the perception and opinion of students of different courses and levels. The efficiency of LMS in seven different components was evaluated. The t-student test was employed to evaluate statistical results.

The results of statistical analysis has been interpretated based on the mean and standard deviation of each studied components. Except for exercises and assignments, other components were less than the average limit. The value of the univariate t-statistic was determined to be less than 1.65 (standard t-value) for all components except exercises and homework. Also, considering that the p-value level for all components (< 0.001), it is concluded that there was a significant difference in the answers of all research questions.

The results can be used to resolve the challenges of E-learning. Due to the prolongation of the outbreak of Covid-19 and the intensification of its consequences such as increasing demand for E-learning, the need for continued economic activities, and employing new tools and more effective use of IT will be necessary.

The annual crisis of natural disasters affects the lives of many people and causes social and economic losses. In many countries, the armed forces are used to help in this type of crisis. As one of the most disaster-prone countries, Japan has had many experiences in the field of natural disaster crisis management, and the country's army has taken significant measures. Therefore, the purpose of this research is to identify the actions of the Japanese army in natural disaster crisis management and its lessons for Iran. The present article is a systematic review study using a systematic search in databases, Science Direct, Springer, Taylor & Francis and Google Scholar with the keywords " Natural disaster ", " Disaster management", " Japanese Self Defense Force " , " Civil military cooperation ", "Emergency response" in the time period of 2008 to 2024 AD, and the sources mentioned in these related articles were also reviewed.: The review of different studies showed that the Japanese army performs many actions before, during and after the crisis of natural disasters. Coding was done in the articles and the central codes and categories were counted. Conclusion Among the listed categories are rescuing and relieving residents, dispatching doctors, nurses, medical technicians, dispatching personnel, providing drinking water and food, logistics measures and cargo of materials, providing transportation, civil services, cooperation with other organizations and training. . Islamic Republic Of Iran can identify such capacities and use them before, during and after the crisis of natural disasters.

Today, with the increasing development of technology and the expansion of the population, we are witnessing an increase in incidents, accidents and crises. Natural disasters have become a part of the nature of our human environment and depend on many factors, including natural factors and human factors, and as a result, they take on a complex structure that makes combating them very difficult and complicated. The issue is what should be considered by the decision maker in hospital evacuation and what factors are effective in this decision, how these factors are affected after the decision and how these factors are involved in the decision process.

The research method is placed in the developmental category. The library method was used to collect information for the background and literature of the research, after reviewing the subject literature, the interview protocol was compiled, including questions with the aim of knowing the variables influencing decision-making. Then interviews were conducted with the experts who accepted the invitation to the interview. Interviews with 7 experts continued until theoretical saturation. After that, key sentences were extracted, coded and analyzed using thematic analysis method with the 6-step approach of Brown and Clark. MAXQDA and Excel software were used for the analysis.

Review of studies and interviews led to the identification of 1156 codes. which was classified into 28 components and 5 dimensions.

On February 6, 2023, at 04:17 Turkish time, a powerful and catastrophic earthquake of magnitude 7.8 on the Richter scale shook central and southern Turkey and northern and western Syria for 75 seconds, leaving widespread damage. In this heartbreaking natural disaster, thousands of Turkish citizens lost their lives, and thousands were injured. Relief efforts began with the immediate intervention of local and civilian forces in Turkey and continued with the assistance of foreign aid forces, including the Islamic Republic of Iran. The purpose of this study is to report on the planning, relief, and treatment measures carried out by the medical teams of the armed forces to help save the lives of the injured and provide suggestions for improving crisis management in current and future situations. The present study used official field reports, literature reviews, and reference databases. First, the actions of the medical centers of the armed forces during the Turkish earthquake were investigated. By reviewing electronic sources, all available documents and articles related to similar medical actions in other countries were identified. After a multi-stage screening process, 20 documents were finally selected, and analysis was conducted after coding. All the actions of the medical centers of the armed forces in the Turkish earthquake incident, in providing optimal medical services to the wounded and injured due to this incident, were identified and presented. Forecasting, planning, and periodic exercises in the country's hospitals, especially those of the armed forces, can save the lives of the injured and improve the treatment process in response to mission needs during unexpected incidents. These measures include pre-accident preparations, post-accident responses, intra-organizational and extra-organizational coordination and interactions, as well as effective periodic training and exercises, etc.

Industrial firefighting (IFF) constitutes a high-risk occupation within the domain of process industries. Firefighting teams serve as the operational component of the incident command team. This study aims to assess the alignment of physical fitness assessments conducted in selected Iranian process industrial firefighting settings and to scrutinize the extent of compliance with The U.S. National Fire Protection Association (NFPA) requirements by analyzing the resultant percentages of similarity in test outcomes.

A cross-sectional observational study was undertaken across 14 Iranian process companies, encompassing two refinery companies and 12 petrochemical companies, employing a census sampling approach. The study’s benchmark was NFPA1582-2018. Data analysis was performed utilizing SPSS 27 software. This investigation focused on assessing the percentage of essential parallels within five distinct groups, along with their corresponding sub-components, in alignment with the tests and elements stipulated in the NFPA standard.

Most of the selected companies (58%) lacked a cohesive program or established standard to assess the fitness of their firefighting personnel. Among the subset of companies (42%) that did employ an evaluation standard, in the majority of instances, a minimal proportion (less than 20%) underwent individualized assessments in line with the components outlined in NFPA 1582-2018 for physical fitness evaluation tests.

Given that 58% of the surveyed process companies in this study lacked a cohesive fitness assessment program and 42% demonstrated limited compliance with NFPA 1582-2018 in the assessed components, this issue underscores the critical need to evaluate the components quality and conduct a technical needs assessment. Developing adaptable and suitable components aligned with the work conditions prevalent in the process industry becomes imperative. Additionally, there must be existed a legal mandate for the pertinent ministry to implement an integrated framework. This scenario necessitates that process companies reevaluate their approaches concerning the selection and oversight of their firefighting personnel.

The main index in resilience engineering is the management commitment index. In this study, a semi-quantitative risk assessment method based on the fuzzy hierarchical analysis method for management commitment index was implemented in evaluating the resilience level of two selected hospitals.

At first, evaluation tools including a 17-question hierarchical analysis questionnaire, a 4-question management commitment risk assessment form and a 2-question integrated management commitment risk assessment form with safety, health and environment were designed and their validity was determined. became. Then they were distributed in two hospitals of Al-Ghadir Tabriz and Khatam Al-Anbia Bandar Abbas affiliated to Faraja and were analyzed with relevant statistical methods.

In the evaluation of the fuzzy hierarchical analysis questionnaire, it was found that the level of resilience has increased from 15.25 in 2018 to 36.37 in 2019. Also, the level of social readiness, sharing and resiliency risk in the two investigated hospitals were 0.97, 0.17, 0.03, 0.96, 0.11 and 0.04, respectively. Also, the cumulative readiness value of management commitment based on safety, health and environment of these two hospitals was 0.81 and 0.74, respectively.

Based on these results, it is suggested that the selected hospitals focus on the effective parameters introduced in the evaluation tools of this study in order to increase the resilience level of these centers.

This study aims to investigate the effect of nurses’ autonomy on the quality of patient care based on Kramer and Schmalenberg’s model

This is a causal-comparative study. Participants were 101 nurses of Imam Khomeini Hospital in Arak, Iran from the intensive care unit and internal medicine, surgery, pediatrics, gynecology, orthopedics, and emergency departments. The data collection tools were Moghimi and Ramazan’s patent care quality questionnaire and an autonomy assessment questionnaire based on Kramer and Schmalenberg’s autonomy model. The data were analyzed in SPSS software.

This study was approved by the ethics committee of Islamic Azad University of Arak Branch (Code: IR.IAU.ARAK.REC.1397.66).

The mean autonomy score of nurses was 3.16 ±0.35, indicating a desirable level. Nurses of all departments had limited autonomy. In the internal department, nurses had unsanctioned autonomy, while in the surgical department, they had autonomous nursing care action. The regression models were significant for all departments except for the internal department. With an increase of one unit in limited autonomy in the intensive care unit, autonomous nursing care in the surgical department, and limited autonomy in pediatrics, gynecology, orthopedics, and emergency departments among the nurses, the quality of care can be increased by 0.253, 0.187, 0.522, 0.205, 0.466 and 0.129, respectively.

Nurses’ autonomy can increase the quality of patient care. The nursing managers need to empower nurses and provide an environment for them to apply their knowledge in practicing autonomy.

Crisis management is an important field of management, especially in the field of health. This study aims to investigate the factors affecting the development of disaster management mechanisms in hospitals of Arak, Iran.

In this regard, 240 questionnaires were distributed among hospital and nursing managers in Arak. The questionnaire had acceptable reliability with Cronbach’ alpha  value of 0.897. 

This study was approved by the ethics committee of Arak University of Medical Sciences (code: 1274.1401.REC.ARAKMU.IR). 

Then, by using structural equation modeling in LISREL software, the designed model was analyzed. Finally, by using statistical tests, the research hypotheses were examined. 

The results showed the significant effect of three factors of “lack of stability in business environment”, “risk taking”, and “organizational culture” on the development of the mechanism of crisis management.

Considering the human life crises in today's world, it is necessary to pay attention and identify the effective factors for crisis prevention, intervention, and resolution. Therefore, the current study was performed with the aim of investigating the effective factors of crisis prevention, intervention, and resolution, focusing on spiritual health in Iran from the perspective of experts.

This was an applied study using a mixed-methods sequential exploratory design, which was carried out in two parts, qualitative and quantitative. In the qualitative part, preliminary dimensions and factors were extracted using the meta-combination technique. Then, using the Delphi method, an open-ended and closed-ended questionnaire that included all the indicators extracted from the literature study was presented to 15 experts who had common scientific expertise and practical experience. In the quantitative part, considering the study and evaluation of various factors of crisis management and Spiritual-Islamic health, a 57-item questionnaire was designed and presented to 50 experts in order to answer the research questions.

Religious and rational beliefs, spiritual connection to God, education and specialization, governmental function, efficient social communication, and positive psychology at the preventive level; Strengthening religious beliefs and values, effective social communication, knowledge-oriented thinking, the use of psychological interventions, positive functioning of the government, individual empowerment and the use of digital technologies at the level of intervention and treatment, and the use of scientific knowledge and expertise, governmental and organizational performance, positive social interactions and Family, individual empowerment, strengthening of spiritual and religious beliefs, application of digital technologies and positive psychology at the problem-solving level were the most important solutions.

The results of this research show that spiritual health and its factors are the main solutions in preventing, intervening, and solving crises, and increasing the spiritual health and wisdom of people and officials can cause more institutionalization of moral virtues among people and officials in confronting and solving the problem with the crisis.

According to the flood records in Mazandaran province, this region is regarded as one of the flood-prone regions of the country, and due to the floods, it has suffered many casualties and financial losses. Therefore, this study aimed to investigate the settlements at risk of flooding as one of the main goals of this research.

This descriptive-analytical study was conducted based on extensive and exploratory research approaches. The required data were collected from monthly discharge and the maximum instantaneous discharge in the stations of Mazandaran province along with the population statistics of the provincial cities, as well as the statistics of the Natural Resources and Watershed Management Organization concerning the floods. Accordingly, the statistics of hydrometric stations from 1971 to 2021 of Iran's water resources management main company, the population statistics of the province based on the census of 2015, and the statistics of floods that occurred from the beginning to 2021 have been used in this study. Flood return periods were obtained in the study stations in different statistical distributions using Hyfa software. Finally, Arc GIS software (version 10.3) was used to zone floods in Mazandaran province.

Based on the results, about 1013 square kilometers of the province's surface accounting for 4.25% of its total area is located in the boundaries of large floods that have a return period of 50 to 100 years. Moreover, due to the high altitude, rainy-snowy events, and the significant amount of precipitation in Sarab (Dali Chai and Lar basins) and Payab, Haraz basin has a significant runoff rate discharge so that about 500 to 600 liters of water flow from this basin annually per square meter.

According to the obtained results, strategies have been proposed to increase resilience against flood risk using different methods.

The health system implements national and regional reforms by developing new policies or reforming the previous policies to respond to the changing needs of society, increasing efficiency, effectiveness, and quality and creating justice. The present study aimed to develop a policy model for producing applied knowledge in health management.

This study was conducted using a qualitative grounded theory method. The qualitative data were collected through in-depth interviews with 15 purposively selected health crisis management specialists and policymaking, public management, innovation management, and industrial management experts in the fall of 2021. The data were analyzed through MAXQDA software.

The most important policymaking indicator was evaluating indigenous knowledge production policies for health crisis management. Training cultural factors in the indigenization of other countries' experiences was the most important indicator in policy education, and missing links in the Ministry of Health were identified as the outcomes of inattention to biological crises. Therefore, the identified indicators can be considered the structural factors of indigenous knowledge production policies for health crisis management.

Following the findings from the qualitative case study, the final model was developed using a set of variables, including the content of indigenous knowledge policy, the process of policies for the production of applied knowledge for health management, the training of policies for the production of applied knowledge for health management, and the structural factors of the policies for the production of applied knowledge for health management.

 Crisis management is an important field of management, especially in the field of health. This study aims to investigate the factors affecting the development of disaster management mechanisms in hospitals of Arak, Iran.

 In this regard, 240 questionnaires were distributed among hospital and nursing managers in Arak. The questionnaire had acceptable reliability with Cronbach’ alpha  value of 0.897. 

 This study was approved by the ethics committee of Arak University of Medical Sciences (code: 1274.1401.REC.ARAKMU.IR). 

 Then, by using structural equation modeling in LISREL software, the designed model was analyzed. Finally, by using statistical tests, the research hypotheses were examined. 

 The results showed the significant effect of three factors of “lack of stability in business environment”, “risk taking”, and “organizational culture” on the development of the mechanism of crisis management.

 As a pandemic disease, Covid 19 has taken the lives of many people all over the world and has put a lot of pressure on the health care system and health care personnel. The experiences of managers and employees can help increase the efficiency of the health systems in future crises. This study was carried out in order to use the experiences of the personnel of the Crisis Section of Zahedan Medical University Public Health Deputy (ZMUPHD) in controlling the Covid-19 epidemic.

 This was a qualitative research conducted in 2021-22 using the content analysis method including 30 employees of the Crisis Staff of the ZMUPHD selected by purposeful sampling. Data were collected based on semi-structured, in-depth interviews and analyzed in eight stages including typing the text of the interviews, determining semantic units, coding the text, revising the codes, classifying and developing the classes, revising the classes, identifying the themes and reporting the data.

Resulte: 

The experiences of the managers and employees of the ZMUPHD to deal withا the Corona pandemic were identified and extracted in 5 main areas including "Legislative", "Operational", "Manpower", "Supervisory" and "Financial", and 13 sub-areas.

 Based on the results of the present study, one of the problems in the administration and management of the Covid crisis was the lack of sufficient supervision and political requirements in order to control and prevent the spread of the disease, as well as the lack of a single decision-making organization. Also, financial problems and problems related to human resources were found to be among the most important issues.  On the other hand, from the point of view of the interviewees, the use of the 4030 system was one of the turning points in crisis management.

By evaluating the level of resilience engineering and resilience engineering combined with safety, health, and environment, the priorities of medical centers to face crises are determined. Therefore, this study aimed to implement a risk assessment model with a checklist designed in a fuzzy environment.

This cross-sectional study, in 2014, in two Faraja hospitals in Iran, using two risk assessment forms including seven resilience indicators (24 sub-indices) and three integrated resilience indicators with safety, health, and environment (8 sub-index) was done that the final risk level in each index was calculated with trapezoidal fuzzy numbers in the fuzzy environment and multiplied by the weight of each expert. Based on this, the priorities of each hospital were determined.

In the evaluation results, it was found that in the first hospital, management commitment and transparency, and in the second hospital, flexibility are the main priorities. In both hospitals, management commitment in HSE, knowledge in HSE, and learning culture in HSE were RE-HSE priorities, respectively.

Based on these results, it is suggested to focus on all the parameters, especially the parameters related to management commitment indicators, transparency and flexibility in RE, and management commitment in HSE.

Objective :

This study aims to design a local community-oriented readiness model (CRM) for Iranian medical universities in providing healthcare services to earthquake victims.

Methods:

 This is an applied-exploratory study conducted at two phases: (1) Designing a CRM for Iranian medical universities in providing healthcare services to earthquake victims (Qualitative approach), (2) Fitting and assessing the CRM (Quantitative approach). In the qualitative phase, a panel of experts including university professors in crisis management, senior managers of medical universities, and consultants in the field of crisis management were considered as the study population. In this phase, a purposive sampling method was used and sampling continued until theoretical saturation was reached. In the quantitative phase, the study population consisted of senior, middle-level and operational managers of 50 medical universities (n=500). Using Krejcie and Morgan’s table, 217 were selected as samples by a cluster sampling method. Eleven interviews were conducted in this study. The data collection tool in the quantitative phase was a researcher-made questionnaire consisting of 40 items, which was distributed and collected online. In the quantitative phase, test the hypotheses were analyzed in LISREL software.

Results:

 It was found that causal conditions had a positive and significant effect on the necessity of community-oriented readiness of medical universities in providing healthcare services at the time of earthquakes (t=0.46). The necessity of community-oriented readiness of universities of medical sciences had a positive and significant effect on the implementation of strategies in providing healthcare services at the time of earthquakes (t=0.61). Environmental conditions had a positive and significant effect on the implementation of strategies in providing healthcare services at the time of earthquakes (t=0.20). Moreover, the implementation of community-oriented strategies by medical universities had a positive and significant effect on reducing costs (t=0.55) and casualties (t=0.68), and on social capital capability (t=0.74).

Conclusion:

 The presented CRM has a good fit and, therefore, can be suitable for evaluating the community-oriented readiness of medical universities in Iran for providing healthcare services to the earthquake victims.