challenge

Considering the rapid increase in the number of elderly people and the lack of infrastructure to provide services to this group, all responsible organizations, in collaboration with the elderly and their families, must set a strategic goal and purposefully guide the community towards community-based care. This study was conducted with the aim of identifying the challenges of underdeveloped elderly day care centers and providing management solutions for the development of these centers.

This was a descriptive-analytical study conducted in 2023 through interviews with 13 experts and managers in the field of aging in the city of Isfahan. For this purpose, a review of the literature related to the research topic was conducted, and in consultation with the supervising and advising professors, semi-structured interview questions were designed to identify the relevant themes of the research objective. After data collection, the data were analyzed using MAXQDA10 software.

Ultimately, 203 semantic codes and 10 subcategories were identified, and finally, 5 main categories. Financial challenges, challenges in human resource provision, the impact of COVID-19 on elderly day care centers, cultural and social challenges of elderly day care centers.

With proper planning and the involvement of stakeholders and decision-makers in the field of aging, the results of this research can be utilized to advance the development of senior day care centers and prevent future crises and challenges related to aging.

Hospital accreditation globally is conducted through two different approaches: employing specific standards for various types of hospitals, or applying the same standards across all hospital types, as seen in Iran and many other countries. This study explored the benefits and challenges of using the same standards for all types of hospitals from the perspective of accreditation experts.

This qualitative descriptive study was conducted with the participation of 30 employees of the target hospitals, national accreditation assessors, and experts from the Ministry of Health's monitoring and accreditation office. The interviews were semi-structured and conducted during individual sessions. The data was analyzed using content analysis using MaxQDA software.

The benefits of the same standards were emereged in three themes ("competitive", "functional”, and "financial"), and the challenges were also emereged in three themes ("challenges related to the nature of the hospital", "challenges related to the accreditation process", and "financial challenges"). “The motivation to compete with other hospitals” and “not paying enough attention to the specific conditions of each hospital” were the most frequent mentioned benefits and challenges, respectively. The “financial” theme was emerged as both benefits and challenges, albeit with different sub-themes.

To optimize accreditation as much as possible, in addition to the existing standards, accreditation organizations should move towards developing and adding specific standards according to the type of hospitals in order to reduce the challenges of accreditation in addition to maintaining the existing benefits.

Clinical education plays a crucial role in shaping the capabilities and professional skills of learners, and it is an essential and sensitive part of medical education. Clinical education provides students with information and skills related to patient care, as well as improving decision-making skills, critical thinking, and increasing students' self-confidence. Clinical education provides an opportunity for transforming theoretical knowledge into practical skills in caregiving, meaning that enhanced education leads to improved quality of care. Therefore, attention to clinical education and its influencing factors is important. With the importance of continuous assessment of the current status of clinical education, it is proposed to review the content of courses and provide clear objectives, lesson plans, clinical education programs, and thorough justification for students. The use of new educational aids, appropriate planning for dividing students into sections, and equipping departments with more facilities can reduce the problems in clinical education. Furthermore, authorities ought to enhance educational quality by regularly evaluating the current landscape and employing feedback from learners and teachers to examine issues and pinpoint existing obstacles and difficulties.

Considering the beginning of the implementation of electronic prescribing in the country, the present study was conducted with the aim of explaining the challenges during the implementation of electronic prescribing.

This study was conducted using a qualitative method through interviews with physicians working in Mashhad University of Medical Sciences in 1401. The participants were selected by purposive sampling, after conducting three in-depth interviews, interview questions were extracted. After the semi-structured interviews were conducted, they were recorded and implemented, in order to analyze them, content analysis method and MAXQDA version 10 software were used.

In this study, the challenges were categorized into two main categories, including the organizational category and the infrastructure category. organizational challenges; Challenges related to insurance, referral of patients, education and information to beneficiaries, monitoring and infrastructure challenges; infrastructure, user interface and database. The main challenges of implementing electronic prescribing were related to the outage and slowness of systems and the Internet and the existence of multiple systems for insurances.

the infrastructure challenges which are among the important obstacles in the path of the full implementation of the electronic prescribing plan should be resolved, in order to improve the implementation problems, the continuous monitoring of the prescribing systems should be considered and the results should be applied immediately, as It is recommended to reform infrastructures, integrate insurance systems, use electronic signatures and electronic version standards, and provide practical training.

Dear Editor, At present is the era of tremendous changes in human knowledge. The importance of knowledge transfers and the use of research results for decision makers, as a supplement to knowledge production, is increasing in developed and developing countries. In Iran, knowledge-based development is one of the pillars of the country's 20-year vision. Nevertheless, despite three decades of efforts in knowledge translation produced in medical sciences, the status of knowledge transfers and exchange is not satisfactory. On the other hand, due to the large amount of time, money and energy that is spent on conducting research, greater effectiveness and optimal use of its results are always the concern of managers and executives at all levels. In such a situation, it is necessary to move from the current situation to the ideal situation through review the current process, formulate intervention and solutions based on the existing context and platform, modify and improve the current trends.

One of the major reforms in the health system is the stratification of the healthcare system. Establishing appropriate connections between health service levels is carried out to reduce costs, create equity, and provide access to necessary services for all people. This research was conducted to identify the communication challenges between the first and second levels of care.

This study was conducted using a scoping review method. At the beginning of 2024, all articles published from 2010 to 2023 related to communication challenges between the first and second levels of care in Iran were searched and collected in English databases PubMed, Scopus and Web of Science, Persian databases Magiran and SID, and Google Scholar search engine using appropriate keywords. A total of 653 articles were obtained, of which 24 were included in the study. The resulting data were analyzed using the framework analysis method.

Reviewing the studies, 21 important challenges were identified and categorized into six areas: governance/leadership, service delivery, financing, facilities and equipment, human resources, and information system.

Weakness in proper cooperation between family physicians and specialists, insufficient training and inadequate staff skills, Weakness in cultural development and building trust in the community, and weakness in coordination among executive agencies were mentioned more than other challenges. This indicates the health system governance's insufficient attention to effectively engaging various key stakeholders in policymaking, planning an implementation process.

 The process of thesis completion inherently involves its own set of challenges and complexities, and understanding students’ perspectives can enhance this process. This study aims to investigate the attitudes of general medical students toward the thesis writing process.

 This cross-sectional descriptive study was conducted on general medical students at Tehran University of Medical Sciences in the year 2021. A total of 117 students, randomly selected from those actively engaged in thesis work or recently defended their theses, participated in the study. The research tool was a questionnaire consisting of 54 questions, including four demographic questions and 50 questions related to the thesis completion process. Data analysis was performed using descriptive and analytical statistics in the SPSS software.

 The most important criterion for choosing the subject of the dissertation was related to the possibility of collecting information from patients’ files (7.15 out of 10). The most favorable answer in the field of choosing a supervisor was quick and convenient access to the supervisor (93 percent). The most favorable answers regarding the process of completing the thesis and its challenges were related to the fact that I was free to choose a supervisor (93 percent) and the involvement of final year medical students in the bedside and intensive care (91 percent).

 University managers with the identified challenges related to the thesis process can take effective measures to solve these challenges and increase the quality of theses.

The study of the health systems in developed countries shows that the prevention of disease is considered as an important and undeniable component in the success of health systems. One of the effective methods to achieve disease prevention at all levels is the use of family physicians. The World Health Organization (WHO) has also mentioned the implementation of the family physician program as an effective strategy in improving service delivery, reducing costs and establishing equity in health care delivery.

Given the significant migration of educated individuals, particularly epidemiologists, throughout the country, it is crucial to investigate the underlying causes. This article presents the findings of an extensive study that sought to explore this issue by gathering insights from experts in the field.

The study was conducted using qualitative methods, employing content analysis. Data were collected between summer and autumn 2023 through semi-structured interviews with 32 epidemiologists in the country. Analysis followed the steps outlined by Lundman and Graneheim, with coding facilitated by MAXQDA software.

The main challenges of epidemiology in Iran were divided into six main categories. In the field of graduate students, problems in recruitment and employment due to the lack of suitable careers, infrastructure and structural problems of the system, research problems and insufficient knowledge about the performance of this field are the most important challenges, and in the field of students, education problems, structural and infrastructure problems were reported. Also, the main reasons for the migration of epidemiologists were the lack of meritocracy and specialization, inappropriate privileges (including the application of unconventional recruitment quotas), lack of a job market and opportunities for graduates, and inadequate compensation and benefits.

Based on the results of this study, it seems that the migration of epidemiologists as a valuable human resource abroad is a serious concern and problem. The lack of a suitable job position and ambiguity in the path to career advancement due to non-adherence to the meritocracy and skill-building system have increased the motivation to migrate in this group.

Despite fundamental advancements in the understanding of health and the new strategy of the World Health Organization in enhancing the health of the individual, organization, and society, health education and promotion is a relatively new major in Iranian medical and health science. However, it has not yet been introduced as a specialist major at various levels. This research aims to investigate the challenges of educational quality and the position of health promotion and education.

The current study employs a qualitative research with a structured content analysis approach. In this research, 24 health education and health promotion specialists, and graduates were chosen using a purposive sampling method From September2022 to May 2023. Using semi-structured interviews, different people’s perspectives on the challenges of health education promotion were investigated, and After 22 interviews, no new code was extracted, but two more interviews were recorded to make sure, and sampling continued until data saturation (24 interviews). The collected data were analyzed using the Graneheim and Lundman approach.

The challenges of the major of health education promotion from the perspective of the research participants include two main components: 1) scientific capacities (with sub-components of improving the curriculum and empowerment of professors and students) and 2) structural capacities (with sub-components of creating a position for the major of health education and promotion and determining the organizational level of employment).

According to the findings, the quality of health education and health promotion may be enhanced by upgrading the curriculum, elevating professors, and providing a space for the major. In this respect, introducing the major at various levels of society can be useful in attracting motivated and talented people to study at higher levels and training scientifically and ethically outstanding professors in this major. As a result, to adapt to the aims of health education promotion and to apply it and the way professors teach, it is suggested to implement a broad curriculum reform and hold meetings with policymakers to expose the area to decision-making levels.

Emergency departments of hospitals play a very important role in the health system, and the effectiveness of these services can be effectively increased by using health information technologies. The purpose of this study was to prioritize the challenges of implementing electronic medical records in the emergency department of selected hospitals in Isfahan. This descriptive-cross-sectional study was conducted in 1401. The research population included doctors and nurses from Al-Zahra, Kashani and Amin hospitals of Isfahan University of Medical Sciences. The data was collected through a researcher-made questionnaire. The validity of this tool was confirmed based on the opinions of 10 experts, and the reliability of the questionnaire was obtained by calculating Cronbach's alpha of 0.85. Data analysis was done using SPSS statistical software software and presented via Mean and standard deviation. The findings showed that challenges in the organizational field, technical field, human field, and financial field had the first to fourth priority, respectively, among the organizational challenges, the increase in the workload of health service providers, the complexity of the processes of accepting and providing services to emergency patients and the lack of necessary infrastructure for electronic transmission of information to interested organizations has been assigned the highest priority. The effective implementation of electronic medical records in the emergency department of the studied hospitals requires the development of effective processes for accepting and providing medical services to emergency patients, providing the necessary organizational and technical infrastructure for proper access of health service providers and other users to electronic records. and providing funds for training users.

‏Considering the importance of the mixed method research in the future of nursing research, it is ‎necessary to examine the challenges faced by nursing researchers and provide solutions for the elimination of ‎problems in this area. ‎The aim of this study is to introduce a brief overview of the mixed method research and its challenges in ‎nursing.‎

This study was performed by reviewing and searching in reliable databases such as Google scholar ‎PubMed, Ovid, Magiran, Sid, with the keyword mixed method research and nursing in Persian and English between ‎the years 2000-2019.‎

In this paper, we have tried to introduce the summary of mixed method ‎research, history, definition, reasons, advantages and disadvantages, the most important typology presented in the ‎nursing is examined and challenges in the design and implementation of mixed method research will be addressed. ‎

The most important challenge in the field of mixed method research in nursing is the lack of a ‎comprehensive and effective guideline to designing and implementing these studies. Therefore, it is recommended ‎that the experts design the appropriate guidelines in order to guide young researchers in conducting mixed method ‎research.

Nurses’ clinical competence, as the basic component of nursing care, is a very important and vital issue. Nursing competence has always been a challenging issue. In order to maintain the standards of nursing care, it is necessary to know the methods of developing and promoting clinical competence. The present study aims to examine and review the challenges and the approaches to obtaining clinical competence in Iran, so that the obtained results can help nursing managers and lecturers with promoting nursing competence, whose ultimate goal is to provide quality care to the patient.

The present research is a review study. The articles written in Farsi or English were included in the study. They were extracted using Farsi databases including SID and Magiran and Latin databases including ProQuest, Science Direct, Google Scholar, Ovid, PubMed. The search was conducted with no time limit until March 2020 and using the keywords nursing competence, nursing clinical competence and competence. After the careful examination of the title, the abstract and the full text of each article, a large number of articles were excluded due to the languages in which they had been written, different titles and purposes and inappropriate abstracts or contents. In the next step, 71 articles (44 Farsi and 27 English) were studied and, finally, 23 articles were included in the study.

Ethical Considerations: 

In order to organize this research, while observing the authenticity of the texts, honesty and fidelity have been observed.

The educational and clinical challenges were investigated, along with the relevant approaches. Unmotivated students and inexperienced nurses’ low level of competence are among the mentioned challenges. Taking both educational and clinical measures, as an effective approach to improving clinical competence, will help reduce the gap between education and clinical practice.

Through recognizing the aforementioned challenges and approaches to improving clinical competence in nurses, it will be possible to ensure quality care provision, which is an important step in developing the health system. The recommended approaches include modifying the curriculum, increasing critical thinking skills in students and professors, increasing professors’ clinical and communicational skills, professors’ using different teaching methods and holding workshops and in-service training courses for nursing personnel and instructors.