فصلنامه پرستاری، مامایی و پیراپزشکی
سال چهارم شماره 3 (زمستان 1397)

Care is the main essence, core, and element of the health system, which facilitates the improvement of the health and well-being of patients (1). In the health system, quality is defined as safe, timely, effective, efficient, fair, and patient-centered provision of care (2). Patient-centered care is one of the six areas expressed about the quality of health system and a vital issue in development of care quality. Today, patient-centered care is recognized as a global issue (3). In addition, patient-centered care is an essential element in improving the health system and gaining public trust, which leads to decreased mean duration of hospital stay, improved patient satisfaction, reduced hospital costs, and an overall enhancement in the treatment condition, health consequences, and life quality of patients (2, 4). Despite the positive impacts reported for patient-centered care, there have been barriers to the provision of this type of care, including lack of comprehensive policies, lack of adequate training in universities and hospitals, lack of coordination in the role of different people in providing patient care, lack of focusing on all aspects of patients, improper communications between healthcare providers, and workforce shortage (4, 5).
Today, considerable attention is paid to the concept of patient-centered care in the planning stage in the educational system and the accreditation process of hospitals. While health institutions and education departments use the concept of “patient-centered” in their terms, there is little evidence on the use of this concept operationally. Moreover, unavailability of this concept in healthcare systems of the world has become a concerning issue (5, 6). In the health system, quality management system are important tools for standardization and improvement of quality of services (5). In this regard, accreditation has been considered as a requirement by the Ministry of Health for the evaluation of hospitals since 2012 (7). Accreditation is a systematic extra-organizational evaluation process carried out to improve care quality and safety. By providing standards, this process directs hospitals toward the establishment of a comprehensive and systematic management system and promotion of safe, high-quality and patient-centered culture (8).
One of the most important standards of accreditation is the patient-centered concept, which includes access to care and continuity of care, observing the rights of patients and their families, patient assessment, patient care, anesthesia care in surgery, drug use and management, and education of patients and their families (9). Therefore, proper use of accreditation is expected to lead to the observing of patient-centered principles in providing services, ensuring patient safety, and constantly improving the quality (10). Despite gaining grade 1 and 2 acceleration by hospitals, the major problems of the health system are the quality and method of provision of health-centered services (6, 8, 9). Several studies have demonstrated the relative preparedness of hospitals in implementing the accreditation standards (6, 9, 10).

Results of other studies have shown that the health system of Iran deals with some challenges in the process of accreditation, including the position of the institution responsible for accreditation, the lack of proper and accurate definition of the implementation methods for accreditation standards, and the lack of a suitable combination of institutions participating in the process of accreditation, which are recognized as a big gap in this area (11, 12).
Furthermore, there is a great emphasis on documents in the accreditation process in Iran, in a way that several developed policies may not be implemented in practice. It seems that the investment aspects in the accreditation process have deflected health cares from their primary clinical objectives (e.g., being patient-centered). All of the issues mentioned can justify the lack of a rational relationship between the accreditation grade of hospitals and quality of patient-centered services. Therefore, the following questions are raised: “to what extent does issuance of an accreditation certificate provides valid evidence on the quality of patient-centered cares?” and “are patients and families considered as care recipients in the accreditation process?”.
What is the actual status of patient-centered care in the health system of Iran with excellent accreditation grades?
The important and effective role of accreditation in improvement of quality in various dimensions is undeniable. However, it seems that the most neglected aspect in provision of high-quality services is the centeredness of patients. In other words, it could be stated that not only the concept of accreditation do not meet the major needs of patients and their companions, but also it is mostly a factor that distinguishes an organization from its competitors.
Patient centeredness has no clear, distinct, and unified status in the execution process of accreditation of hospitals. Meanwhile, patient centeredness is a strategic concept in accreditation that must be beyond reducing errors and complaints and performing periodic evaluations for earning a grade (2, 12). Therefore, the concept and culture of patient centeredness must be identified and established fundamentally so that effective steps could be taken toward providing high-quality cares and achieving patient satisfaction. Accordingly, along with the implementation of accreditation standards, it is vital to pay attention to educational, clinical, and research infrastructures, especially in the area of safety of care and centeredness of patients, so that the proper performance of healthcare providing organizations could be ensured.
In order to improve the current status of the accreditation process, it is suggested that more dynamic and accurate analysis of the existing evidence on the effectiveness of accreditation components in providing patient-centered and high-quality results be carried out before planning for evaluation of the effect of accreditation and issuance of a certificate to hospitals. Furthermore, the culture of patient centeredness must be institutionalized in a way that it would be regarded an essential concept in all hospital standards (e.g., processes and outcomes of care provided by all medical and paramedical departments) and not just areas related to nurses.

Attaining optimal performance along with enhancing memory and recognition are among the most important goals of students in the field of academic achievement. This study aimed to evaluate the effect of computer assisted rehabilitation on the performance of working memory and recognition in the forms of Industrial Design students of Tabriz Islamic Art University. This quasi-experimental research was conducted on two groups of 15 subjects, who were selected through simple random sampling. Data collection tools included the companion rehabilitation program and test of working memory and recognition in forms. Data analysis was performed in SPSS version 21 using One-way ANCOVA. In this study, there was a significant difference between the test and control groups in terms of mean pretest and post-test scores (P<0.01). Accordingly, computer assisted rehabilitation improved the working memory and recognition in the forms of the subjects in the test group. According to the results of the study, computer assisted rehabilitation can be used as a method to achieve optimal performance in students.

Social physical anxiety refers to the feeling of distress associated with the perceived evaluation of one's physical self, which reduces the self-esteem of people. On the other hand, obesity and its associated disorders are a growing epidemic across the world. Therefore, this study aimed to evaluate the relationship between a course of regular physical activity and social physique anxiety in obese women. This descriptive-correlational research was conducted on 141 obese women attending physical fitness classes in Ajabshir, Iran in 2017, who were selected via random sampling and based on Morgan Table. Data were collected using Beck's physical activity questionnaires and social physique anxiety scale by Hart. Data analysis was performed using descriptive statistics, Pearson’s correlation coefficient, and multiple linear regression. In this study, there was a reverse association between labor (P=0.001), exercise (P=0.001), and leisure time (P=0.001). In addition, 34% of changes in the social physique anxiety of women was predicted by the index of labor. Exercise can improve social physical anxiety and body image. Therefore, performing exercise to reduce physical anxiety seems to be necessary.

Occupational burnout is one of the most common consequences of occupational stress. Nurses are orderly, caring, and motivated people before entering the nursing job, who, after encountering workplace stress and problems, tend to leave their careers. Therefore, this study aimed to determine the relationship between occupational burnout and the intention to leave in nurses working in the training hospitals of Sanandaj, Iran in 2015. In this cross-sectional research, 165 questionnaires were distributed among nurses working in different wards of training hospitals of Sanadaj selected by quota sampling (stratified). Data collection tools included occupation and demographic characteristics sheet, Maslach Job Burnout Questionnaire, and Attwod and Hinshaw intention to leave Prediction Scale. Data analysis was performed using Mann-Whitney U, Kruskal-Wallis test, and Spearman’s correlation coefficient at the significance level of 0.05. In this study, the level of occupational burnout was reported at 27.4±27.33 and 25.4±21.85 in dimensions of emotional exhaustion and depersonalization, respectively, which was considered moderate. Moreover, the level of occupational burnout was low in the dimension of incompetence (19.5±59.45). Mean and standard deviation of intention to leave was 3.04±0.34. Results were indicative of no significant correlation between occupational burnout and intention to leave. According to the results of the study, there was no association between occupational burnout and intention to leave.

Mood disorders are one of the most prevalent and costly disorders that reduce function and quality of life. This study aimed to evaluate the relationship between cognitive attentional syndrome and mood illusions in students of Islamic Azad University. This descriptive and correlational research was conducted on all students of Islamic Azad University of Tabriz (N=380) selected via multistage cluster sampling. Data were collected using cognitive attentional syndrome questionnaire and Beck's anxiety and depression questionnaire. Data analysis was performed in SPSS version 19 using descriptive statistics (frequency, percentage, mean and standard deviation), as well as Pearson’s correlation coefficient and regression analysis. In this study, there was a significant relationship between cognitive attentional syndrome and mood illusions of depression and anxiety. Moreover, cognitive attentional syndrome significantly predicted the mood illusions of depression and anxiety (P<0.01). Attention cognitive syndrome is a factor affecting the mood illusions of students, and is able to predict depression and anxiety. Therefore, it is suggested that counseling sessions be designed to improve cognition and attention in order to reduce the mood illusions of students.

Physical fitness is the ability to perform tasks efficiently and effectively and can reduce diseases caused by immobility. Positive attitude toward physical fitness in nurses is associated with improved self-esteem, enhanced work quality, reduced burnout and decreased environmental stressors. The present study aimed to evaluate the attitude of nurses in Zare Hospital of Sari, Iran toward their physical fitness. This descriptive and cross-sectional research was conducted on all nurses working in Zare Hospital in 2015, who were selected via census sampling. Data were collected using demographic characteristics questionnaire and physical self-description questionnaire (PSDQ). In addition, data analysis was performed in SPSS version 20 using descriptive and inferential statistics (Chi-square and Fisher’s exact test). In this study, 34% of the nurses had a good attitude toward their physical fitness while 59.4% and 6.6% of the subjects had a moderate and poor attitude in this regard, respectively. According to the results, no significant difference was observed between the attitude of male and female nurses toward physical fitness (P=0.103). In this respect, the only significant difference between the male and female attitude was related to the subscale of physical activity (P=0.003). Moreover, no significant difference was observed between nurses with various work experiences and in different age groups regarding the attitude toward physical fitness. In general, the attitude of the participants was reported to be at a moderate level. Considering the special role of nurses in the healthcare system of the country, the necessary incentives and facilities could be provided to nurses in order to participate in physical activities so that their spiritual and physical health could be improved.

One of the most important educational concerns in the past few years has been the effective presence of students in theoretical classes. Classroom attendance is an opportunity for learning and reducing student dropouts. This study aimed to determine the effective factors of the presence of students in theoretical classes from the perspective of dental students of Gilan University of Medical Sciences, Rasht, Iran. This descriptive, analytical, and cross-sectional research was conducted on 112 dental students, selected via census sampling. Data were collected using the standard questionnaire of effective factors of the students in the classroom (20 items). Data analysis was performed in SPSS version 21 using descriptive and inferential statistics (independent t-test and ANOVA) at the significance level of P<0.05. In this study, mean age of the subjects was 22.7±2 years. In addition, 55.4% of the subjects (N=62) were male and 49.1% (N=55) were local students. The highest mean scores were related to the dominance of professors over the course content, proper teaching method, interest in the course topics, and application of contents presented in actual situations, respectively. In addition, among the factors affecting the presence of students in theoretical classes, the highest mean score was reported for issues related to students. According to the results, there was a significant relationship between academic year and the field of factors related to the professor (P<0.05). Scientific proficiency of professors, teaching method and interests of students were among the effective factors of the presence of students in theoretical classes.

Nursing is one of the most important occupations that play a key role in the treatment and improvement of patients. High work load and psychological problems can significantly reduce the quality of services and endanger the lives of patients and the health of the nurses. The study aimed to determine the relationship between the workload of nurses and their performance in the intensive care units (ICUs) of teaching hospitals in Tehran, Iran in 2017. This descriptive and correlational research was conducted on nurses of teaching hospitals in Tehran, Including Sina, Imam Khomeini and Shariati hospitals. In total, 188 out of 371 nurses were selected based on the Cochran Formula. Subjects completed the questionnaires of workload and performance of nurses. Data analysis was performed in SPSS version 20 using stepwise regression. In this study, 75% of nurses assessed their performance to be favorable. According to the results of the stepwise regression, the subscale of workload was able to predict 39% of the performance of nurses. According to the results of the study, there was a reverse relationship between occupational performance and workload of nurses since the increased workload of nurses working in ICUs reduced their performance.