فصلنامه پژوهش های سلامت محور
سال پنجم شماره 2 (پیاپی 17، تابستان 1398)

Residents spend much of their time at the hospitals to earn their required educational skills and although they act as a kind of human resource in the hospital, they increase hospital costs. The present study was designed to calculate the share of educational costs of different medical residents in hospitals.

In this descriptive and applied study performed in one of the hospitals affiliated to Iran University of Medical Sciences, the hospital cost items of education of residents in different medical fields during the academic year of 2017-2018 were identified by use of two scenarios.

In short, mean educational cost of one resident in the studied academic year was about 5357$ based on the first scenario and about 5404 $ according to the second scenario. Based on both scenarios, salaries paid to residents accounted for more than 50% of the costs followed by the cost of consumed materials by residents. Forensic Medicine and Anesthesiology residency programs had respectively the lowest and highest share of costs in both scenarios.

The cost of training in the hospital is different among residency fields based on the required tests and errors in each field. But, in order to save hospital costs, the culture of optimal use of materials as well as medical equipment should be taught to residents.

The hoteling quality improvement package of the Health Reform Plan has provided Health Ministry managers with an unprecedented opportunity to optimize the hoteling services. This study investigated the managers’ view on the challenges and opportunities of this package.

This qualitative study with phenomenology approach was done on 15 hospital managers and staff managers of Isfahan University of Medical Sciences selected through purposeful sampling. Data were collected through semi-structured interviews with the average time of 25 minutes. All interviews were analyzed using the thematic content analysis approach and MAXQDA10 software.

The identified challenges were classified in 6 main codes and 24 sub-codes. The main codes contained: financial, managerial and planning, monitoring and evaluation, legal cases, equipment/ facilities and buildings. The Identified opportunities were classified in 4 main codes and 10 sub-codes with main codes containing main advantages of hoteling, patient satisfaction, management and process opportunities and structural and infrastructural opportunities.

To reduce the challenges of hoteling package and reinforcement of the opportunities, some strategies should be considered by the health system policymakers such as the equitable allocation of budget resources, training managers and more supervision to avoid the waste of resources, continuity of resources and resource allocation based on the real needs, budget allocation and expenditure according to the guidelines.

One of the most important factors for the maintenance and improvement of each organization is its employees’ loyalty to the organization. The aim of this study was to determine the factors affecting employees’ loyalty to the organization from the perspective of staff and managers at Rafsanjan University of Medical Sciences.

From the perspective of staff, the coefficient between the variables of employees’ loyalty to the organization and the components of organizational commitment, organizational support and condition, financial benefits and independence and autonomy were 0.412 and 0.192, 0.466 and 0.321, respectively, which shows a significant relationship between staff loyalty to the organization and the mentioned components. From the managers’ perspective, the coefficients between employees’ loyalty to the organization and the components of organizational commitment, organizational support and also job-organizational conditions were 0.261, 0.464 and 0.442, respectively, which indicates a significant relationship between the loyalty of employees and the mentioned components.

Among 159 people died, 69% were girls and 31% were boys. The most kind of accidents occurred to them were injury (39.67%), poisoning (20.56%), and falling (15.11%). Accidents range was higher among girls and among 3-4-year-old children. Age, Sex, and season of death did not have any correlation with the kind of accident however there was a significant correlation between accidents occurred amongunder-5-year-old children and their season of death. 

Through establishing critical thinking in the organization, employees can directly express their views and criticisms to the managers, so that the perceptual gap between managers and employees will be reduced. This will make employees more loyal to the organization.

Stroke is the third leading cause of death and the most common disease of old age. Pre-hospital care time is very important in these patients. The purpose of this study was to determine the status of time indices of pre-hospital emergency services in stroke patients of Fars province.

This cross-sectional descriptive study was performed from March 2018 to December 2018. Medical files of 327 stroke patients received emergency cares by Emergency 115 were selected through census sampling and reviewed. Data gathering tool was a checklist and data were analyzed through SPSS20 software package.

Stroke patients comprised 0.2% of all emergency 115 patients. Among stroke patients, 51% were men and 80% were elderly. From all, 88.7% were transferred to the hospital, 11% received urgent care in place and one patient had died. Among the studied cases, 32% had a history of stroke, 41% had high blood pressure and 8% had heart disease. The mean time of transforming stroke patients to the hospital was 37 minutes from the first calling of Emergency 115. For other transferred patients, mean times of transferring by ambulance and Air Emergency were respectively 52 and 38 minutes.

Monitoring the performance of Emergency Technicians reduces service time and the rate of mortality and morbidity of stroke patients. By screening for health and increasing public awareness in the field of health, mortality and disability can be prevented in these patients.

Ethical values act as the most powerful factors influencing citizenship behaviors. This research was conducted to investigate the relationship between ethical climate and organizational citizenship behavior in nurses of hospitals affiliated to Shahid Beheshti University of Medical Sciences.

This descriptive-analytical study was performed on 307 nurses selected through random sampling in 2016. Data gathering tools were two questionnaires of ethical climate and organizational citizenship behavior. Data analysis was done through SPSS20 and using descriptive statistics, t-test, One- Way ANOVA, correlation and multiple regression tests.

Mean scores of ethical climate and citizenship behavior were respectively 3.51 ±0.55 and 3.49 ± 0.45 that reflects the favorable view of nurses towards ethical climate and citizenship behavior. Head nurses had the highest mean scores in the dimensions of ethical climate. Among the dimensions of citizenship behavior, the dimension of conscience gained the highest mean score among nurses. There was a significant relationship between employment status and ethical climate (P<0.001) and also a positive and significant correlation between ethical climate and citizenship behavior (P<.0.001).

Promotion of ethical climate enables nurses to respond better to ethical stress, to adapt to other causes of workplace dissatisfaction and consequently showing citizenship behaviors. Some meetings are required to be held in order to improve the relationship between physicians and nurses, to create alignment and understanding among staff and consequently to improve citizen behaviors.

Ensuring high quality care for diabetic patients is a challenge for healthcare systems throughout the world. The aim of this study was to evaluate the relationship of quality of services provided to type 2 diabetic patients with self- assessment in comprehensive health service centers.

This descriptive-analytic cross-sectional study was conducted on 203 patients with type 2 diabetes referred to ten comprehensive health service centers of south Tehran/ Iran in 2018 selected through convenience sampling method. Data collection tool was a questionnaire for comprehensive assessment of quality of health services. Data were analyzed through SPSS22 and using t-test, ANOVA and logistic regression statistical tests.

From the perspective of patients, mean score of quality of services was 7.47. Among different health services, the highest mean score of quality was related to trust and continuity of service while, support and prevention gained the lowest mean score of quality. There was a significant statistical relationship between the quality of service and self-assessment of diabetes control in the past 12 months (P= 0.007). Also, a significant relationship was found between the quality of service and diabetes complication (P = 0.04). With each unit increase of the quality of service, the odds of a standard visit increased by 27% (P = 0.013). 

Design and implementation of interventions in order to increase the social support of patients and sharing their experiences with each other as well as improving the dimensions of prevention and safety in care are essential.

Department of Nutrition is one of the most important parts of a hospital that has a significant role in patient's satisfaction. Managers' attention to the quality of nutrition services reduces hospital costs. This study was conducted to identify the challenges of the nutrition department of a selected teaching hospital.

The present study was a qualitative study done with phenomenological approach in 2018. Purposeful sampling and snowball sampling were used. Data collection was done through semi-structured interview.  Participants were 25 individuals involved in the nutrition department of the selected teaching hospital in Kerman. Finally, data analysis was done using framework analysis.

The identified challenges were classified into 7 main codes and 21 sub-codes. Main codes were the contracts and tenders, staff supervision, financing, operational line monitoring, human resources, quality of food and physical space. 

Paying attention to the hospitals’ nutrition departments is one of the main factors in patients' recovery and an inseparable part of the treatment process. Therefore, hospital managers and policymakers should pay particular attention to this part and to improve the nutrition department status of the hospitals through reviewing and modifying contracts and tenders, staff supervision, financing, queue monitoring and providing sufficient human resources, high quality food and required physical space.

Environmental health professionals are among the most important sources of health system in the health sector. Issues such as job stress and job dissatisfaction can have an adverse effect on organizational commitment of health personnel. The purpose of this study was to investigate the relationship of job stress and job satisfaction with organizational commitment in environmental and occupational health professionals working in Alborz and Ahvaz Jundishapur Universities of Medical Sciences.

This cross-sectional, descriptive-analytical study was performed on 238 occupational health and environmental health staff. Data were collected using Osipow Job Stress Scale, Ellen Meyer's Organizational Commitment, and Susan Job Satisfaction questionnaires.  In this study, t-test, two way ANOVA and linear regression analysis were used to determine the factors affecting organizational commitment. Data were analyzed through SPSS statistical software version 22.

The majority of the studied subjects were women (75.5% of environmental health staff and 81.5% of professional occupation staff).  Among the dimensions of organizational commitment, continuous commitment obtained the highest score among employees of Environmental Health (30.19 ± 6.15) and Occupational Health (27.55 ±7.49). Job satisfaction had a strong significant relationship with the three dimensions of organizational commitment (P<0.01).

Through teaching stress management skills and increasing job satisfaction in these occupational groups, organizational commitment could be improved.