نشریه پرستاری ایران
پیاپی 130 (تیر 1400)

One of the basic principles of health care is to maintain patient safety. Today, patient safety is a priority for any healthcare system that seeks to ensure and improve the quality of care. Being safe from dangers and injuries when receiving healthcare services is one of the most obvious and fundamental human rights. Despite advances in healthcare, patient safety, and patient-centeredness are still worrying issues around the world.  According to the World Health Organization, tens of millions of people die or become disabled annually due to clinical errors or unsafe treatment processes, which is one of the five leading causes of death in the world. Recent reports also show that approximately, 13.5% of hospitalized patients experience at least one adverse event during their hospitalization each year, 44% of which is preventable. The biggest challenge to make the healthcare system safer is changing the culture. Assessing the patient safety culture can provide information on how structures and processes within the system affect patient outcomes. However, the question remains that, given the structure of the existing healthcare system and the fact that in recent years, patient safety has been at the forefront of accreditation of medical centers, has the safety culture been able to find and establish its place in these centers and has the staff of medical centers (especially nurses) paid attention to patient safety culture due to the changes that have taken place in the past years. Therefore, this study was conducted to compare patient safety culture in nurses of Sabzevar Vasei Hospital between 2016 and 2020.

The present study is a descriptive-analytical cross-sectional study that was conducted between 2016 and 2020. 123 nurses of Vasei Hospital were selected in 2016 and 124 were selected in 2020 via convenience sampling. Inclusion criteria were having at least 6 months of work experience and consent to participate in the present study, applied in both 2016 and 2020. A two-part questionnaire was used to collect data. In the first part, the demographic information of the samples including age, gender, field and degree, occupation, type of employment, work experience in the hospital, work experience in the recent ward, working hours per week were examined. The second part of the questionnaire included the Persian version of the "Patient Safety Culture Survey" (HSOPSC). The questionnaire was designed by American Agency for Healthcare Research and Quality in 2004. In the present study, the questionnaire was given to 10 experts to confirm the validity, and their opinions were applied. The reliability of the questionnaire was investigated in 2016 using Cronbachchr('39')s alpha coefficient which was between 0.74-0.81 for safety culture and its various dimensions. This questionnaire has 42 questions designed on a 5-point Likert scale ranging from strongly disagree to strongly agree. Therefore, each question was assigned a score of 1 to 5. This questionnaire has 12 dimensions including the frequency of reporting events, the overall perception of safety, managerial expectations and actions, organizational learning, teamwork within the organization, open communication channels, communication and feedback, non-punitive response to errors, staff-related work issues, safety management support, teamwork out of the organization, transmission and exchange of information. In this study, after calculating the percentage of positive responses in each dimension (sum of completely agree and disagree options), and based on the questionnaire guide and examining the 12 dimensions, an average positive response of at least 70 indicated optimal safety culture, between 50-69 showed a moderate level of safety culture, and below 50 indicated a low level of safety culture. Data analysis was performed using descriptive statistics, chi-square, Fisherchr('39')s exact test, and independent t-test in SPSS version 16, and the significance level was set at P<0.05.

The obtained results regarding the individual characteristics of the study units showed most subjects were women and married. There was no significant difference in terms of demographic characteristics of nurses in 2016 and 2020 (P>0.05). The overall score of patient safety culture in 2016 was 41.9 ± 6.9% which was low, also the overall score of patient safety culture in 2020 was 51.2 ± 7.7% which was moderate. In 2016, expectations and managerial actions had the highest score (63.1 ± 29.3%) and non-punitive response to errors had the lowest score (11.3 ± 15.6%). In 2020, the dimensions of communication and feedback and non-punitive response to errors had the highest scores (70.6 ± 23.4% and 31.8 ± 24.3% respectively) among the various dimensions of patient safety culture. The comparison of the mean scores of some dimensions in 2016 and 2020 was also statistically significant (P<0.001). The results showed better performance of some dimensions such as the frequency of reporting, open communication channels, communication and feedback, non-punitive response to errors, staff-related work issues, and transmission and exchange of information in 2020 compared to the initial survey in 2016. Regarding the dimensions of organizational learning and teamwork within the organization, the average score was higher in 2016, which was also statistically significant. Comparison of mean changes in other dimensions of the overall perception of safety, management expectations and actions, safety management support, and teamwork outside the organization in 2016 and 2020 were not statistically significant (P>0.05). In 2016, 61% of nursing staff made no errors, which was equal to 47.6% in 2020and is not statistically significant. Also in 2016, 12.2% of patients reported the safety of the ward to be very good or excellent, which was 26.6% in 2020, and is statistically significant (P<0.05).

The findings of the study indicate that while there are significant improvements in the overall score of safety culture and some of its dimensions, there are still dimensions of patient safety culture that managers and officials should strive to improve and strengthen. In this regard, general strategies for further improvement of patient safety practices and more investment in determinants of patient safety culture, especially in the areas of organizational learning and teamwork within the organization, should be guided and informed. Also, regular management and assessment of patient safety can enable hospitals to better understand and perform more efficiently.

Childbearing is one of the most important components of population science and is more important than other demographic phenomena such as death and migration. Therefore, population policies in most countries are mainly focused on reducing or increasing fertility. Nowadays, we are facing a decrease in the tendency to have children in Iran, so that the total fertility rate (TFR) has decreased to 6.5 since mid-1978 and reached replacement level fertility in 1999 and is expected to decrease to 1.13% during 2020 - 2024. According to the Low Population Growth Scenario released by the United Nations in 2010, if Iran continues replacement level fertility and has no plan to balance it, its population will reach 31 million in the next 80 years, and 47 percent will be the elderly over 60 years. These statistics and reports have caused serious concerns for the authorities, and the Supreme Leader of Iran has mentioned this issue several times and called for serious planning and legislation to get out of this situation. This has made population growth policies one of the priorities of the government. Meanwhile, according to previous researches, Markazi province is ranked as the third city in terms of the low desire of women to have children. This study aimed to determine the factors related to childbearing willingness in 18-45 -year old women referring to Arak health centers in 2019.

This cross-sectional study was performed on 255 women aged 18-45 years, in 2019. The women were unwilling to have children. Data were collected from these women referring to 10 health centers in Arak who were selected through cluster sampling. Sampling was performed in January 2019. The data were collected through a questionnaire and included demographic information and variables related to childbearing willingness taken from Piltan et al.chr('39') questionnaire (2015) which included 78 items on religious beliefs (21 items), economic status (15 items), social participation (14 items), marital satisfaction (6 items), childbearing problems (7 items), gender socialization (5 items), fashionism (6 items), and fatalism (4 items), scored on a 5-point Likert scale ranging from strongly agree (1) to strongly disagree (5). In order to assess the validity of the questionnaire, researchers extracted all the factors related to childbearing unwillingness from different researches and included them in the personal characteristics part of the questionnaire and a few faculty members assessed its reliability. Also, to evaluate the validity of the variables related to childbearing unwillingness, factor analysis methods and KMO test were used and all major components with a factor load of higher than 0.5 were confirmed, indicating a minimum acceptable correlation between factors and the items. In order to investigate the factors related to childbearing unwillingness in women referring to Arak health centers in 2019, independent t-test and chi-square were used and also to investigate the normal distribution of data, skewness, and kurtosis were used.

According to the results, 9% of women unwilling to have children obtained low scores in terms of social participation, and 90.9% obtained medium and high scores. In addition, 9.8% of women unwilling to have children had low economic status, and 90.2% had medium and high levels. 3.9% of women unwilling to have children were at the low level in terms of marital satisfaction and 96% were at the medium and high levels. 2% of women unwilling to have children were at a low level in terms of childbearing problems and 98 were at the moderate and high levels. 38.8% of women unwilling to have children obtained low scores for gender socialization, and 61.2% obtained medium and high scores. 48.2% of these women obtained low scores for fatalism and 51.7% were obtained median and high scores. In addition, 32% of the women had low scores in terms of fashionism, and 68% had medium and high scores. Also, the results of the study revealed that only 0.4% of the women participating in the study had low religious beliefs and 11.4% had average to high religious beliefs, and 88.2% were at the high level. Given that the upper and lower limits for the variables of social participation, economic status, marital satisfaction, childbearing problems are positive, so at 95% confidence interval, a direct relationship can be concluded between the variables of social participation, economic status, marital satisfaction, childbearing problems with childbearing unwillingness in women referring to Arak health centers at 95% confidence interval. Also, considering that the upper and lower limits for the variables of gender socialization and fatalism are negative, and the lower limit is negative for fashionism, so at 95% confidence interval, no significant relationship can be concluded between the variables of gender socialization, destiny and fashionism with unwillingness to have children. The results showed that only 0.4% of participants had low religious beliefs, 11.4% had average religious beliefs, and 88.2% reported high religious beliefs.

The decline in population growth in Iran is one of the most important problems and based on the results, women who do not want to have children have higher scores in terms of social participation, economic status, and marital satisfaction, so, it is necessary to teach them the importance of having children in health centers. On the other hand, in the present study, higher education level and social participation of women have been suggested as important factors related to womenchr('39')s unwillingness to have children. On the other hand, fertility problems were reported in most women who did not want to have children. Accordingly, proper management of active forces in society, including women, can prevent a sharp decline in fertility. This can be done by paying attention to family-oriented policies. In fact, providing low-cost care services for the children of mothers with higher social participation and making some laws in this area help women to combine maternal and social roles. As a result, women can engage in extracurricular activities such as education, employment, and social activities while caring for their children, and on the other hand, the tendency to have children may increase by reducing the problems of childbearing. One of the limitations of the present study was that self-report of marital satisfaction and economic status may have affected the accuracy of the results, which was beyond the control of the researcher.

Bipolar disorder is one of the most common psychiatric disorders in the 21st century. It is a chronic, recurrent disorder causing mood swings, and patients alternate between episodes of mania and depression. Diagnosis of bipolar disorder is a stressful issue for the individual and his family. The disease not only causes anxiety and stress for the client, but also causes severe disturbances to his family. The family caregivers of clients with a psychiatric disorder and the resulting stress do not react in the same way and choose different ways to deal with the illness. Denial, anger, feelings of shame, as well as indifference and change in the relationships between family members are among the negative feelings in caregivers. Caregivers can only overcome the stress of caring for a client with a psychiatric disorder and maintain their health and that of their family when they are resilient. The concept of resilience in caregivers of clients with psychiatric disorders refers to the flexible and well-developed behavioral pattern of caregivers in response to the difficulties and challenges encountered while caring for the client. Resilience in caregivers of clients with psychiatric disorders is a dual concept. On the one hand, caregivers overcome the difficulties and challenges of caring for the client and take steps to maintain and improve his physical and mental health. On the other hand, by promoting their mental health, they are able to act stronger than before in the face of advanced troubles and problems. Therefore, this study aimed to determine the effect of a psychoeducation program on the resilience of caregivers of patients with bipolar disorder hospitalized in Sanandaj Psychiatric Center.

This is a quasi-experimental study conducted during autumn and winter, 2019. The samples included 64 caregivers of a client with bipolar disorder hospitalized in Sanandaj Psychiatric Center. Convenience sampling was employed, and the samples were randomly divided into experimental (32) and control (32) groups. For sampling, the researcher first visited the psychiatric center and identified caregivers of clients with bipolar disorder. Then, the researcher introduced the study and obtained written informed consent. In the next stage, the caregivers who met the inclusion criteria were selected. First, the caregivers of the control group and then the caregivers of the experimental group entered the study (to prevent the transfer of information in the groups). Caregivers were asked prior to the study to complete a demographic questionnaire and the Connor-Davidson resilience scale (CD-RISC). The caregivers of the experimental group underwent psychoeducation in groups of 4 to 5. The training lasted four weeks and was performed one a week for about 45 to 60 minutes. Psychoeducation followed a systematic and structured approach in order to raise awareness and change the attitude of families about the nature of the disease, how to treat it, increasing communication skills, and problem-solving skills during the training sessions. Some components of psychoeducation, which were appropriate to the community under study, were discussed by providing examples and past experiences. After 4 weeks of intervention, the questionnaire was completed again. During this period, the control group did not receive any program other than the usual hospital training program and, like the experimental group, took the post-test. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent t-test and paired samples t-test) in SPSS 16.

The results showed no difference between the experimental and control groups in terms of the distribution of background variables. The mean pre-test scores of resilience in the control and experimental groups were 22.65 ± 5.80 and 23.44 ± 5.61, respectively, which shows that the two groups were not statistically different (P=0.59). The mean scores of resilience post-test in the control group and the experimental group were 23.19 ± 6.12 and 33.97 ± 3.36 respectively, which shows a statistically significant difference (P<0.001). Comparison of resilience scores in the pre-test and post-test scores of both groups shows that resilience scores were not statistically different in the pre-test and post-test scores of the control group (P=0.11), while a statistically significant increase was observed in the post-test of the experimental group compared to the pre-test (P<0.001).

The results of the present study showed that psychoeducation is effective on the resilience of caregivers of clients with bipolar disorder. Accepting the fact that a family member is diagnosed with a psychiatric disorder scares the family. Caregivers find it difficult to talk about the client they are caring for, and caring for a client with a psychiatric disorder causes despair, helplessness, and ultimately depression in the caregiver. Considering that in our country the only sources of support for patients are families and short-term hospitalization centers and family plays the main role of caring and treatment, in case of recurrence of the disease, the client is hospitalized which will exert more pressure and stress on the family. In this regard, resilient caregivers show more independence, are able to think well, and believe in their abilities to change their environment. When family members feel that they too are part of the treatment team, they can provide adequate support to the client. Thus, psychoeducation, as an effective method with the intervention of caregivers to help the client needing care is an important step towards the challenges and tragedies in the family. On the one hand, psychoeducation will change the familychr('39')s attitude towards the client and the disease, and on the other hand, it also significantly affects the clientchr('39')s view of his current situation. Therefore, this educational program can be implemented alongside family-based programs in psychiatric centers, and it is necessary to consider programs such as psychoeducation as one of the ways to promote resilience in clients and their caregivers.

Drug addiction is one of the serious problems that has caused many concerns in society. In Iran, addiction is highly prevalent among different age groups. Due to diagnostic and reporting conditions, accurate statistics about the number of addicts are not available. However, the population of drug addicts seems to be increasing every year, and this is a serious warning to society. A large number of drug users refer to drug treatment centers every year, but after a while, they tend to use drugs again, which is one of the challenges of society. According to the results of some studies, there is a significant relationship between hope and the cleansing period of drug addicts. Since hope can be a fundamental and motivating factor in drug withdrawal and may play an important role in all stages of drug withdrawal, from action to continuing withdrawal and recovery, it seems that implementing interventions that can raise hope in addicts experiencing withdrawal is necessary for drug withdrawal and its continuation. Therefore, considering that happiness-based programs can increase life expectancy in people, this study aimed to determine the effect of the happiness program on the hope of addicts experiencing withdrawal at the psychiatric center of Zahedan.

This is a quasi-experimental study. Men aged 18 to 50 years who were admitted to Zahedan Psychiatric Hospital in autumn and winter of 2020 for drug withdrawal comprised the study population. The samples included 92 addicted men. They were selected based on convenience sampling procedure and were randomly divided into intervention (n=46) and control (n=46) groups. Inclusion criteria were no physical symptoms of withdrawal such as pain and restlessness, no psychotic disorder associated with drug abuse, no participation in another counseling program at the same time, and no other addicted family members. More than one session absenteeism and hospital discharge prior to completion of the program were exclusion criteria. In this study, first the control group and then the intervention group entered the study based on non-random sampling procedure. This method was used to prevent the transfer of information in groups. Data collection tools in this study included demographic information form and Miller Hope Scale. This questionnaire was conducted in two stages; pre-test and posttest which was conducted two months later. In the intervention group, eight sessions of the Fordyce Happiness Program were performed every other day. The content of the sessions was prepared based on the Fordyce training program. The Fordyce Happiness Program is a program designed to increase peoplechr('39')s happiness and includes eight cognitive components and six behavioral components. The study was conducted based on six Fordyce behavioral components that included components such as increasing activity, increasing social interaction, strengthening close relationships, fostering social personality, creativity, engaging in meaningful works, and self-worth. Data were analyzed using independent t-test, paired t-test, chi-square, and ANCOVA in SPSS 16. The study was statistically significant at P<0.05.

The results of the Shapiro-Wilk test showed normal distribution of data. Therefore, parametric tests were used in this study. The findings showed that most addicts experiencing drug withdrawal were married and mostly used a combination of opium derivatives. The mean hope scores of these addicts before the implementation of the Fordyce happiness program in the intervention and control groups were 139.15 ± 54.06 and 179.22 ± 58.30, respectively, and then changed to 187.25 ± 8.99 and 172.16 ± 45.50. Independent t-test showed that the mean hope scores of addicts both before (P=0.001) and after (P=0.002) Fordyce happiness program were significantly different between the intervention and control groups. In addition, paired t-test showed that the mean scores of hope in the intervention group increased significantly (P=0.001) and decreased significantly in the control group (P=0.005). The results of ANCOVA for controlling the significant effect of pre-test scores and duration of addiction showed that the mean scores of hope among addicts experiencing drug withdrawal were significantly different between the two groups after the intervention (P=0.001).

The present study was conducted to determine the effect of happiness programs on the hope of addicts admitted to Psychiatric Hospital for drug withdrawal. The results of ANCOVA for controlling the significant effect of pre-test scores and duration of addiction showed a statistically significant difference between the mean hope scores of addicts in both groups after the intervention. In fact, the findings showed that implementing the Fordyce Happiness Program can raise the hopes of addicts experiencing drug withdrawal. Therefore, considering that hope has a motivating role in people and is an important factor in maintaining and continuing drug cleansing, happiness programs such as the Fordyce Happiness Program can affect addictschr('39') hopes, which is an important factor in preventing relapse. Therefore, it is suggested that the behavioral component of Fordyce Happiness, which can be easily implemented by nurses, be implemented in drug treatment centers, such as wards and drug treatment camps. Not only can the happiness program be included in the daily routine of addicts experiencing withdrawal, but also, it can be continued after discharge from medical centers. One of the limitations of the present study is the generalization of results to addicts with a history of mental illness. This study was also performed on addicts who were hospitalized in a psychiatric hospital for drug withdrawal. Therefore, generalizing the results to addicts who refer to drug treatment camps to understand addiction should be done with caution.

Given the importance and role of the organizationchr('39')s human resources, focusing and addressing issues such as the quality of work life that lead to increased employee performance, reduced absenteeism and leave of duty is important. Quality of work life is a set of organizational conditions and is created when the management of the organization is democratic, staff are treated with respect, and a safe work environment is provided. In other words, improving the quality of work life in staff is one of the important factors to ensure the sustainability of the health system. Considering the sensitive and stressful job situation of emergency center staff and the contradictory results of researches conducted on the quality of life of staff, the present study aimed to analyze the relationship between perceived organizational support and quality of work life of the operational staff of Tehran emergency centers.

This descriptive, cross-sectional, correlational study was conducted on the operational staff of Tehran Emergency Center in the second six months of 2019. The sampling method was multi-stage stratified with the proportional allocation and 200 qualified staff from the six emergency centers of Tehran (north, south, east, west, center, Islamshahr) were included in the study. Inclusion criteria were having a diploma and higher degrees and having at least six months of experience as operational staff. Demographic information form, quality of work life questionnaire developed by Walton, and Eisenberg perceived organizational support questionnaire were used for data collection. The researcher returned 24-48 hours after the distribution of the questionnaires and collected the completed questionnaires. Then, the data were analyzed using independent t-test, ANOVA, Pearsonchr('39')s correlation-coefficient, and Kruskal-Wallis tests in SPSS version 16.

The results of the current study revealed that 42.2% and 41.1& of staff considered their income to be insufficient and somewhat sufficient respectively and the average work experience of the surveyed staff was 10.68 ± 6. The quality of work-life of staff of medical emergency center of Tehran was 96.1 ± 22 which was moderate. The quality of work life in the dimension of social integration in the job with an average of 3.09 ± 0.97 was the highest and in the dimension of the role of work life with an average of 2.35 ± 0.87 was the lowest among other dimensions. Besides, the organizational support average was 82.2 ± 0.152 which was at the intermediate level and the average score of organizational support was 28.49 ± 5.06. Finally, there was no significant relationship between the quality of work-life and its dimensions with perceived organizational support. The results of the correlation between these variables and demographic characteristics of staff of emergency center showed a statistically significant relationship between that the quality of work life with education (P=0.013). The average score of staff with diploma was significantly lower than staff with associate degree (P=0.026), bachelor degree (P=0.002), and master degree (P=0.016), and the difference was not significant in other cases. Another variable that had a statistically significant relationship with the quality of work life was employment status (P=0.015). The average score of staff with casual employment was significantly lower than corporate (P=0.041) and formal staff (P=0.006). Moreover, perceived organizational support had no statistically significant relationship with any of the individual and job variables of the staff. The average score of staff with casual employment was significantly lower than those with corporate (P=0.041) and formal employment (P=0.006). Perceived organizational support also had no statistically significant relationship with individual and job variables of the staff.

According to the results of the study on the average perceived organizational support and quality of work life, organizational efforts of managers and related officials should be directed towards optimizing the organizational support and quality of work life of this group of staff. It is important to pay attention to these two concepts in the pre-hospital emergency operation staff because it can affect the professional, personal, life, and social aspects of their life. Considering that this study was conducted in Tehran Emergency Center, it is suggested that similar researches be conducted in other medical centers of other cities and on other clinical professions to compare the results.

Along with the growth of the aging population, there are several challenges for this population group as well as for caregivers and health policymakers. One of the most important challenges is the increase in care needs due to the increased suffering of the elderly from chronic and malignant diseases and disabilities. Therefore, due to the high prevalence of cancer and also the growth of the aging population, palliative care appears to be one of the important priorities of the health system. Palliative care has been identified as an important and ongoing part of cancer care. Palliative care is an approach that improves the quality of life of the patient and his family in the face of problems related to life-limiting diseases by preventing the patientchr('39')s suffering and improving the patientchr('39')s symptoms and other physical, mental, spiritual, and social problems. In fact, palliative care alleviates the disease-related pain and its effects on the patient and her family from the diagnosis of the disease to the control of pain and other symptoms. Studies have shown that there is a significant relationship between palliative care received and the quality of life in patients with chronic diseases such as cancer. Quality of life is also a multidimensional concept and nurses have an important role in improving the quality of services and care by considering the physical, mental, spiritual, religious, cultural, and social aspects of the patients. Therefore, it is necessary to first investigate the existing conditions and the quality of palliative care in the health centers and then take effective measures to improve them. Therefore, this study was conducted to determine the quality of palliative care from the perspectives of the elderly with cancer admitted to Firoozgar Educational and Medical Center in 2019.

This was a cross-sectional study. A total of 123 elderly patients with cancer admitted to Firoozgar Hospital in 2019 (November to January 2019) were selected through continuous sampling procedure. Inclusion criteria were informed consent to participate in the study, no cognitive impairment (a minimum score of 7 out of 10 based on AMT test) in the elderly, the ability to communicate and answer the items of the questionnaire, no known mental illness (based on the patientchr('39')s medical record), confirmed cancer (according to the medical diagnosis and medical record). The exclusion criteria were no consent to participate in the study, non-cooperation in each stage of completing the questionnaire (AMT, demographic form, palliative care quality tools). Data collection tools included the short-form anxiety management training (AMT) to analyze the elderlieschr('39') mental health status and cognitive system, demographic form, and quality end of life questionnaire (QEOLC-10) which were completed through face-to-face interviews with the samples. The palliative care quality questionnaire assesses the quality of palliative care provided from the perspectives of patients with chronic diseases. This questionnaire includes 10 items with different dimensions of staff communication skills, patient-centered care system, symptom reduction management, staff emotional skills, and care based on patient values which are rated on an 11-point scale (range: 0-10). Data were analyzed using descriptive and inferential statistics such as independent t-test and ANOVA using SPSS Software version 16 at the significance level of P≤0.05.

The mean age of the elderlies was 65.55 ± 4.12 years. The highest frequency was related to the age group of 60-64 years, which shows that the subjects were classified as young-old. Among them, 76 (61.8%) cases were male and 47 (38.2%) were female. Almost all samples in these studies were married (95.9%), retired and unemployed elderly had the highest frequency with (47.2%) and (41.5%), respectively. More than half of the study samples, about (56.9%), had a history of hospitalization, among which (47.1%) declared that they were hospitalized for one to two weeks and (48%) of the elderly were suffering from gastrointestinal cancer, which was more common than other types of cancer. In this study, the quality of palliative care in various dimensions (patient-centered care system, personnel communication skills, symptom reduction management, personnel emotional skills, patient values) was at the desired level. (54.5%) of the elderly reported the quality of palliative care to be desirable. The mean and standard deviation of palliative care quality was 65.55 ± 4.12. In all dimensions of quality of care, the two variables of the current hospitalization period (P=0.012) and nursing skills (P<0.001) had the most statistically significant relationship with the quality of palliative care. The quality of palliative care in pain management had a statistically significant relationship with gender (p = 0.047), current hospitalization period (P=0.015), and nurseschr('39') skills (P<0.001), which was significantly higher in men than women, and had the highest frequency during 3-4 days of hospitalization, and nursing skills had a significant role in all the aspects.

In general, the results of this study showed that relief from physical, psychosocial, social, and spiritual problems through palliative care is possible for more than 90% of patients at the advanced stages of cancer. Palliative care to treat and alleviate the cancer-related symptoms and improve the quality of life of patients and their families can help people live more comfortably. It is especially true in places where there is a large number of patients with advanced cancer and there is little chance of treatment. In this study, the quality of palliative care from the perspective of the studied elderly was rated as desired, which is one of the reasons for providing such services in the special palliative care ward of Firoozgar Medical Center with experienced and trained caregivers. However, the main problem of the nursing system in Iran regarding palliative care for patients with cancer is that this type of care does not have a specific framework for nurses and is not seriously included in the formal curriculum.

The emergency department is the heart of the hospital and the entry point for patients to provide health services and emergency nurses are one of the largest working groups in the hospital and the most influential force in determining the quality of services provided. The main mission of this department is to save the lives of patients. Therefore, emergency department nurses have a heavy responsibility and it is necessary to have the necessary professional motivation and commitment along with sufficient knowledge and skills. Therefore, information about the productivity and quality of work life of its employees can be a basis for taking appropriate measures and prepare the ground for achieving the desired conditions. this study was conducted to determine the productivity and quality of work life of emergency department nurses.

This study was a cross-sectional descriptive study and From September to November 2016, it was performed on 189 nurses working in the emergency department of educational and medical centers affiliated to Shahid Sadoughi University of Medical Sciences, who were selected by stratified allocation method. Data were collected  as self-report using  a demographic questionnaire and  Manpower Productivity Questionnaire and Work Quality of Life Questionnaire (QNW). ANOVA and t-test in SPSS software version 18 were used to analyze the data. 

The average productivity of nurses working in the emergency department was 92.55 with a standard deviation of 11.68. The average score of total quality of working life was 143.67 with a standard deviation of 26.98. The quality of working life had the highest average score in the field of work with an average of 3.58 and the lowest average score in the personal life dimension with an average of 3.04 The results showed that there was no statistically significant relationship between any of the demographic characteristics and nurseschr('39') work productivity. Among the studied job characteristics, there was a statistically significant relationship with the employment productivity of emergency nurses (p <0.05). There was a statistically significant relationship between nurseschr('39') quality of work life with marital status (p <0.01) and education (p <0.05). Overtime (p <0.05) and choice of working hours (p <0.01) had a statistically significant relationship with the quality of working life of emergency nurses.

The findings of the present study showed that productivity and quality of work life in emergency nurses was at a moderate and relatively desirable level, respectively. Therefore, there is still a long way to go to achieve the desired productivity and quality of life. Therefore, it is necessary to make comprehensive plans to improve the productivity and quality of work life of nurses. This planning can be done at the macro level by senior managers of the health system and at the micro level by the management of the hospital complex.

Background &

Accidents are a chain of events that lead to damage and detectable disease. Although some consider home to be the safest place, about a third of incidents occur at home. One of the high-risk groups in domestic accidents is toddlers. Physiological patterns associated with the developmental stages of toddlers make this group susceptible to such events, so that accidents are the main cause of death in the first five years of children's lives worldwide. Health education programs can empower parents to prevent domestic accidents. On the other hand, the effectiveness of health education programs is mostly dependent on having accurate information about mothers' awareness, attitude, and practice. Considering that more evidence is needed to take necessary measures to implement related interventions, this study aimed to determine the factors related to awareness, attitude, and practice of mothers of toddlers in preventing domestic accidents.

This was a descriptive correlational study conducted on 280 mothers with toddlers referred to community health centers from April to September 2019. In this study, multistage cluster sampling method was used to collect data. Each area of the north and south regions of Hamadan city was considered as a cluster and two comprehensive health centers were selected from each cluster through simple random method and among the selected comprehensive health centers, mothers were selected through convenience sampling method and based on inclusion criteria. Inclusion criteria were living in Hamadan city, having at least one toddler, not having a toddler with incurable diseases, and not being pregnant. Also, exclusion criteria included reluctance to continue participation in the study despite the initial agreement. Data collection tools were demographic questionnaires, history of injury, and a researcher-made questionnaire based on awareness, attitude, and practice in preventing domestic accidents that were completed by the samples. In order to determine the validity of the questionnaire, qualitative content validity was used, and test-retest was used to check the reliability of the instruments. After writing the proposal and approving the plan, the researcher referred to the comprehensive health centers of Hamadan city and identified the mothers of toddlers with inclusion criteria and invited them by telephone or with the help of the staff to participate in the project. All mothers were given the necessary explanations about the objectives, procedure, and duration of the study (6 months), and written informed consent was obtained from them. At the beginning of the study, the subjects were given the data collection tools and the self-assertion questionnaires were completed. In order to provide a calm environment for answering questions, mothers (as representatives of parents) were asked to leave their children to their companions before receiving clinic services (vaccination, and growth monitoring) and answer questions in the educational class of the relevant centers. After completing the questionnaires, data were analyzed using Kolmogorov-Smirnov tests to ensure normal distribution, Kruskal-Wallis to determine the relationship between qualitative demographic variables and awareness, attitude towards behavior and practice, and Spearman correlation test to determine the relationship between quantitative demographic variables with awareness, attitude towards behavior and practice in SPSS 16 software.

According to the results, (44.6%) of the mothers of toddlers had a university education and (72.8%) of the mothers were housewives. Also, (58.3%) of toddlers were girls and (46.7%) of parents kept their children in kindergarten. Mean scores of awareness with a value of 18.1 ± 1.5 was the highest point obtained by mothers (good), mean scores of mothers' attitudes with a value of 18.8 ± 4.6 regarding the adoption of preventive behaviors were regarded as weak, and the mean score of practice with a value of 24.3 ± 10.1 was regarded as good. Also, a positive significant relationship was observed between the age of the toddler and the level of awareness, between the family dimension and the number of children, and between the age of the toddler with the mother's attitude towards behavior, between maternal education and awareness and practice, between father's education with awareness, attitude and practice, between father's employment status with awareness and attitude, between mother's employment status with awareness, and between childcare status with attitude (P <0.05). Among the total number of people surveyed, 15 toddlers were injured in the accident. Burning, poisoning, asphyxia, and drowning were respectively the accidents occurring in the children with a history of injury. (72%) of these cases had resulted in temporary disability and 13 victims were girls. All reported cases had occurred in the age group of one to one and half-year-old toddlers.

Considering the poor average scores in attitude and practice of mothers and also considering the important role of education in promoting preventive behaviors of accidents, it is necessary to educate mothers more in order to improve their awareness, attitude, and practice regarding the prevention of children's accidents. Also, the findings of this study and similar researches in this field can be a guideline for planners and authorities to use the present findings to perform interventions to improve the awareness, attitude, and practice of mothers about the prevention of domestic accidents in toddlers.