Health in Emergencies and Disasters Quarterly
Volume:8 Issue: 2, Winter 2023

The COVID- 19 pandemic has created many challenges for health care sector around the world. One of these challenges is the increasing need for health care workers, especially nurses. According to the International Nursing Council (ICN) about 6% of COVID-19 cases were among health care workers (range 0 to 18%). Because most nursing activities require direct contact with patients, nurses are more vulnerable to Infection with COVID-19. Complaints of chronic fatigue have been common among survivors of SARS and Middle East respiratory syndrome–related Coronavirus (MERS). Fatigue is a mental feeling of weakness, lack of energy and exhaustion. Chronic fatigue usually lasts more than 6 months and does not decrease with rest and can lead to decreased productivity, increase absence from work, quit the job or dismissal by employers due to unwillingness to care for patients with COVID-19 and reduce the quality of care. During the outbreaks, increasing in demand and decreasing in the labor force following the possible illness or leaving the job also the prolongation of the pandemic outbreak process make the shortage of nurses more critical. Therefore, in the first stage, in order to maintain the safety of the existing nursing staff, special protocols should be considered to reduce the risk of infection of nurses. Finally, more research should be done to identify chronic fatigue syndrome cause and mechanisms and its possible effects on the quality of personal and professional life of nurses.

At the end of December 2019, a new infectious disease was reported in Wuhan, China. It was a new type of coronavirus named COVID-19. The spread of COVID-19 created an emergency in the global health system and the elderly was identified as a vulnerable group to the disease.

This is a systematic review conducted to manage the vulnerability of the elderly during the COVID-19 pandemic. Accordingly, all articles published in this field from the beginning of March 2019 to the end of June 2021 have been extracted from the following databases: Web of Science, PubMed, Scopus, Cochrane Library, Google Scholar, Irandoc, Magiran, MedLib, and SID.

High incidences of COVID-19 are exacerbated in the elderly with cognitive disorders, immunodeficiency, malnutrition, use of various medicines and social problems, anxiety, distance from the family, lack of healthcare, history of falls, multi-drug use due to old age during the COVID-19 pandemic, in addition to the elderly with underlying diseases, such as kidney failure, diabetes, high blood pressure, arthritis, heart, and respiratory diseases.

The prevalence of vulnerability in the elderly was high during the COVID-19 pandemic, which can be a significant risk factor for health. Suffering from several simultaneous diseases, the number of medicines used, the history of falls, underlying diseases, and living alone were some of the vital determinants of vulnerability and considering the adverse consequences of vulnerability, difficulty in designing and implementing appropriate interventions and self-care education for the elderly and their families to manage drug use, treating chronic diseases, and preventing falls, it seems necessary to observe health protocols and stay at home.

It is necessary to prepare nurses for their important and accountable roles in disaster response teams. Given the lack of in-service training courses, nurses’ knowledge and skills in responding to disasters are lower than the desired level. This status can lead to nurses’ poor performance in caring for victims of disasters. This study aims to determine the effects of empowerment programs on nurses’ competence in disaster response.

A total of 70 nurses working in Ardal and Naghan hospitals in Chaharmahal and Bakhtiari Province, Iran, in 2020 were selected via a sampling method. One hospital was randomly selected as the intervention and the other as the control. The members of the intervention group were divided into 5 groups. Educational sessions were held in four 2-h sessions in one month. In addition, the intervention consisted of a 2-day workshop, hanging posters, and pamphlets that covered topics of competencies in disaster nursing.

The results showed that the mean score of nurses’ competence score significantly increased in the intervention group (P=0.001); however, no significant difference was observed in the control group (P>0.05). Additionally, significant improvements were observed in all dimensions of competencies in the experimental group. The Mean±SD scores of the increase in different domains of nurses’ competencies were as follows: management, 16±4.6; ethical competency, 12±2.8; personal competency, 18±8.6; and technical competency, 30±9.3. 

According to other study results with the same scale in Iran, nurses’ competencies in disaster response are not desirable; therefore, it is recommended that nurses, administrators, and other members of the healthcare system use these results to improve nurses’ competencies through in-service training.

Hospitals play an important role in protecting the health and survival of people during disasters. Despite the development of risk management programs worldwide in recent years, hospital preparedness in disasters is low and one reason for that is the lack of hospital standards for disaster preparedness. This study aims to develop hospital accreditation standards for hospital disaster risk management based on national and international experiences.

We used a mixed-method explanatory sequential approach. At first, a comparative study was conducted and the disaster risk management (DRM) hospital standards were extracted from 10 selected countries, namely the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, and Denmark. Standards were analyzed according to the DRM life cycle and the most comprehensive framework was chosen. For national experiences, purposeful semi-structured interviews were conducted with 22 experts in disastrous events in the country and continued until the saturation stage. In addition, Graneheim and Landman’s contractual content analysis method was used for data analysis. After combining international standards and national experiences, the proposed standards were introduced and the content validity index and content validity ratio were done by 25 experts.

Differences were observed in the quality and quantity of the selected countries’ DRM standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. A total of 27 standards from the International Standards Review and 31 standards from interviews were added (a total of 58 standards). The content validity results of the standards were within acceptable limits. After editing and determining the measurement criteria, the final standards were introduced.

This study introduces comprehensive DRM standards based on international and national documents and experiences that can be useful for policymakers and accreditation organizations in both developed and developing countries for hospital evaluation. This is also useful for hospitals as a roadmap for promoting preparedness in disasters.

Because COVID-19 has become a pandemic, public health measures to cut off human-to-human transmission may include quarantine and social isolation. This study aims to demonstrate the effects of the COVID-19 pandemic on demographic variables and their relationship to the level of social participation during the pandemic.

In June 2020, the community integration questionnaire (CIQ) was transcribed along with the required demographic information on a web-based platform. A total of 461 people (Mean±SD age: 36.86±5.8 years) completed the questionnaire in a cross-sectional study. The effects of COVID-19 on social interaction were then calculated by analyzing the community integration questionnaire scores before and after the outbreak of COVID-19 and the data were analyzed using the SPSS software, version 26.

Quarantine measures had the most damage in the reference group (participants under 24 years old) (P<0.001) compared to before the COVID-19 outbreak. Except for participation in productive activities (compared to the elderly) (P<0.001), in all cases and among all age groups, integration and the total score of the questionnaire decreased. 

Psychosocial stress and reduced participation in social and life spheres are the results of quarantine measures and social distancing. Meanwhile, the participation rate of the under 24 years old age group significantly decreased in all areas. Following that, the older age group had a significant decrease in social participation. The results of this study can be used to prioritize the vaccination of different people in the community according to the amount of damage caused by COVID-19.

Unintentional poisoning is a critical type of poisoning by which people injure themselves with no intention. Such a condition occurs accidentally, occupationally, or through abusive manners. The present study aims to examine the one-year frequency and causes of unintentional poisoning in patients treated by the prehospital emergency center in Qaemshahr City, Iran, in 2016.

This is a cross-sectional descriptive study of 259 patients with unintentional poisoning. The variables were extracted and then registered in the questionnaires. The data were analyzed by the SPSS software.

In this study, 83.8% of the patients were male and 16.2% were female. Most toxicity cases (89.1%) were unintentional as a result of drug abuse in the forms of tramadol abuse (42.8%), narcotic drugs (26.6%), and alcohol (19.7%), ranking 1 to 3, respectively.  A total of 48.2% of the unintentional poisoning cases were caused by medicinal factors and other cases (51.8%) were due to non-medicinal agents. Benzodiazepines and cardiovascular drugs were the most common drugs causing a medicinal overdose. Gastrointestinal poisoning was the most prevalent way of toxicity (77.6%) and the rate of death was 4%.

The results of the present study and similar research show that unintentional poisoning includes large populations of toxicity cases that occur mainly by drug abuse, such as tramadol and narcotic drugs. This study can be considered a pattern to conduct more research in the relevant fields.

Studies show that leaving the hospital with personal consent is increasing. This phenomenon has unpleasant and sometimes irreversible consequences. This study aims to investigate the causes and consequences of leaving the hospital with the personal consent of patients referred to the emergency department of hospitals affiliated with Qom University of Medical Sciences in 2021.

In this descriptive-analytical study, 345 patients were selected who, with personal consent, left the emergency department of selected hospitals affiliated with Qom University of Medical Sciences in 2021. The study data were collected via a questionnaire and a checklist. The questionnaire comprised demographic variables, patient-related factors, personnel-related factors, and hospital-related factors. The checklist of the consequences included questions about leaving the hospital with personal consent. The data were analyzed using descriptive and inferential statistics in SPSS software, version 20.

Of 345 patients included in the study, 55.9% were male and the mean age of patients was 47.1 years. The most important reasons for leaving the hospital with personal consent were as follows: personal reasons (22.9%), fear of continuing treatment (11.9%), preference to continue the treatment in other medical centers (9.3%), the suggestion of other hospital staff (35.1%), not having the desired doctor (27%), nurses’ suggestion (19.4%), lack of care (20.4%), and inadequate hospital space and facilities (14.0%). The consequences of leaving the hospital with personal consent in this study included re-admission and hospitalization (10.3%), mortality (3.4%), heart disease (0.87%), and mental disorders (0.57%).

After identifying the reasons for leaving the hospital with personal consent and highlighting the irreparable human and financial consequences, these causes should be eliminated to prevent irreparable and unfortunate consequences. Such causes include personal reasons, fear of continuing the treatment, and lack of care. Fixing the causes requires proper planning and effective actions.