نشریه مدیریت ارتقای سلامت
سال سوم شماره 4 (پیاپی 12، پاییز 1393)

Documenting patient education (PE) in patient''s records is an important tool for validating educational interventions to support the legal rights of both patient and clinical experts. The aim of this study was development and evaluation of a structured «Patient Education Record» for complete documentation of PE process. This methodological research، carried out in Alzahra University Hospital in Isfahan (2012 to 2014). Through organizing three groups of central، steering and feedback groups and purposeful sampling، 256 professionals and experts participated in this study. Two stages of development and evaluation of the form was conducted with gathering 24 series of primary participants'' feedbacks and viewpoints consisting 49 field notes، 11 interviews and 52 reports during 9 months pilot period accompanied with six series of secondary feedbacks. Qualitative content analysis was done for evaluation of advantages and inhibitors of the form until achieving data saturation and approval revised form. Primary PE record، developed in a structured format with a header of patient''s profile، followed by four tables of educational services from admission to discharge time with 9 columns of subtitles for filling in full PE process through footnote abbreviations. Revised form developed during pilot period، consists fewer abbreviations with four tables of initial assessment as well as teaching records from admission to home care by both clinical professionals and physicians. Drugs considerations and recommendations transferred to discharge card. Education inhibitors consist of the complexity and disorientation of clinical professionals with primary form as well as lack of time، manpower، skill and educational media. Advantages of PE record for the organization، patients، and clinical experts were explained in two categories، six axial codes and 43 secondary codes. «Patient Education Record»، facilitated complete documentation and implementation of PE process. The developed form would be useful for recording patients'' education in other hospitals

The concept of organizational citizenship behavior has attracted many researchers and managers. Behaviors can be due to one of the basic ways to increase the effectiveness of organizations. The aim of this study was to determine correlation between organizational commitment and organizational citizenship behavior in Tehran welfare staffs. In This descriptive-correlation study، 100 people were selected through random sampling. Data were collected with، «Organizational Commitment Questionnaire» and «Organizational Citizenship Behavior». Content validity of the instruments was measured by opinion of 10 lecturers and reliability by using Cronbach''s alpha. To analyze the data، SPSS/21 was used. Results show that there is a significant and positive relationship between organizational commitment and organizational citizenship behavior (P≤0. 01، r=0. 325). Also the dimensions of organizational citizenship behavior، altruism (P=0. 01)، civic virtue (P=0. 0) and conscientiousness (P=0. 003) have a significant and positive relationship with organizational commitment. Increase of organizational commitment in welfare employees، has improved the citizenship behavior. Managers are recommended to develop organizational commitment، to implement appropriate programs in order to achieve organizational goals.

Using the organizational excellence models as a framework for evaluating the performance has been used by many leading organizations in the world. The aim of this study was to evaluate the performance of Bardaskan city health network by using the model of the European Foundation for Quality Management (EFQM). In this descriptive study، 25 managers، officials and experts in Bardaskan Health Network، Iran، participated in year 2013. Data collection instrument، (Performa Approach) was based on the EFQM Model. Validity of the instrument was measured by content validity and reliability by test re- test. Score for each of the nine criteria according to RADAR logic was calculated. Collected data were analyzed by SPSS/16. The total score of Bardaskan Health network was 211. 8 out of 1000. Enablers got 138. 5 and results 73. 3 points. Percentage scores for each of the nine criteria of the model was as follows: leadership 26%، strategy 34. 3%، employer 31. 1%، resource and partnership 30%، processes 21. 4%، customer results 6%، employer results 20. 7%، society results 16. 6% and key performance results 21. 7%. Strategy criteria have the most and customer criteria have the lowest score. Bardaskan health network performance was evaluated as moderate low. More Focus to improve initiatives on the weakness area which has more effectiveness on the performance of the network is suggested.

Readmission is a potentially avoidable and costly outcome of hospital stay depends on several factors such as lack of patient and family''s discharge preparation. This study aims to determine the correlation between discharge preparations and readmission of preterm infants hospitalized in neonatal intensive care units of Shahid Beheshti University of Medical Sciences. This descriptive correlational study was conducted among premature infants hospitalized in the neonatal intensive care units of three teaching hospitals affiliated to Shahid Beheshti University of Medical Sciences as the study population. Sample consisted of 245 premature infants admitted to the neonatal intensive care unit، selected using convenience method based on study entry criteria. At the time of discharge، demographic characteristics questionnaire، and «Discharge Preparation Checklist»، including 28 valid and reliable items، were completed. One month after discharge، hospital readmission of neonates were followed through contacting parents. Data were analyzed using SPSS/17. 97 infants (39. 6%) were re-admitted within one month after discharge. The discharge of preterm infants overall readiness scores were 21/56  3/69 averagely. There was a significant difference between neonate''s hospital readmission and discharge preparation score in Mann-Whitney test (P<0. 001). Discharge preparation has a strong relation with premature infant''s readmission. In addition، to the baby''s condition at discharge، knowledge، ability and parents readiness at the time of discharge، has an effective role in preventing readmissions and its emotional and financial consequences for the infant and family. Planning for discharge and monitoring its implementation، would be an important step towards preventing readmission.

Wide verity of causes of death exist in ageing societies. It is suitable to apply competing risk models in order to investigate and analyze time to death in the target population. The aim of this study was to identify some factors effective on survival of the elderly living in nursing home using Copula Competing Risk Model with Bayesian approach. In a descriptive-longitudinal study، data were collected from 510 elderly’s medical documents in Kashan Golabchi elderly nursing home. To identify effective factors associated with time to death of the elderly، medical diagnosis of cause of death cited in elderly’s documents were considered. Later، Competing Risk Model using Clayton Copula Function based on Bayesian approach was fitted and Credible intervals were estimated. To analyze the data WinBugs Software was used. In univariate analysis، being in the age at the beginning of reception، hypertension، family history of cardiovascular diseases، history of myocardial infarction، history of stroke were significant for time to death due to cardiovascular diseases in the elderly. In multivariate analysis، age group 75 to 90 years at the beginning of the reception (HR=2. 1; CI 95%= (1. 26، 3. 67)) and history of stroke (HR=2; CI 95%= (1. 28، 3. 32)) were significant for time to death due to cardiovascular diseases in the elderly. One of the benefits of statistical modeling is the ability to generalize its results. According to the results، some crucial factors accelerating the time of death in elderly were identified. Therefore، it is highly recommended that، in therapeutic and preventive actions in order to increase the survival time for the elderly the significant studied factors should be considered.

Breast cancer is the most common cancer in women in the absence of timely diagnosis and treatment which will lead to death. Health beliefs play an important role in the health behaviors of people. This study was carried out to determine correlation between health beliefs and breast cancer early detection behaviors among females referring to health centers in Khoy city. In this descriptive-correlational study، 8 health centers from different parts of Khoy were selected by cluster sampling and 162 females were included in the study. Data was collected using Champion’s Health Belief Model Scale. Content Validity was measured through 10 experts'' opinion and reliability by measuring Cronbach alpha and test-retest. Data were analyzed by SPSS/16. The majority of participants had strong health beliefs about the benefits of breast self-examination (82. 7%) and mammography (10. 5%). There was significant statistical correlation between job، educational level، marital status and BSE performance and between age and mammography (P<0. 05). There was no significant correlation between health beliefs and breast cancer early detection behaviors. Although there was a strong health belief in women، early cancer detection behaviors was not performed. Therefore، educating and encouraging housewives، married، uneducated and adolescent women as well as providing a suitable place for breast examination in health centers are necessary.

Increase of elderly population in the world is a critical issue. Retirement and limitation of social activity are some of the problems that elderly people face. Hence، this study was conducted to determine social participation، barriers and related factors in elderly people in Tehran. This descriptive-correlational study was conducted on 330 elderly people above 60 years old in city of Tehran in 2014. Demographic characteristics questionnaire and “Canadian Community Health Survey (CCHS) - Social Participation” were used for data collection. The data were analyzed with SPSS/20. The mean score of social participation was 15. 96 (±4. 30). Around 37. 7% of elderly people did not have any social participation. Factors associated with social participation included، cost of social activities (36%)، disease and illness (30%)، and transportation problems (27. 3%). The male elderly with low age، married، university educated، and low number of offspring’s had significantly better score of social participation (P< 0. 05). Although social participation in elderly people was low، many of them did not have any social participation. Therefore، planning to increase the salary، managing disease or illnesses، reducing transportation issues and considering other associated factors are suggested to improve social participation in elderly people.

Unequal distribution of health in the developing countries is one of the main challenges of health systems. This leads to inequality in social status، living conditions and social interventions of the government''s efforts to fail. Current study aimed to develop a conceptual model of social determinants of health inequalities in Iran with a qualitative approach.

This study was a qualitative content analysis. The participants were consisted of 33 experts of social determinants of health field which were selected through purposive sampling. Semi-structured interview was used for data collections. Directed content analysis with Nvivo software was conducted.

This study resulted in 14 themes and 55 sub-themes as determinants of inequality on health in Iran. Main themes were disasters، socio-economic status، macroeconomic policies، leadership، social policies، public policies، culture and social values، social protection، social cohesion، religious، international factors، behavioural and biological factors، psychological factors، health system and socio demographic factors.

Inequalities in health can be avoidable due to its main determinants of economic status، education، employments. Hence social factors determining health approach، is suggested to formulate macro-economic and social policies in the country and it requires more attention.