Motivation of the nurses in pre-hospital emergency and educational hospitals emergency in the southeast of Iran

Nurses' motivation for performing cardiopulmonary resuscitation: a cross-sectional study

BACKGROUND

Nurse motivation can have a significant impact on the quality of cardiopulmonary resuscitation and the patients' survival. Therefore, the present study aimed to examine nurses' motivation for performing cardiopulmonary resuscitation.

METHODS

This cross-sectional study focused on 217 nurses in a teaching hospital in Iran, in 2023. A random sample of nurses was selected from four hospital departments (emergency, critical care, medical, and surgery). These nurses completed the demographic information and motivation for cardiopulmonary resuscitation questionnaires. The data were analyzed using Mann-Whitney, Spearman coefficients, and Kruskal-Wallis and multiple linear regression tests.

RESULTS

The mean score of the dimension of the feeling of achievement (4.10 ± 0.50) was high in the nurses' motivation for performing cardiopulmonary resuscitation. There were more motivational factors in the emergency department compared to the other departments in terms of the feeling of achievement, high chance of success, low chances of success, recognition and appreciation, perceived importance, and beliefs (p < 0.05). The nurses who had participated in cardiopulmonary resuscitation workshops and had a bachelor's degree had a higher mean score in the dimension of perceived importance (p < 0.05). The correlation coefficient showed that there was a significant negative correlation between the nurses' frequency of participation in cardiopulmonary resuscitation and their motivation scores in the dimensions of the feeling of achievement(r=-0.170), low chances of success(r=-0.183), perceived importance (r = -0.302), and beliefs (r = -0.250; p < 0.05). The department variable predicted the motivation score in the dimensions of feeling of achievement, high chance of success, low chance of success, perceived importance, and beliefs. The sex variable predicted the motivation score in the dimensions of facilitator of resuscitation and high chance of success. Besides, the variable of years of membership in the CPR team predicted the motivation score in the feeling of achievement and high chance of success (p < 0.05).

CONCLUSION

Nurses would be more motivated to perform a quality cardiopulmonary resuscitation if they had a feeling of success. The nurses' motivation was affected by certain factors such as their department, sex, education level, years of membership in CPR team, number of participation in CPR, and participation in educational workshops.

A systematic review and meta-analysis of musculoskeletal disorders among firefighters

INTRODUCTION

Due to the nature of their job, firefighters face many ergonomic risk factors and are exposed to several musculoskeletal disorders (MSDs). The aim of this systematic review and meta-analysis was to investigate the prevalence of MSDs among firefighters.

MATERIALS AND METHODS

This study was conducted based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The literature search was conducted in the databases of PubMed, Scopus, Web of Science, Science Direct, SID, ISC and Google Scholar without applying a time limitation until the end of July 2022. The random effects model was used for meta-analysis, and the I2 index was used to check heterogeneity among studies. The data were analyzed using STATA version 14 software.

RESULTS

The primary literature searches in the databases identified 1,291 articles, 26 of which were entered the meta-analysis stage after screening, study selection, and quality assessment, including 36,342 firefighters. Based on the results of a meta-analysis, the overall prevalence of MSDs among firefighters was 46.39% (95% CI: 32.45-60.32, I2 = 99.7%, P < 0.001). The prevalence of MSDs was also investigated at neck (18.36%), low back (34.32%), shoulder (18.68%), hands (7.43%), upper back (10.15%), knee (19.97%) and foot (6.66%).

CONCLUSION

Considering the relatively high prevalence of MSDs among firefighters and their higher exposition to specific job-related risk factors of MSDs compared to other professions, it is suggested to provide firefighters with appropriate training, implement ergonomic interventions, and regularly screen them to reduce MSDs.

A comparative study on specialized services in pre-hospital emergencies in Iran and selected countries

The quality of emergency services is one of the indicators describing the health status of countries. Moreover, the specialization of services and targeted response to any accident or disease has been the priority of pre-hospital emergency operations in some leading countries. This study aimed to compare the special services provided in the emergency department of several selected countries. This was a comparative study that was done in Isfahan in 2022. Data were collected by reviewing the literature provided by libraries and emergency websites of selected countries. We selected countries based on the accessibility of information in two groups of developed countries and countries with the same income and population as Iran including Germany, France, The United States, Australia, Britain, Malaysia, and Turkey. Data were classified and compared based on staff, vehicles, and specialized services. Emergency staffs in most countries were of different skill and training levels. Ambulances varied in equipment types in various land, air, and sea forms and dimensions. Developed countries had more modern ambulances and equipment. France and Germany were operating more especially. Specialized teams are dispatched only in the United States and Germany. Existing studies have shown the adequacy and effectiveness of these teams in reducing complications and mortality and improving the prognosis of patients. The use of specialized teams appropriate to each emergency based on the specific and targeted response is effective in improving the prognosis of patients. The results of this study are suggested to beneficiaries to improve the quality of emergency care and reduce complications and potential causalities.

Effectiveness of feedback type on performance quality and satisfaction of nursing student: A comparative interventional study

BACKGROUND

Although feedback has a major impact on teaching and learning, the type and way of providing it can have diverse effects. The purpose of this study was to compare the effect of two types of verbal and written feedback on nursing students' performance quality and satisfaction.

MATERIALS AND METHODS

This experimental study, that carried out in 2019, has a crossover design. The participants included 30 bachelors of science in nursing at Shushtar Faculty of Medical Sciences, who were assigned to two groups of 15. The first group received first verbal feedback and then written, during basic nursing skills training. The second group received first written feedback and then verbal. At the end of each half of the training sessions, students' performance and their satisfaction were assessed by, researchermade observational checklists, and a satisfaction questionnaire, respectively. Data were analyzed using SPSS16 software and analyzed using Chi-square and paired t test. Significance level < 0.01 was considered.

RESULTS

The mean scores of students' performance in the stages of verbal and written feedback were 15.7 ± 2.5 and 17.7 ± 2.3, respectively. Written feedback was more effective in students' performance (P = 0.001) and students were more satisfied with this type of feedback (P = 0.001).

CONCLUSIONS

According to the present study, using written feedback can improve the quality of students' performances and is associated with high satisfaction. Thus, professors should pay more attention to feedback in their educational processes and use different types of feedback, especially written feedback, in line with the context.

Role of demographic variables in investigating occupational stress of disaster and emergency medical management center

BACKGROUND

Emergency medical services face stressful environments such as departments dealing with injuries and sick patients that pose challenging situations for the healthcare staff. This present study investigates the role of demographic variables in investigating occupational stress of disaster and emergency medical management center in 2021.

MATERIALS AND METHODS

This present descriptive study selected a sample size of 200 medical personnel associated with disaster and emergency medical management center in Iran, according to the inclusion chosen criteria. The study used a tool consisting of two parts, including demographic information and a job stress Health and Safety Executive (HSE) standard questionnaire. The study selected respondents through Cochran's sample size formula using stratified random sampling with a cross-sectional research design for data collection. This present study has analyzed received data using performed the descriptive and inferential information (t-test and one-way ANOVA) at a significance level P < 0.05. The participants of the survey were males only.

RESULTS

The study results specified that the mean age of respondents was 30.14 ± 5.96. The study results exhibited that the mean score of total occupational stress was 3.41 ± 0.26. The results showed the highest (4.34 ± 0.35) and the lowest (2.72 ± 0.86) stress levels were related to role dimensions.

CONCLUSIONS

The study findings revealed a significant relationship between stress level and participants' age, marital status, educational level, type of base, workplace, and the number of work hours per month. Emergency medical personnel experience a high level of occupational stress. Senior managers can use similar studies to implement measures to reduce the experience of employees' stress.

Training needs assessment of hospital CEOs in a developing country: the example of Iran

BACKGROUND

It is essential to identify the necessary competencies of hospital CEOs in order to improve the quality and efficiency of services they provide. Expert leadership skills and competencies can have a significant impact on the success of an organization, benefiting both patients and staff. This study aimed to assess the competencies and training needs of hospital CEOs in Iran public hospitals.

METHODS

We conducted this cross-sectional analytical study through a self-assessment questionnaire, which was a web-based platform developed by the WHO country office in Iran, between July 2018 and September 2018. The questionnaire was completed by 180 hospital CEOs and included a core set of 81 items based on Assessing the Competency of Hospital CEO. These items were categorized into five superordinate categories: leadership, personality and quality of individual behavior, knowledge and business skills, social responsibility, and healthcare environment. In addition, we conducted focus groups with 30 hospital CEOs, supervisor assessments with 10 hospital managers, and interviews with 10 supervisors.

RESULTS

Of the 180 questionnaires distributed, 78% were returned, and most respondents were medical specialists. The need for leadership competencies such as individual behavior skills and change management received the highest priority. Most respondents required training in management skills, including financial management, governance, strategic thinking, quality improvement, and disaster management.

CONCLUSION

Providing needs-based education is crucial, especially in developing countries. In this study, leadership and strategic thinking were found to be the most needed competencies among hospital CEOs in Iran. These findings serve as reference points for developing countries with similar backgrounds and healthcare environments as Iran.

The Role of Social Support and Socioeconomic Factors in the Prediction of Depression among First-Year Undergraduate Students

Aim

This study was devoted to determining the role of social support and socioeconomic factors in predicting students' depression.

Methods

In this cross-sectional study, all first-year undergraduate students in the Shahrekord University of Medical Sciences, Iran, during the 2019-2020 academic year were included via the census method. Data collection tools include a researcher-made checklist about demographic and socioeconomic status, a standard questionnaire of perceived social support, and Beck's depression questionnaire. Smoothly clipped absolute deviation (SCAD) linear regression was used to model the role of social support and socioeconomic factors in predicting depression.

Results

Out of the 220 first-year undergraduate students, 174 (79.1%) were female, and 176 (80.0%) were single. The mean ± SD of depression score among the first-year undergraduate students was 10.56 ± 5.19, and the mean ± SD of social support score was 48.86 ± 5.46. The mean score of depression was significantly higher in female students than in males (11.09 versus 8.59, P = 0.001) but was not statistically significant in different categories of age (P = 0.70), marital status (P = 0.37), ethnicity (P = 0.10), parents' education, and the other demographic variables. Pearson's correlation showed an inverse and significant correlation between depression and social support (R = -0.20, P = 0.003). The mean score of depression was at the highest level for students of public health and environmental health majors and was the lowest for students of laboratory sciences, which was statistically significant (P < 0.001). After adjusting the other variables, SCAD regression showed that social support plays a key role in depression prediction, and increasing social support leads to a decrease in depression score.

Conclusion

Considering the existence of an inverse and significant correlation between depression and social support, any intervention to promote social support for first-year undergraduate students may decrease depression.

Academic burnout among undergraduate nursing students: A quantitative survey approach

BACKGROUND

Exposure of nursing students to constant work pressure, stress, and emotional turmoil during both clinical and theoretical sessions of nursing training often leads to academic burnout among them. The aim of the study was to determine the presence of academic burnout among undergraduate nursing students and the association of academic burnout with age, gender, year of nursing program, residence location, and relaxation technique practice.

MATERIALS AND METHODS

A descriptive survey design was used, and data were collected from 266 undergraduate nursing students from Udupi Taluka, South India. Baseline information was collected through a demographic proforma, and Oldenburg Burnout Inventory for Students was used for assessing academic burnout. A stratified proportionate sampling technique was used to select the study sample. The data were collected from April 2021 to May 2021. Descriptive and inferential statistics were used for the analysis by using Statistical Package for the Social Sciences (SPSS) version 16.

RESULTS

The study revealed that most of the participants had high levels of academic burnout (163, 61.7%), emotional exhaustion (165, 62%), and disengagement (173, 65%). Moreover, academic burnout was significantly associated with age (χ²= 8.669, P = 0.012) and relaxation technique practice (χ²= 9.263, P = 0.002). Additionally, disengagement was significantly associated with gender (χ²= 9.956, P = 0.002), residence location (χ²= 7.032, P = 0.027), and relaxation technique practice (χ²= 8.729, P = 0.003).

CONCLUSIONS

Based on the findings of the study, we recommend that the faculty and administrators of nursing institutes must incorporate strategies for the prevention or reduction of academic burnout in the nursing curriculum.

Human Resource Management as an Area of Changes in a Healthcare Institution

Purpose

The underlying objective of the paper was to investigate the areas that require changes in human resource management in healthcare institutions. The practical objective of the study was to formulate recommendations targeted at the management staff of a healthcare institution, which allow to increase the adaptability and development capacity of medical personnel with the use of appropriate instruments and methods of human resource management.

Patients and Methods

The quantitative research was conducted among 652 patients using the services of primary health care clinics located in the Silesian province in Poland, in 2019. The share of women in the research sample was 61%, and men - 39%. 11% of the respondents were students, 27% - people of retirement age, and 62% were economically active. An anonymous survey questionnaire was used. Calculations were performed using Statistica software. Mann-Whitney U-test and correlation analysis using Gamma (Γ) coefficients were used.

Results

The results of the empirical research showed that the respondents positively assessed most of the examined elements (over 70% of positive opinions). Negative opinions did not exceed the error threshold and amounted up to 5%. The presented results allowed to conclude that the expectations and preferences of patients should be constantly monitored, have an impact on the management of medical personnel and imply introducing changes in the weakest areas.

Conclusion

The conducted research made it possible to identify the needs and expectations of patients and to develop possible solutions to improve human resource management in healthcare entities. In order to improve the operating conditions of the clinic, managers should constantly monitor patient satisfaction and, if necessary, introduce changes to raise service standards. This will allow early detection of shortcomings and the introduction of necessary changes in the clinic.

How does centralized isolation treatment strategy affect the medical staff's mental health during the COVID-19 pandemic?

Background

During the coronavirus 2019 (COVID-19) pandemic, the Chinese Government adopted a centralized isolation treatment (CIT) strategy for patients, which has greatly improved the efficiency of the pandemic response. However, compared to those in local hospitals, anti-COVID-19 medical staff in mobile cabin hospitals, where the CIT strategy was adopted, suffered more mental health problems. This study aimed to explore how the CIT strategy affected the medical staff's mental health by comparing anti-COVID-19 medical staff who worked in mobile cabin hospitals to those in fever clinics of local hospitals.

Methods

Following the standard scale development procedure, this study first developed a scale measuring the mental health of anti-COVID-19 medical staff. Using SPSS 23.0 and Amos 23.0 software, the exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability analysis method were conducted to support the scale development. In the main investigation, a survey method using the developed scale was used, and 839 anti-COVID-19 medical staff from five hospitals in northern China were recruited as participants by snowball-sampling method. The first survey was conducted in February 2020, when the first round of COVID-19 was at a serious time. In April 2020, after the first round of COVID-19 in China was initially contained, and medical staff who worked in mobile cabin hospitals returned to local hospitals, a follow-up survey was conducted on these participants. Using SPSS 23.0 software, a series of 2 × 2 mixed-design ANOVA was conducted, in which working conditions (mobile cabin hospital vs. local hospital) served as a between-subject factor, time points (during vs. after the first round of COVID-19) served as a within-subject variable, and the indicators of the medical staff's mental health served as dependent variables respectively.

Results

The reliability and validity of the developed scale were desirable. The mental health problems of anti-COVID-19 medical staff were mainly manifested as anxiety, powerlessness, fear of infection, and somatization. Compared to those who worked in local hospitals, anti-COVID-19 medical staff who worked in mobile cabin hospitals where the CIT strategy was adopted suffered more powerlessness, fear of infection, and somatization. After returning to local hospitals, symptoms of fear of infection and powerlessness of medical staff who used to work in mobile cabin hospitals decreased significantly. However, their anxiety symptoms were not relieved, and their somatization symptoms even increased.

Conclusion

This study implied that the mental health of anti-COVID-19 medical staff in mobile cabin hospitals adopting CIT was worse than in local hospitals. Moreover, with the first outbreak in remission, the mental health recovery of medical staff in CIT hospitals was slower than in local hospitals. Relevant practitioners should pay more attention to the mental health condition of anti-COVID-19 medical staff who work in CIT hospitals. The psychological assistance service for them should continue even after they return to the local hospitals.

Heroism and paramedic practice: A constructivist metasynthesis of qualitative research

Objectives

We aimed to identify, appraise, and synthesise the qualitative literature to develop theory on heroism and paramedic practice.

Hypothesis/research question

What does published literature tell us about heroism and paramedic practice?

Setting

Paramedics and other healthcare workers (HCWs) faced an outpouring of public support for them early in the COVID-19 pandemic which brought into focus the relationship between them and society, where they are portrayed as heroes.

Participants

We conducted a metasynthesis using Evolved Grounded Theory and procedural guidelines of Noblit and Hare to guide analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines were also applied.

Results

151 papers were retrieved and eleven included in the final sample. Studies were moderate to very low quality, involving a wide range of methodologies and settings; none specifically explored heroism and paramedic practice. The following interrelated themes were constructed on heroism and paramedic practice: (a) Myth, Folk law, and storytelling in heroism and paramedic practice (b) The epic journey of heroism and paramedic practice (c) Heroes and Zeroes: The fluctuating Societal Value in heroism and paramedic practice (d) Politicisation, and objectification in Heroism and Paramedic practice.

Conclusion

Paramedics have long been characterised as heroes, but this may not reflect their everyday experiences. Heroism in paramedic practice can provide scripts for prosocial action, inspiring others, and leading to more social heroic actions. Paramedics may however be ambivalent to such heroism narratives, due to politicisation, and objectification in the media and society. This metasynthesis is only one of many possible constructions of heroism and paramedic practice and is the first point in making sense of and developing theory on heroism and paramedic practice.

Study registration

PROSPERO: CRD42021234851.

Job demands and job resources for job satisfaction and quality health outcomes among nurses during COVID-19: A cross-sectional study in Indian health settings

BACKGROUND

Coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for the Indian health-care system. Nurses, being vital partners of health care, experience tremendous challenges and job stress to deliver quality health care with limited resources. Drastic surge in health-care demands during COVID-19 pandemic amplified the challenges for nurses, yet it remains a neglected area of concern. Job resources like working conditions, team support, and job demands like workload, stress, and ethical dilemmas greatly affect the job satisfaction and health outcomes in nurses. The study aims to identify the job demands and resources among nurses in connection to COVID 19.

MATERIALS AND METHODS

A quantitative cross-sectional design was adopted to assess the impact of job demands and resources among registered nurses (N = 102). Those in the age group of 21-58 years and working in regular and COVID-19 patient care were included. Semi-structured interview schedule was used, and psychological impact was assessed through DASS-21 scale. Data analysis was done by descriptive and analytical statistical applications using Statistical Package for the Social Sciences (SPSS) 20. The level of significance was P ≤ 0.05.

RESULTS

The study findings revealed that 66.67% of the nurses frequently experienced work pressure, 72.55%experienced frequent moral distress, and 80.4%were dissatisfied due to being non-participatory inpatient care decision making. Of all, 67.3% agreed that they hadjob dissatisfaction and 79.4% felt conflicting work climate.

CONCLUSION

Nurses, being key players in the health care, experience constant challenges in the delivery of safe and quality patient care. Addressing the challenges of job stress and promoting job resources can positively impact their job satisfaction, perceived autonomy, job morale, and commitment, which directly influence positive health outcomes.

Challenges of prehospital aerial operations in response to earthquake hazards: A qualitative study

BACKGROUNDS

Due to the severity of the earthquake, it may need immediate treatment and transfer of the injured people to advanced medical centers, as well as dispatch of the expert team and specialized health equipment to the accident-affected area. Aerial emergency is an important responsibility of the health care system in this situation. The study aimed to extract the prehospital emergency challenges of Iran aerial operations emergency in response to the earthquake.

MATERIALS AND METHODS

The study was qualitative content analysis with conventional approach. Sampling was done in a purposive method and data were collected through semi-structured interview. The panel involved consists of 26 health professionals in medical emergencies. Recorded interviews were transcribed into written and then conventional content analysis was used to derive coding categories directly from the text data.

RESULTS

Content analysis is provided 97 initial codes, 20 subcategories and 4 main categories including challenges of "response assessment," "support," "pre-hospital staff-management," and "response operation," respectively.

CONCLUSIONS

The results showed that the necessity to assess the affected area, staffing, and management actions, including integrated operations command and the development of a dedicated response plan, as well as the use of strategies inter-organizational coordination in the response phase to earthquake. This study also emphasized that providing standard equipment, support actions, and strengthening communication infrastructure, and updating the aerial emergency system should be considered as one of the priorities of the emergency organization of Iran to provide a desired response to the earthquake.

Does workplace spirituality enhance motivation of hospitals social workers? The scrutiny in Iran

BACKGROUND

In today's world as the globe of organizations, employees tend to show endeavor and more involvement in organizational goals and mission by creating workplace spirituality.

AIM

The present study aimed to investigate the role of workplace spirituality in improving hospital social worker's motivation.

METHODS

The study employed a cross-sectional design and was conducted in 19 private and governmental hospitals in Karaj city, Alborz province, north Iran in 2019. The statistical population included all 302 hospital social workers who were selected as the sample population according to Cochran's formula. Using two standard questionnaires of workplace spirituality and employee motivation, we assessed the role of workplace spirituality in improving the hospital' social workers' motivation.

RESULTS

According to research findings, there were significant relationships between workplace spirituality, meaningful working, sense of community, forgiveness, and honesty with hospital social workers motivation p ⩽ .05. There was a significant difference between age group, gender, level of education and workplace spirituality, and motivation of hospital social workers p ⩽ .05.

CONCLUSION

Findings suggest that health planners and authorities may need to examine factors that contribute to the promotion of workplace spirituality to increase the motivation of hospital social workers for improved performance of health organizations.

Saudi Arabian Community Perceptions on Saudi Female Paramedics: A Cross-Sectional Study

INTRODUCTION

Although emergency medical services (EMS) stakeholders acknowledge the need for both male and female paramedics in the EMS field, the Saudi EMS system is currently only staffed by male paramedics and emergency medical technicians (EMTs) working in EMS organisations.

AIM

To understand and explore the Saudi Arabian community's perceptions on engaging Saudi female paramedics in the EMS workforce.

MATERIAL AND METHODS

This was a cross-sectional survey design using convenience sampling of the public in Riyadh city by self-administered English and Arabic language questionnaires. Questionnaire validity was assessed by face and content validity.

RESULTS

Of the 3603 surveys distributed, 3132 were returned (87% completion response rate). Most respondents were aged between 18 and 29 years (n = 1308, 41%), and the sex distribution was (n = 1646, 52.6%) male and (n = 1486, 47.4%) female. Overall, 77% (n = 2412) of the respondents supported the need for female paramedics in Saudi Arabian ambulance services, and 74.8% (n = 2343) preferred that female paramedics treated female patients.

CONCLUSION

This is the first public study to explore Saudi public perceptions about female paramedics in EMS in the Riyadh region, Saudi Arabia. The Saudi public is supportive of female paramedics being employed as paramedics in the country. Moreover, significant differences in perceptions were evidenced in the sex groups over any other factors.

Nursing Students' Competency to Attend Disaster Situations: A Study in Western Iran

OBJECTIVE

The disaster preparedness of nurses is important as nurses are members of a health care team that needs to work systematically and collaboratively in all conditions. Although education and training naturally underpin effective practice, disaster nursing education is rarely provided to nurses in Iran. Because disaster situations, by definition, overwhelm health services, it is likely that nursing students will be required to join their colleagues in the response. The purpose of this study was to evaluate the competency of nursing students to attend disaster situations.

METHODS

This descriptive, analytical study was conducted in western Iran in 2020. A total of 70 nursing students in the fourth (final) year of their undergraduate nursing education entered the study by a census sampling method. Data collection was undertaken using a validated disaster competency assessment questionnaire. The data were analyzed using SPSS version 21 (IBM Corp, Armonk, NY) with descriptive and analytic tests.

RESULTS

The mean age of participants was 21.4 ± 2.14 and 57.1% of them were women; 45 participants (64.3%) had received no disaster-related training, and 88.6% had no history of participating in disaster exercises. The total score for nursing students' competence was 125.58 ± 14.19. There was a significant relationship between the mean score of nursing competence in response to disasters and student history of participating in an exercise and training course (P < 0.001).

CONCLUSION

Students' competence in disaster situations is poor. Awareness of the competence condition of nurses is the first step to improve their preparedness as the most key members of the disaster health team. Conducting disaster-related training may be appropriate. The results of this study can provide evidence for the development of educational policies in disaster nursing education.

Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study

BACKGROUND

Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment.

METHODS

A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale.

RESULTS

Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility.

CONCLUSIONS

This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.

How emergency nurses cope and motivate themselves to sustain their caring work: An integrative literature review

AIMS AND OBJECTIVES

The aim of this integrative review was to assess how emergency nurses cope and motivate themselves to sustain their caring work.

BACKGROUND

The need to enhance sustainability of the workforce creates a demand to consolidate contemporary evidence related to emergency nurses' motivations, how they cope and sustain themselves for caring work.

DESIGN AND METHODS

The integrative literature review informed by Whittemore and Knafl involved searching four databases, which yielded 977 published research papers (2008-2021). A total of 33 studies met the inclusion and quality assessment criteria. The PRISMA checklist for review was followed.

RESULTS

No studies addressing all three areas (motivations, coping and caring sustainability) together were identified. Integration of evidence from quantitative and qualitative research was achieved in three categories: (1) emergency nurses' motivations to sustain their work, (2) emergency nurses' coping strategies and (3) sustaining care as emergency nurses.

CONCLUSION

To sustain themselves in caring work, emergency nurses need to be intrinsically and extrinsically motivated and know how to cope effectively with stressors and work demands. There is need for research examining the relationships between these aspects of emergency nursing work.

RELEVANCE TO CLINICAL PRACTICE

To ensure the sustainability of emergency nurses' work and careers understanding of the factors that influence and sustain their motivations and coping strategies is important for nurses and their clinical leaders and managers.

Qualitative Study of Health System Preparedness for Successful Implementation of Disaster Exercises in the Iranian Context

OBJECTIVES

Implementing disaster exercises in different parts of the health system is one of the important steps in providing and developing disaster risk management plans. Considering the importance of promoting health system preparedness through exercise, the present study aimed to identify and explain necessary and original components for successful implementation of preparedness exercises of the health-care system in disaster.

METHODS

The study was a qualitative content analysis. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 25 health professionals in disaster. Directed content analysis was used to analyze the data, which extracted the initial codes after performing the recorded interviews on paper and immersing them in the data analysis.

RESULTS

The data analysis resulted in the production of 100 initial codes, 14 subcategories, 6 main categories of "coordination and information management," "standards and indicators," "conduction and control of the process," "logistic management and supplies," "management of treatment operation," and "management of health operation," under the original theme of "implementation of exercise."

CONCLUSIONS

The findings of this study can greatly increase the attention of senior managers to preparedness in all areas of the health system, especially managers of prehospitals and hospitals who are the forefront of the response to the disaster. The findings of this study can be considered as a guideline for the implementation of principle and standardized health system preparedness exercises.

Observance of patients’ rights in emergency department of educational hospitals in south-east Iran

Purpose

Patient right is the most important ethical right in the hospital, which equally, belongs to every human kind. Observance of patient right is responsibility of all treatment staff when they offer treatment and care for patient. This study aims to investigate observance of patients’ rights in emergency department of educational hospitals in south-east Iran.

Design/methodology/approach

This study used a cross-sectional design and was conducted in four educational hospitals affiliated with the Kerman University of Medical Sciences in 2018. Using a two-section standard questionnaire of Patients’ Rights Charter, this study assessed patients’ rights observance using a census method, N = 382. The data from the questionnaire were analyzed using descriptive statistics including mean and standard deviations and analytic statistics such as Kolmogorov – Smirnov, ANOVA, t-test and Pearson test using SPSS 21.

Findings

Means of total score for observing all essentials of patients’ rights in emergency department of educational hospitals were at a moderate level (43.10 ±15.05) from the viewpoint of patients. The area of “providing health services based on respecting patient’s privacy and observing the essentials of secrecy and confidentiality” enjoying the highest mean score (86.89 ± 24.39), was at a good level compared to other areas. The area of “having access to effective complaint management system” showed the lowest mean score (23/85 ± 23/07) from the participants’ perspective proving a poor level. Between the patient rights observance and gender, education level, resident status and duration of hospitalization, a significant relationship was observed.

Originality/value

As regarded in this study, the degree of patients’ rights observance was moderate so, culture, paying attention to the rights of all stakeholders, identifying barriers and various factors, including the professional and environmental differences in the assessment of the need, should be considered by policymakers to design promotional and regulatory programs for improving the rights of the patient.