The challenges of implementation of clinical governance in Iran: a meta-synthesis of qualitative studies

Policy brief: addressing the shortage of human resources in the Iranian health system

This policy brief highlights the critical shortage of healthcare workers in Iran, which hinders access, quality, and patient outcomes. The growing demand from population increases and chronic diseases, coupled with issues like geographic maldistribution, workforce migration, inadequate training, and limited support systems, exacerbates the crisis. Urban areas benefit disproportionately, leaving rural communities underserved and healthcare quality compromised. Evidence-based recommendations include incentivizing rural placements, improving workforce management systems, enhancing salaries and working conditions, expanding education and training, and leveraging digital health tools and task-shifting models. A phased implementation strategy is proposed, combining short-term pilot projects with long-term reforms to build a resilient healthcare workforce.

Exploring a guide for codes of ethics for the development of ethical competence in Iranian nursing students: a systematic review and meta-synthesis

BACKGROUND

Improving the ethical competencies of nursing students, as an important dimension of professional competence, is a primary objective of nursing education. Thus, this study aimed to explore a guide for codes of ethics for the development of ethical competence among nursing students in the healthcare system of Iran.

METHODS

This is a systematic review and meta-synthesis of qualitative studies conducted in the healthcare system of Iran. The review included studies published between January 1, 2000 and March 2024. We conducted a comprehensive search in various international and national databases, including Web of Science, PubMed, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and SID. Initially, 86 qualitative studies were identified, and after a meticulous screening process, 39 studies were carefully reviewed. Finally, 10 qualitative studies were selected for analysis. The meta-synthesis employed an interpretive approach by thematic synthesis.

RESULTS

Based on our results, four main themes and 10 categories, along with summarized codes, were extracted as crucial elements of the codes of ethics for the professional competence of Iranian nursing students. The main themes identified were knowledge, standards, experiences, and attitudes (KSEA).

CONCLUSIONS

The concept of codes of ethics for developing professional competencies in Iranian nursing students was detected as a multidimensional concept with four major areas. By emphasizing the rights of clients and the standardization of nursing practice, this set of ethical codes can contribute to preventing clinical errors and legal issues at hospitals and educational settings. Furthermore, it fosters a positive environment that encourages professional behaviors among nursing students. Nursing students, as future nurses, should apply codes of ethics when facing emerging ethical challenges. Nurse educators have a crucial role in providing students with the necessary preparation and guidance during their professional socialization process in nursing schools.

Explore the practice and barriers of collaborative health policy and system research-priority setting exercise in Ethiopia

INTRODUCTION

Collaboration is gaining prominence in the priority setting of Health Policy And System Research (HPSR). However, its practice and challenges are not well explored in Ethiopia. Understanding the practice and barriers of collaborative Health Policy and System Research will help design approaches and platforms for setting inclusive and participatory policy and system-level health research topics. This paper explores the practice and barriers of collaborative HPSR-priority setting exercise in Ethiopia.

METHODS

This study investigates the practice and barriers of collaborative health policy and system research priority-setting exercises in Ethiopia. Utilizing a mixed-methods approach, we conducted Key Informant Interviews (KIIs) and an online self-administered survey with open-ended questionnaires to capture diverse perspectives from stakeholders involved in the research priority-setting process. Through conventional content analysis, we identified key contents related to current practices, challenges, and opportunities for enhancing collaboration in health policy and system research prioritization.

RESULTS

Our findings reveal a complex landscape characterized by varying levels of stakeholder engagement, institutional capacity constraints, and competing priorities within the health research ecosystem. Despite notable efforts to foster collaboration, stakeholders identified persistent challenges such as limited resources, institutional fragmentation, and inadequate coordination mechanisms as barriers to effective priority-setting processes. The implications of our research extend beyond academic discourse, with direct relevance to health policy and system research practice in Ethiopia. By shedding light on the dynamics of collaborative priority-setting exercises, our findings offer valuable insights for policymakers, researchers, and practitioners seeking to enhance the effectiveness and inclusivity of health research prioritization processes. Addressing the identified barriers and leveraging existing strengths in the research ecosystem can contribute to more evidence-informed health policies and programs, ultimately improving health outcomes for Ethiopian populations.

CONCLUSIONS

Most institutions do not apply health policy and system research-priority setting to conduct informed decision-making. The barriers explored were weak integration, lack of knowledge, system, and platforms for the priority setting of Health Policy and System Resreach. So, it is recommended to build skills of different actors in the Health Policy and System Research-priority setting exercise and design a system and platform to integrate different stakeholders for collaborative research topics priority setting.

Recurrence of medical errors despite years of preventive measures: A grounded theory study

BACKGROUND

Despite great efforts to improve patient safety, serious preventable medical errors continue to occur. Accurate rooting causes of error recurrence are essential for reviewing methods to prevent them. This study aimed to identify the main causes of the recurrence of medical errors despite their previous occurrence.

MATERIALS AND METHODS

This qualitative study was performed using the grounded theory method, with theoretical sampling from April to July 2021, through semi-structured interviews with 25 experts and treatment staff of hospitals under the auspices of four universities of medical sciences in Iran.

RESULTS

Four main parts were identified: 1) primary and secondary factors leading to the occurrence of errors, 2) error prevention policies, 3) causes of error repetition, and 4) contextual factors.

CONCLUSION

The attention, seriousness, and commitment of health system managers, from top to bottom, to patient safety are essential for preventing error recurrence. The institutionalization of patient safety education from universities and attention to individual, social, and cultural factors should also be given serious attention.

A critical analysis of Iran health system reform plan

INTRODUCTION

Iran's Health System Reform Plan (HSRP) were initiated in public and hospitals affiliated to Medical Sciences Universities in June 2015. The purpose of the present paper is to provide a critical analyse of the HSRP and its outcomes.

METHODS

The study was carried out as a review critical analyse in 2019. The pertinent articles were searched for in Science Direct, PubMed, Ovid, and Google Scholar using keywords "health sector," "reform plan," "health system reform," "health services," "health care system," and "Iran." Published articles in scientific national and international journals in Persian and English language, of which the full-texts were available, were entered into the study. Finally, from a total of 75 articles obtained, 45 studies were carefully reviewed.

RESULTS

Several factors, which impact in the success of Iran's HSRP such as social-economic and political outlooks, lack of official information and a comprehensive management system, in addition to failure to extend continuous performance control, economic sanctions against Iran. Other factors are limitations on financial transactions between Iran and the rest of the world due to the sanctions, relying merely on a few instructions, and negligence of the required infrastructures. In terms of advantages of the plan, relative decrease in patient's share in medical expenses, improvement of emergency wards, and relative decrease in the rate of C-section operations are notable.

CONCLUSION

Better implementation of Iran's HSRP entails the provision of resources and facilities such as stable and adequate resources, proper management of available resources, payment mechanisms reform, attracting, and facilitating private sector's participation.

Chronic Disease Self-Management Among Iranian Older Adults: A Scoping Review

Background: Implementing care models that emphasize chronic disease self-management (CDSM) strategies may be an effective approach to the growing prevalence of chronic conditions in Iran. We, therefore, conducted a scoping review on CDSM among older Iranians to identify existing gaps and opportunities to improve chronic disease care. Method: We conducted a search in CINAHL, EMBASE, MEDLINE/PubMed, and Cochrane library. Selected articles were charted based on year of publication, language, objectives, methods, target chronic disease(s), sample demographics, self-management type, and key findings. Results: We selected 73 articles. The main components of CDSM addressed were social support, education, physical activity, nutrition, self-monitoring, spirituality, and financial support. Older Iranians reported low levels of physical activity. Conclusion: Enhancing the quality of CDSM research and provision of coaching to enhance older adults' social and mental health are among the main strategies to enhance CDSM among the Iranian older population.