Workplace violence against health care workers during the COVID-19 Pandemic: A systematic review and meta-analysis

INTRODUCTION

During the COVID-19 pandemic, Health Care Workers (HCWs) have been at the frontline against the disease and have direct contact with patients and their companions, so they are exposed to all sorts of Workplace Violence (WPV). The aim of this study was to investigate the prevalence of WPV against HCWs during the COVID-19 pandemic.

METHOD

This study was conducted according to the PRISMA guideline, and its protocol was registered at the PROSPERO under the code of CRD42021285558. Articles were obtained from data resources such as Scopus, PubMed, Web of Science, Science Direct, Google Scholar, and Embase. A literature search was conducted from the beginning of 2020 to the end of December 2021. Meta-analysis was conducted using the Random effects model, and the I² index was used to check the heterogeneity.

RESULTS

In this study, 1,054 articles were initially obtained during the primary search, of which 13 were finally entered in the meta-analysis. According to the results of the meta-analysis, the prevalence of physical and verbal WPV were 10.75% (95% CI: 8.20-13.30, I² = 97.8%, P = 0 < 001) and 45.87% (95% CI: 36.8-54.93, I² = 99.6%, P = 0 < 001), respectively. The overall prevalence of WPV was obtained, 45.80% (95% CI: 34.65-56.94, I² = 99.8%, P = 0 < 001) were reported.

CONCLUSION

The results of the present study showed that the prevalence of WPV against HCWs was relatively high during the COVID-19 pandemic; nevertheless, it was lower compared to the area prior to the pandemic. Therefore, HCWs need essential training to reduce stress and increase resilience. Also, considering organizational interventions (including policies to ensure that HCWs report WPV to their supervisors, increasing staffing per patient, and installing systems for HCWs to call for immediate assistance) can increase the resilience HCWs.

Design and psychometrics of risk assessment tool for makeshift hospitals: Focusing on pandemics

Pandemics caused a change in the health service delivery system. In disasters with massive injuries or epidemic, the capacity to admit the injured and infected patients to provide health services faces the challenges. Covid-19 virus is a respiratory disease that from its emergence until January 18, 2023, the Covid-19 virus has infected more than 672 million people worldwide. In most countries, makeshift hospital has been set up as intermediate medical centers to keep people who are likely to be carriers of the disease to control communicable diseases. Most makeshift hospitals already have alternative uses and, have changed into temporary or intermediate care centers. Based on the search of research team, any standard tools were found to assess the makeshift hospitals safety. All the safety assessment tools were related to the hospital, but since makeshift hospitals are mostly non-hospital structures, the research team has designed and validate a makeshift hospital safety assessment tool for the first time in this study. The present study is a mixed method that was conducted in 3 phases including; a document review, explaining the components affecting non-structural and functional safety of the makeshift hospital, designing makeshift hospital safety assessment tools and analyzing the results and validating it in 2022. Content validity and reliability were measured by CVR and CVI, ICC and Cronbach's alpha. In the fourth phase, with the participation of 15 specialists, managers, experts, qualitative and quantitative validity of content was done. Data were analyzed by SPSS version 21 software. The final tool contains 186 items and a 5-point Likert designed for very low safety (1), low safety (2), moderate safety (3), good safety (4), and very good safety (5). The scores of each makeshift hospital were calculated based on the items and the degree of safety. Cronbach's alpha coefficient for tool was 0.98. Retesting the questionnaire after two weeks confirmed the stability of tool (ICC = 0.98). The validity and reliability of this tool were confirmed with 186 items in 2 factors and 26 subcategories including risk of disaster, non-structural safety, safety of windows and shutters, hospital access, information and communication management, patient safety and hygiene and etc. All centers providing health services, whether temporarily or permanently, must have safety to continue their activities in disaster and maintain the safety and health of staff and inpatients. The makeshift hospital safety tool can be a suitable tool for assessing the risk and eliminating their vulnerabilities, and it can also provide important indicators for the design and set up of the makeshift hospital to policymakers and executives in the field of health.

Process and components of disaster risk communication in health systems: A thematic analysis

Risk communication (RC) is one of the necessary functions in disaster management. Establishing communication processes such as planning, transparency of policies and guidelines, RC expert training, providing communication infrastructure and evaluation in the shortest period reduces confusion and management inconsistency. One of the existing challenges is not knowing the exact dimensions of risk communication and its components in disasters. The aim was to identify the components of disaster risk communication in the health system. This research was conducted by systematic review and searching of the databases of PubMed, Scopus, Web of Science, ProQuest, Google Scholar and ScienceOpen 2000-2021 to identify the components of disaster risk communication in the health system. Thematic content analysis was used for data analysis. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 chart was used for systematic search, and a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used for quality determination. Out of 12 342 articles extracted, 25 studies were included for analysis. The components of disaster risk communication were analysed in 6 categories and 19 subcategories. These categories include communication (communication processes, communication features and infrastructure), information (content production, content characteristics and publishing), risk communication management (risk perception assessment, planning, coordination and logistics), monitoring and control (monitoring and evaluation, accreditation, documentation), education and training (public and organisational) and ethics and values (culture and social beliefs, ethics and trust). According to this research, the establishment of communication infrastructure and advanced equipment such as various structured formats for communication and artificial intelligence; online and offline communication support systems; and timely and accurate notice can help achieve goals such as coordination and organisation in the health system and increase social participation.

Contribution

This study has clarified and explained all the main components and measures of risk communication that can be used for planning scientifically.

Time Management Behaviors and Emotional Intelligence in Head Nurses in Emergency and Intensive Care Units

BACKGROUND

Time management is of particular importance in nursing. One of the most effective variables associated with time management is emotional intelligence (EI). This study assessed the relationship between time management and EI and the level of EI and time management skills in head nurses in emergency and intensive care units.

METHODS

A cross-sectional study was conducted on all head nurses in the emergency and intensive care units of nine educational hospitals at Isfahan University of Medical Sciences in Iran in 2015 using Bradberry-Greaves' EI and Macan's Time Management Questionnaires.

RESULTS

Participants' total time management score was (104.15 ± 6.98); total EI score was (128 ± 15.80). There was no significant relationship between overall EI and time management skills. There was a significant relationship between age and the emotional self-awareness dimension of EI (p = .027) and the mechanics dimension of time management (p = .037), and between work experience and overall time management skills (p = .049) and the mechanics dimension of time management (p = .038).

CONCLUSIONS

Specific EI and time management skills may help head nurses to cope with the challenges they face, which may improve the quality of nursing care. Nursing leaders should consider the importance of time management and EI in increasing motivation and satisfaction of nursing staff and improving quality of care.

A model to explain the challenges of emergency medical technicians' decision making process in emergency situations: a grounded theory

BACKGROUND

To manage life-threatening conditions and reduce morbidity and mortality, pre-hospital's on-scene decision making is an influential factor. Since pre-hospital's decision making is a challenging process, it is necessary to be identified this process. This study was conducted to explore the model of Iranian emergency medical technicians' decision making in emergency situations.

METHODS

This study was applied through grounded theory method using direct field observations and semi-structured interviews. Purposeful sampling with 26 participants including 17 emergency medical technicians including dispatchers, physicians of medical directions, managers and 1 representative for court affairs was performed. Interviews were lasted from October 2018 to July 2019. Corbin and Strauss approach, 2015 (open, axial and selective coding) were used to analyze data.

RESULTS

A paradigm model was developed to explain the relationships among the main categories. Decision making in the context of fear and concern was emerged as the core category. Unclear duties, insufficient authorities and competencies as well as lack of enough decision making's protocols and guidelines were categorized as casual conditions. Other important categories linked to the core category were interactions, feelings and "customer focus approach". Action-interaction strategies were taken by Emergency Medical technicians lead to some negative consequences that can threaten clinical outcome and patient safety.

CONCLUSIONS

Based on the finding of this study, Emergency Medical technicians' decision making in the context of fear and concern, as the core concept of this model, lead to decrease in quality of the pre-hospital services, stakeholders' dissatisfaction, hospital emergency units' overload, decrease in reputation of the Emergency Medical Technicians, threat to patient clinical outcome and patient safety. To prevent of these negative consequences, facilitation of the Emergency Medical Technicians' on-scene decision making is recommended.

A model for Vision Zero implementation in Iran: a grounded theory study

BACKGROUND

Road Traffic injuries (RTIs) are major global health issues, but they have been neglected. RTIs are multi-faceted in nature and, like many injuries, are costly but preventable. Iran has one of the highest rates of deaths due to traffic accidents among middle-income countries. Hence, there is a need for effective and preventive approaches in road safety management. One of the new approaches to road safety is the Vision Zero. The aim of this study was to design a Vision Zero implementation model in Iran.

METHODS

This present study was conducted using the qualitative grounded theory approach. Purposive, snowball and maximum variety sampling were used to select participants. In-depth interviews were used to collect data. Grounded theory method was used to analyze the data using Corbin and Strauss method.

RESULTS

In this study, 19 interviews were conducted with 17 participants. Based on data analysis, a total of 4 main categories and 13 subcategories were obtained. According to the participants, the lead agency was recognized as the core category. Other concepts were categorized as causal conditions, intervening conditions, contextual conditions, action/interaction strategies, and consequences.

CONCLUSIONS

Establishing a lead agency with inter-organizational coordination through political support and legislation and changing the approach of road safety can be effective in implementing a Vision Zero. Also, improving the safety attitude of the stakeholders and changing their approach through training and advocacy from various organizations related to road safety is effective in creating a lead agency and implementing a vision zero. In addition, in order to implementation of the model, it is very important to pay attention to the economic, political and ethical underlying factors towards human beings.

Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study

BACKGROUND

To avoid making decisions based on the unproven opinions of emergency medical technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical protocols. As protocol-based on-scene decision-making is influenced by many challenges, identifying these challenges can result in providing appropriate conditions for EMTs' decision-making. Therefore, this study aimed to identify the barriers and requirements in the off-line emergency medical protocols implementation m in the prehospital emergency medical system.

MATERIALS AND METHODS

To conduct this study, qualitative content analysis using 10 field observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was used to analyze the data.

RESULTS

Seven categories (15 subcategories) including education and awareness (professional training and education and community-based education); attitudes (professional attitude and community attitude); interactions and coordination (interpersonal interactions, organizational interferences, and community's interactions); rules and instructions (instructions and supportive rules); control system (monitoring and evaluation and motivational system); accessibility (recourses and communication); and organization (structure and process) were obtained as the obstacles and challenges in the offline emergency medical protocol implementation in the prehospital system.

CONCLUSIONS

There are many challenges in implementing offline emergency medical protocols in the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital emergency protocols, it is necessary to facilitate these challenges and improve the EMTs' knowledge, attitude, and performance through cooperative and skill-based education. The findings of this study can be useful for EMS systems from national to local levels.

Factors affecting development of air ambulance base: A systematic review and thematic analysis

Nowadays, air ambulances have been developed as part of advanced emergency medicine services with many countries employing these services for transferring patients in usual and emergency conditions. However, there are challenges concerning the optimal development of air ambulance base. The present research aimed to identify factors affecting the development of air ambulance bases to provide the opportunity of planning to improve the quality of emergency medical services. In this systematic literature review, the peer-reviewed papers in fiv electronic databases, including Medline through PubMed, Scopus, Web of Science, ScienceDirect, and ProQuest, as well as available gray literature, were searched and selected. Two combinations of groups were used as keywords: the Health Planning and development factor, air ambulance base. The focus was on the PRISMA checklist, with no time limitations until from 1990 to January 2020. Finally, through 5156 related citations, 20 articles were included. Descriptive and thematic content analyses were evaluated. The factors affecting the development of the air ambulance base were classified in fiv categories and 14 subcategories as follows: navigation criteria, process indications and standards, sociopolitical factors, and current situation of the area. There are few studies on factors affecting the development of air ambulance bases. It is necessary to apply multidimensional models to consider various factors for development. The development of high populated cities, events and ceremonies with a crowd of participants, and increase of human-made disasters are making these services increasingly indispensable.

The Bridge Between Need and Access: Distribution of Trauma Care Facilities at a Religious Mega Mass Gathering

Participating in mass gatherings puts people at risk of incidents. The distribution of resources should be based on need. The purpose of this study was to investigate the distribution of trauma care facilities based on need and access at a religious mass gathering in Iran. This national cross-sectional study is based on obtained data including the number of visits to health centers (NVHC) and the number of injuries visits health center (NIVHC) as needs and the number of physicians, paramedic, ambulance, and treatment center as access in border cities of Iran and Iraq in 2016. Gini coefficient, Lorenz curve and the Pearson correlation coefficient were applied to measure the level of equality in the distribution of trauma care and the correlation between access and need. The facilities were relatively distributed equally at the border towns in Iran; however, were not equally distributed in Iraq. There is no significant association between the paramedic for NIVHC and ambulance for NIVHC and NVHC. Moreover, there was a significant association between physician for NIVHC and NVHC, a paramedic for NVHC, and treatment centers for NIVHC and NVHC. The consequences of incidents could be reduced if distributing trauma care facilities equals at mass gatherings. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):442-447.

Preparedness challenges of the Iranian health system for dust and sand storms: A qualitative study

BACKGROUND

The dust and sand storms (DSS) in Iran increased in recent years, which have caused adverse health effects. Regarding the effects of DSS on the health indicators, the health system plays a key role based on the mission and the services which it provides. The present study was conducted, in Iran, to fill the existing knowledge gap and to understand the preparedness challenges of the health system in response to the DSS.

MATERIALS AND METHODS

Twenty-one semi-structured interviews, in 2016-2017, were undertaken. This study carried out using purposeful sampling with key informants in the Khuzestan Province, national policymakers in Tehran, as well as people affected by this phenomenon. A qualitative approach, using the conventional content analysis, was employed to analyze the collected data.

RESULTS

Four main categories that appear to explain the preparedness challenges of the health system for DSS include the risk assessment, knowledge management, organizational elements, as well as monitoring and evaluation.

CONCLUSIONS

It is imperative that policymakers of the country pay special attention to the hazard risk understanding and managing the various aspects of the beliefs and attitudes associated with DSS. The development of early warning system, regular drills and exercises, as well as public and specialized health promotion training related to this phenomenon are suggested.

Helicopter Emergency Medical Services in 2017 Kermanshah Earthquake; a Qualitative Study

INTRODUCTION

Becoming aware of experiences, and lessons learned in challenges can help optimize planning and improve efficiency and effectiveness. The present study aimed to address the challenges of helicopter emergency medical services (HEMS) from the viewpoint of the managers involved in HEMS in Kermanshah earthquake.

METHODS

This qualitative research was done using the content analysis method. The data were collected by semi-structured interviews.  The study population consisted of directors who participated in management and transfer of injured people in the earthquake-stricken area of Kermanshah. Sampling was purposeful in the first stage and then by the snowballed method.

RESULTS

In the present study, 479 codes were initially extracted regarding participants' perspectives and experiences and after eliminating duplicates, 53 codes were finalized. After analyzing the data, 4 categories and 12 sub-categories were extracted. In this research, lack of integrated management and process-oriented preparedness were the subjects with the highest number of codes.

CONCLUSION

According to the findings of this study, it is suggested that comprehensive training programs should be implemented for effective management of the air emergency process during disasters such as earthquakes.

Qualitative study of health system preparedness for traumatic incidents in a religious mass gathering

BACKGROUND AND OBJECTIVES

Traumatic incidents may occur during religious mass gatherings. A lack of preparedness by the health system to respond to traumatic incidents may increase the mortality rate. This study investigated the factors that affect the preparedness of a health system to respond to traumatic incidents, and we provide appropriate suggestions for improving the response to such incidents during religious mass gatherings.

METHODS

A qualitative research method was used with a conventional content analysis approach. In total, 22 semi-structured interviews were conducted employing the content analysis method. The data were analyzed based on the means of the meaning units, condensed meaning units, sub-themes, themes, and codes.

RESULTS

Four main categories and nine sub-categories emerged from the data: factors that increased or decreased the occurrence of incidents (with three sub-categories comprising risk perception and fatalism, pilgrims' responses to incidents, and health system response to traumatic events); medical infrastructure (with two sub-categories comprising medical infrastructure in the host country and medical structures in border cities); organizational resource category (with two sub-categories comprising manpower, and equipment and facilities); and coordination of responsible organizations (with two sub-categories comprising inter-organizational coordination and inter-agency collaboration). All of the data were extracted from the experiences of the participants.

CONCLUSION

Similar to other mass gatherings, Arbaeen requires multi-sectoral and international planning, organizing, and management. The key factors that could improve the preparedness to respond to traumatic events in Arbaeen include training, increasing the perception of risk, changing the attitudes and behavior of pilgrims, developing a national strategic plan of the health system preparedness for policymakers, and implementing scenario-based exercises for executives.

Preparedness components of health systems in the Eastern Mediterranean Region for effective responses to dust and sand storms: a systematic review

Background: Dust and Sand Storm (DSS), according to estimates by global reports, will increase dramatically in the Eastern Mediterranean Region (EMR). Numerous health problems caused by DSS will be severely affected regions and vulnerable groups. This study aimed to identify the components of the preparedness of health systems for the DSS phenomenon in EMR. Methods: In this systematic review, the peer-reviewed papers in four electronic databases, including Medline through PubMed, Scopus, ISI Web of Science and the Cochrane library, as well as available grey literature, were searched and selected. The research process was carried out by including papers whose results were related to the potential health effects caused by desert dusts in EMR. Was used the combination of three groups of keywords: the exposure factor, health effects as outcomes, and the countries located in EMR. The focus was on the PRISMA checklist, with no time limitations until December 2017. Finally, through 520 related citations, 30 articles were included. Descriptive and thematic content analyses were evaluated. Results: The preparedness components were divided into three and ten main categories and subcategories, respectively. The three categories covered the areas of DSS hazard identification, planning and policy-making, and risk assessment. Conclusions: Recognition of the health system preparedness factors for DSS in EMR will help policy-makers and managers perform appropriate measures when dealing with this hazard. More studies should be conducted to understand these factors in other parts of the world. Registration: PROSPERO registration number CRD42018093325.

The Relationship between Nurse's Job Stress and Patient Safety

BACKGROUND

Patient safety is a key element of the quality of health services. Nurses are the largest group that care for patients, observing safe in nursing care would reduce injuries, disability, morbidity and mortality. However, high stress can lead to a decline in the quality of nursing care.

AIM

This study aimed to investigate the relationship between job stress of the nurses and patient safety in a teaching hospital of Hamadan in 2017.

MATERIAL AND METHODS

This is a cross-sectional study. The data was gathered by a questionnaire of Nurse's job stress prepared by the researcher that after confirming the validity and reliability was completed by 198 nurses of three teaching hospitals of Hamadan city that were selected by simple random sampling and the checklist of patient safety that was collected by the researcher. Data analysis was done in the two levels of descriptive and analysis statistics.

RESULTS

The results showed that the job stress of the nurses and patient safety (mean = 1.75 and SD = 0.114) have been at an average level. There was no statistically significant relationship between Nurse's job stress and patient safety because the Spearman correlation coefficient showed that r = 0.007 and p = 0.919. Among the demographic factors, there was only a significant relationship between marital status and Nurse's job stress (p < 0.05).

CONCLUSION

Because of nursing job stress is affected by different working conditions, further studies in the many hospitals are needed. Moderate levels of patient safety are not acceptable; Therefore, heath's policymakers should focus on providing the safety of all patients at the optimal level, with more effort to reduce the stress of their nurses at the lowest level.

Exploring challenges of health system preparedness for communicable diseases in Arbaeen mass gathering: a qualitative study

Background: Infectious diseases are common problems in mass gatherings, especially when there is a lack of health system preparedness. Since Iran is one of the most important countries on the walking path of Arbaeen and has a vital role in providing health services to pilgrims, the experiences of health challenges by participants is of key importance. The aim of this study is to explore stakeholders' experiences on the health system's preparedness and challenges, and to provide suggestions for preventing infectious diseases during the Arbaeen mass gathering. Methods: A qualitative research method was used with a conventional content analysis approach. The number of participants was 17, including 13 executive managers and 4 health policymakers who entered the study among participants. Semi-structured interviews were used to generate the data. Interviews were analyzed by means of content analysis after face-to-face interviews. Results: Data analysis resulted in the extraction of four main themes and 11 sub-themes. Health infrastructure defects in Iraq has three sub-themes (health abandonment in Iraq, the weaknesses in health culture and problems related to the health system); poor control of the causative factors of infectious diseases has three sub-themes (the underlying factors of the prevalence of contagious diseases, health system response to communicable diseases and ignoring the risks of the Arbaeen ceremony); the low perception of risk in pilgrims has three sub-themes (lack of awareness in pilgrims, fatalism in pilgrims and unhygienic belief in pilgrims); and the ineffectiveness of health education has two sub-themes (training shortage in the targeted group and educational content problems) that shows participant's experiences of the health system's challenges for coping with infectious diseases during the Arbaeen ceremony. Conclusion: Pilgrim-based training, planning and controlling other challenges may change these threats to opportunities and improve the health of participants of the mass gathering of Arbaeen in the region.