International Journal of Hospital Research
Volume:3 Issue: 2, Spring 2014

Workplace violence against female nurses is a significant and increasing problem. This study aimed to investigate workplace violence against female nurses in three general hospitals of Ilam located in Western Iran and identify factors influencing it incidents. Seventy seven nurses were randomly selected and surveyed. The data were collected using an author-designed instrument. The survey instrument consisted of 26 items on the demographic and employment characteristics (sex, age, work experience, marital status, degree of education, and the working department), and 19 multiple-choice questions related to verbal/physical abuse by patients (5 items), verbal/physical abuse by patients’ visitors (5 items), and nurse reactions (9 items). The validity and reliability of the questionnaire were examined using the CVI and Test-retest methods. T-test and ANOVA were used for comparison of the mean values. The correlation between the variables was explored using Pearson coefficient. Of the total participants, 83.1 % and 22.1 % had faced with verbal and physical violence by the patients during last year, respectively. Moreover, 88.3 % and 31.2 % of nurses had experienced verbal and physical assaults by patients’ companions, respectively. Most nursing staff believe that reporting aggressive evident is not useful at all. A significant correlation was found between physical assaults by patients and nurses’ age. In addition, a significant relationship between verbal violence by patients and nurses’ marriage status was identified (P < 0.05). Our results revealed a high rate of workplace violence against female nurses. To alleviate this problem, public training together with legally pursuing of individuals committing aggressive violence is essential. The fact that young and single nurses are more prone to violence shows the importance of employing experienced nurses in certain healthcare activities.

Shift working has the potential to negatively influence the quality of work life among nurses. The purpose of this study was to investigate the outbreak of shift work-related disorders and the relationship between shift work and job satisfaction in nurses of Ilam University’s subsidiary hospitals, in order to identify potential strategies for decreasing risk of health problems among nurses. In a cross-sectional study, 84 shift working nurses at three hospitals were randomly selected. The Survey of Shift worker (SOS) questionnaire was used as the major study tool. The nurses’ demographic and work condition data were collected using a research-made questionnaire. T-test was used for inferential analysis of the data. Psychological disorder (96.4%) was found to be the most prevalent shift work-related problem followed by social life (84.5%) and digestive problems (81%), respectively. Nurses who had chosen shift work voluntarily showed significantly higher job satisfaction as compared with nurses who were forced to work on shift (P < 0.05). Our study recommends that shift work is assigned preliminarily to the nurses who voluntarily choose to work on shift, in order to reduce the associated disorders and increase nurses’ job satisfaction.

Job burnout is a major source of healthcare human resources inefficiency with severe negative impact on patient care, physical-psychological health of staff, and healthcare costs. Psychological empowerment is a relatively new concept showing promise in boosting different aspect of human resources management. In this study, we pursued the question of whether psychological empowerment has any positive impact on hospital staff job burnout. Out of 820 staff of Mehr Hospital (Tehran), a sample of 270 staff from different job categories, including services, administrative, and health care categories was selected using stratified random sampling method. Psychological empowerment was measured using Spreitzer’s questionnaire (1995), and Maslach Burnout Inventory (2001) was used for assessing job burnout. Correlations between variables were examined using Pearson coefficient. A high level of job burnout was identified among the hospital staff. Healthcare staff showed a higher job burnout as compared with administrative and serving staff. Significant negative correlation was observed between psychological empowerment and job burnout (P < 0.05). In addition, certain dimensions of both constructs showed significant intercorrelations. The finding that psychological empowerment correlates with lower intensity and frequency of job burnout, encourage hospital managers to launch initiative for constant psychological empowerment of the staff in order to achieve higher human resources performance.

Needle stick and sharp injuries (NSIs) has remained as a persisting occupational hazard among the healthcare workers. This study aimed to provide updated information on the intensity and potential causes of the problem in Iran, by surveying a sample from major hospitals affiliated with Tehran University of Medical Sciences. Of 3312 healthcare workers with the potential risk of exposure to the Needle stick and sharp injuries, 295 who had experienced NSIs during the period of the study (June 2012 to June 2013) were included to the study. The participants were asked to complete a specific form developed by the Infection Control Committee of University with their data of age, gender, level of education, marital status, occupation, work experience, work shift, description of needle stick and sharp injuries occurrence.Data were summarized and analyzed using descriptive statistical methods. The reported incidence rate of needle stick and sharp injuries was determined to be 11.2%. The majority (39%) of incidents has been occurred in nurses followed by housekeeping workers (18.3%) and doctors (11.27%), respectively. While more than half of injuries have occurred in individuals of lower than 30 years old, the majority of cases (70.5%) had work experience of less than 5 years. In addition, most incidents had been occurred in the morning work shift (53%). Phlebotomy was found to the practice most frequently leading to injury incidents. The low rate of NSIs suggests underreporting calling exploration of the causative factors. The fact that the majority of incidents have occurred in young and low-work-experience individuals requires specific focus on educating and improving awareness of this group with regarding safety issues.

The burn injuries are one of the serious public health problems which impose a high economic burden on patients and their family, health sector and community in general. This study aimed to explore epidemiological data of burn patients and factors influencing costs of hospitalization due to burn injuries in Kermanshah Province situated in Western Iran. The study surveyed 625 burn patients who were admitted and died in the Imam Khomeini Hospital’s Burn Center in Kermanshah Province from 21 March 2009 to 20 March 2012. The data about demographics, cause of burn, burned body surface (BBS), length of stay (LOS), and cost of hospitalization were collected from hospital documentations. Descriptive analytical methods were used for data analysis. The mean and median age was 32.5 and 27 years respectively. The female/male ratio was 2.45 (181 male and 444 female). Flame was found as the most common cause of death due to burn (~93 % of all deaths). The mean cost of hospitalization per one day stay and per one percent of BBS was 2897062.5 and 234897 IRR, respectively. This study provides a holistic view for hospital managers and health policy-makers on demographic characteristics and cost of hospitalization due to burns in Kermanshah Province. Also the results showed that the cost of hospitalization in burn injury are related to the LOS, % BBS and the cause of burns.

Discharge against medical advice (DAMA) is a significant healthcare problem posing negative impact on effectiveness of patient care and costs of the health system. In order to address this problem, first the potential influencing factor should be identifies. This study followed two major first, to evaluate the prevalence and potential causes of DAMA, and second, to evaluate the impact of informed interventions on controlling the phenomenon. The study enrolled all DAMA patients hospitalized in Sina Hospital of Tabriz (Iran) during the first three months of 2013. A questionnaire asking the reasons for early discharge in terms of staff factors, treatment factors, patient factors, and environmental factors was developed in the Clinical Governance Office and the DAMA patients were asked to complete the questionnaire before leaving the hospital. Based on review of the responses, a number of interventional measures were devised with the consultation of head nurses of different departments. The interventions were executed in a 9-month period and the DAMA rate was compared before and after the interventions. Family involvement was found to be the major factor contributing to DAMA followed by job involvement, hospital type, and length of hospitalization. After introducing the interventions, a 36% reduction in the rate of DAMA was achieved. Our study demonstrates that systematic identification of factors contributing to DAMA followed by interventions based on the resulting insights can lead to remarkable reduction of discharge against medical advice.

Pharmaceutical expenditures are responsible for a major part of health systems’ cost. According to the WHO’s statistics, Iran is the first among the 20 countries in the world in terms of drug consumption. The first step in controlling consumption of a particular good is to identify factor inducing the relevant demands. Hence, this study aimed to identify the pattern and demand-inducing factors of drug consumption in Iran. The time series data of pharmaceutical expenditures was acquired from the yearbooks of Iranian Ministry of Health and Medical Educations. The time series data of medicine price index and per capita income were obtained from the documentation of the Central Bank of Iran. Pharmaceutical demand was modeled as a function of economic variables using the logarithmic transformation of Cobb-Douglas demand function and regression coefficients were estimated. Households income and medical liability insurance and medicine prices showed a positive and a negative impact on medicine expenditures, respectively. The elasticity of price and income was found to be less than one suggesting medicine as an inelastic and normal good. Our results imply that policies such as enhancing financial resources of insurances, rationalizing the allocated expenditures, and appropriate packaging of the insured medicines based on elasticity of income and demand, providing insurance premium based on the type and rank of the disease, implementation of coinsurance according to the type of medicinal services would help control of drug consumption.

Medication error underreporting by clinical staff prevent identification of type and intensity of medication errors, and addressing strategies. Most investigation of barriers to medication error reporting comes from public hospitals. This study aimed to explore the issue as perceived by nursing staff in private hospital. A sample of 97 nurses from a 180-bed private hospital situated in Mashhad City (Western Iran) was surveyed. A literature-based questionnaire consisting of 16 questions asking the reasons for medication error underreporting from the nurse’s perspective was used as the survey tool. The content validity of the survey tool was explored by using nursing experts’ opinions. The reliability of the tool was examined using test-retest method. Data were summarized using descriptive statistical methods. The factors contributing to the medication error underreporting were ranked based on their importance scores, and clustered into three major ranking categories: very important, moderately important, and slightly important. T-test and ANOVA were used for comparison of the medical error factors between the demographic groups. Fear of legal involvement, fear of losing job, and fear of the consequences of error were identified as the three major factors contributing to medication error under reporting. Age, work experience, working department, type of shift work and marital status were significantly we found to be influential on reporting medication errors. According to our results, factors related to the potential consequences of reporting constitute the major concern of nurses in reporting. This observation that is corroborated by numerous previous findings emphasize the importance of developing rational and blameless climate for honest reporting of un-intended medication errors and taking the advantages of these reports for improving patient safety.