مرضیه گرایی

Due to the increasing difficulties and resource constraints in the field of health, the optimal use of health care facilities has received great attention. Therefore, using appropriate methods of management to avoid wasting limited hospital resources is of high significance. One of the key tools used as a lever to control and reduce health costs is to shorten the patient's length of stay. Accordingly, investigating the possible causes of prolongation of patients’ stay in the hospital and the proper use of hospital beds are among the most important issues with regard to the use of hospital facilities.
The present study is an analytical-descriptive study, using a cross-sectional method to determine possible causes of prolongation of patients’ stay in the hospital after the issue of discharge order by physicians in Shahid Faghihi Hospital in 2016. The collected data were submitted to SPSS software and analyzed using t-test, Pearson correlation, and chi-square test.
The percentages of the patients who had extended their stay because of financial problems, unwillingness to leave the hospital, absence of insurance staff, lack of companions, lack of health insurance, and transference to other hospitals were 68.4%, 0.7%, 6.2%, 7.1%, 4.4%, and 11.1%, respectively. 
Hospital authorities’ awareness of the average prolongation of patients’ stay in the hospital and the reasons behind that can be effective in decision-making and planning for organizations. Recognizing such problems and proposing solutions to reduce patients’ length of stay and making plans for it can reduce unnecessary and excessive stays and hospitalizations; hence, reducing hospital costs.

Hand washing is one of the most efficient and effective ways to prevent the transmission of microorganisms from one person or one place to the patients. However, despite the importance of hand washing by the medical personnel, the results of some studies indicate lack of proper hand washing by them. The present study aimed to determine the barriers to hand washing from the viewpoint of nurses working in general hospitals affiliated to Shiraz University of Medical Sciences in 2017. This was a cross-sectional and descriptive-analytical study conducted on 312 nurses working in general hospitals affiliated to Shiraz University of Medical Sciences. The required data were collected using a valid and reliable questionnaire consisting of two parts, including the studied nurses' demographic characteristics and 48 items related to the hand hygiene barriers in four dimensions of individual barriers (12 items), managerial barriers (19 items), equipment barriers (10 items), and environmental barriers (7 items). The collected data were analyzed using SPSS 21.0 through independent t-test and ANOVA. The p value of less than 0.05 was regarded as statistically significant. The results showed that equipment barriers and individual barriers had, respectively, the highest (2.85 ± 0.65) and lowest (2.62 ± 0.46) means. Also, there were significant relationships between the means of managerial and equipment barriers and the studied nurses' sex, between the means of individual and managerial barriers and the nurses' employment status, between the means of equipment barriers and the nurses’ marital status, and finally, between the means of managerial barriers and the nurses' working shifts (P-value<0.05). According to the results, in order to remove the barriers to the nurses' hand washing, the following suggestions can be made: running adequate and appropriate training courses and developing a proper culture in the hospital wards to increase hand washing, using appropriate monitoring and motivational systems; providing timely, adequate facilities and equipment and also selecting appropriate disinfectants for nurses' hand washing, etc.

Nurses are exposed to significant occupational stress compared to other healthcare professionals, which predisposes them to the risk of cognitive failure and the incidence of clinical errors. The present study aimed to assess the correlation of occupational stress and cognitive failure in the incidence of clinical errors among nurses. This cross-sectional study was conducted on 367 nurses at eight hospitals in Tehran, Iran in 2017. The participants were full-time nurses employed in the selected hospitals with more than six months of clinical experience. Demographic data of the participants were collected, and the scores of occupational stress and cognitive failure and frequency of medical errors were determined using self-administered questionnaires. Moreover, a binary logistic regression model was applied to verify the influential factors in the incidents associated with patient safety among the nurses. In total, there were 367 valid responses, and 19.61% of the nurses had experienced clinical errors. Mean total scores of occupational stress and cognitive failure were 3.48 and 1.98, respectively. According to the binary logistic regression analysis, the most important influential factors in the incidence of clinical errors were the received wages (odds ratio [OR]=0.066), clinical experience (OR=2.114), cognitive failure (OR=3.897), duty-related stressors (OR=2.837), and interpersonal relations associated with stressors (OR=0.340). According to the results, the incidence of clinical errors was influenced by cognitive failure, occupational stress, received wages, and clinical experience. Therefore it is recommended that hospital managers retire the nurses with higher clinical experience and recruit younger nursing staff. In addition, nursing managers should develop and apply appropriate policies and strategies to reduce occupational stress, which in turn diminishes the incidence of clinical errors