فهرست مطالب مصطفی شهابی نژاد

Stressful experiences related to the workplace and organizational missions cause stress, psychological burden, and physical injuries in police officers. The continuation of these experiences will affect the quality of work-life of police officers. This study aimed to explain the concept of quality of police work-life and factors behind it based on the lived experiences of police officers.

This qualitative study was conducted in 2018–2019 the police organization using the conventional content analysis approach. Participants were police officers who were selected through purposeful sampling with maximum variation. Data were collected from 13 police officers through in-depth semi-structured face-to-face interviews. Interviews were recorded, transcribed verbatim, and analyzed through the conventional content analysis method proposed by Graneheim and Lundman. MAXQDA software was used for analysis and organization.

The factors behind police officers’ quality of work-life were categorized into three main themes namely, "effective management and leadership", "working in bottleneck", and "accepting the working conditions". Each theme consisted of two to six subthemes.

Quality of work-life of police is a contextual, multidimensional concept affected by the type of management and leadership, existence of refreshment and supportive facilities, and the degrees the staff accept their working conditions. Authorities are responsible to improve the police staff’s quality of work-life so that they enjoy their organization and work. Improving the organizational atmosphere by creating pleasant working conditions can help improve the police staff’s quality of work-life despite their difficult working conditions.

This study is a report about two Soldiers that suffered from lower extremity pain in two different time during military service in Garrison . In their initial visits in Medical center, they are treated as an outpatient . With intensifying symptoms and recurrences, they have Hospitalized with diagnosis of necrotizing fasciitis. Both patients after fasciotomy and several times of necrotic tissue debridement, they have treated with antibiotics, at the same time. Finally, one of patient died and another was improved. Discussion and Because muscle sprains and muscular injuries are abundant in soldiers, there is a possibility of Streptococcus group A (GAS) transmitted by the blood from the throat to the blunt trauma site or the muscle strain and pressure on the muscle. Injury prevention strategies should be developed by commanders in barracks

Health is recognized as one of the prerequisites for social welfare systems. Insurance coverage changes the behavior of the consumer (patient) and the provider (doctor) of the medical services, which is considered a moral hazard. This study was conducted with the aim of addressing the concept of moral hazard and its types and consequences in health insurance marketing.

This is a review article that its related articles have been selected from published literature in national and international databases. The database of English texts includes Pubmed, Science direct, Scopus and the Google Scholar search engine and Persian texts including Magiran, Sid, Irandoc, Iranmedex and Medlib. Articles were searched between the years of 2009 and 2018. Finally, among the articles founded, 52 related articles were selected, which studied moral hazard in health insurance system.

Moral hazards are caused by the change in service providers and consumer behavior as a result of being insured due to the presence of a third-party payer. The third-party is another agent or company, such as insurance, which covers the cost of patients and therefore the consumer and service provider are not motivated to reduce received services. In moral hazard, people with higher insurance coverage, make less efforts to prevent (ex-ante moral hazard), and with the onset of illness, they use more and better health care services (Ex-post moral hazard). The moral hazard of the consumer is the most significant form of moral hazard.

Moral hazards have negative consequences, such as reducing the welfare and increasing costs in the health system. It is essential to investigate and recognize the effects of moral hazard and its control in order to prevent undesirable outcomes and misallocation of resources. To control consumer moral hazard, one can use franchise, especially for highly elastic services.

The improvement of patient safety is a universal necessity. Also, one of the components that plays an important role in improving the level of patient safety in hospitals is patient safety climate. The purpose of this study was to identify factors affecting the patient safety climate in the military hospitals of Kerman city, Iran.

The present study was an analytical study, using a factor analysis model, conducted in 2015 in the military hospitals of Kerman. The sample size was 200 people of nursing staff in the mentioned hospitals. Data was collected through a questionnaire. The criterion for data analysis was an exploratory and confirmatory factor analysis.

Nine effective factors on patient safety climate were extracted ─including supervisors' attitudes, management support for patient safety, non-punitive responses to error, team collaboration, medical care safety, workload, error management, employee empowerment, and communications.

The dimensions of the patient safety climate can be different in the variety of environments and the impact of each dimension on that can be also varied in hospitals

Occupational hazards are the most common occupational health problems. Health systems, like other high-risk workplaces are exposed to risk factors. Occupational hazards by creating job injuries can effect on the performance of personnel and jeopardize people's lives who working in these environments.
This study was conducted in 2017 in a military hospital. Data collection instrument was check list that designed based on literature review and similar studies. The face and content validity was confirmed by experts and its reliability by using Cronbach's alpha coefficient obtained 0.81. The instrument measured physical, chemical, ergonomic, psychological, biological, and safety hazardous. Data collected were analyzed by SPSS 17 software using descriptive and inferential statistical methods.
Most occupational hazards in hospital staff are associated with psychological hazards and biological hazards, ergonomics, safety, physical and chemical are the next category. Most occupational hazard related to orthopedic surgeon and the lowest occupational hazard associated with hospital statistics staff.
Based on the findings of the research staff of a hospital are constantly exposed to potential occupational hazards and act in vulnerable conditions that this could have a negative impact on the health of body and mind staff. Psychological hazards are at the top of the occupational hazards for workers .

Nursing is known as a profession with a high level of stress. This occupational stress has an adverse effect on the health and abilities of nurses in the workplace. This study aimed to determine the occupational stressors among nurses of a military hospital.
This cross-sectional descriptive study was conducted among the nurses of a military hospital selected by census sampling in 2016. Data were collected by the Expanded Nursing Stress Scale (ENSS) questionnaire. Then, the analyses were performed using descriptive and inferential statistical tests in SPSS software.
The findings showed that 70.23% of nurses had a moderate stress level. Psychological factors, physical factors, and social working environment were identified, respectively, as stressors among nurses. The absence of physician in an emergency situation has been reported as the most influential statement of occupational stress among this group. It is necessary to mention that occupational stress level of nurses had a significant relationship with work experience (p=0.030) and wards of hospital (p=0.001).
In summary, with full recognition of occupational stressors, managers can provide a background of preventing burnout and promoting the health among nurses.

Nuclear accidents in any shape or anywhere require presence of trained individuals and medical teams on the site of accident. Considering the important role of nurses in efficient management of these disasters, they should possess special qualifications in different areas. This study was done with the aim of assessing the knowledge of nurses working at a military hospital in the face of nuclear accidents.
This Cross-sectional descriptive study was carried out in 2015 in a military hospital. The study population consisted of nursing staff of the hospital, which were included using consecutive sampling. The tool used for this study was a questionnaire consisting of 2 parts. The first part was about the demographic data of the participants and the second part had 14 questions for evaluating the knowledge of the participants on facing nuclear accidents. Gathered data were analyzed using SPSS version 17 and descriptive statistics methods such as t-test and ANOVA.
In this study, 136 of the nursing staff with the mean age of 32.99 ± 4.56 years participated (76.5% female). 83.8% had a Bachelor’s degree and their mean work experience was 8.03 ± 3.86 years, while 76.5% of them had no history of presence or service in any accident or disaster. Only 5.8% of the participants had sufficient knowledge of consequences of a nuclear accident and 80.3% of them had not participated in any training courses regarding nuclear victims. Knowledge of the nurses was evaluated as poor (m = 25) and results showed that there is no significant correlation between work experience (p = 0.330) and type of ward (p = 0.718) with the knowledge of nurses on encountering nuclear accidents.
Knowledge of nurses in facing nuclear accidents was poor and hospitals need to design disaster management programs and review its details with the staff in the form of trainings and maneuvers. In addition, decision-makers of educational programs for nursing students should include the topics related to nuclear disaster management and prepare the graduates for facing these accidents.

Penetrating injuries that happens in armed conflicts can be caused by bullet's direct hit or collision of published fragments. This study aimed to investigate epidemiology of hospitalized wounds due to gunshot and fragmentation in a military hospital.
In this retrospective study, the numbers of 76 medical records of patients injured by gunshot were studied in a military hospital during a period of five years. The collected data were analyzed using descriptive statistics and inferential methods by SPSS 21 software.
The mean age of injured persons and the mean length of their staying in the hospital was 32.3±8.5 years and 10 days, respectively. Based on our results, 80.2% of injured persons experienced gunshot to at least one of the four limbs (arms or legs). Also, 14.5% of them injured in more than one limb and 13.1% were hospitalized in more than one medical service.
The limbs are the most common affected organ in military conflicts and orthopedic surgeons have the most significant role in the treatment of these diseases.

Conflict occurs anywhere human resources as the main asset of an organization involved and when collision and integration between different tasks exist. It can lead to decreased job satisfaction of staff, if not managed properly. Therefore, managers must be familiar with this phenomenon and known style of its management. This study aimed to determine the relationship between job satisfaction and different styles of conflict management.
This cross-sectional study was carried out on 322 medical staffs of hospitals in Kerman city in 2011. The hospitals were selected through cluster sampling, and the personnel were selected randomly. The data were analyzed using SPSS 17 software package and also with descriptive and inferential statistical tests.
Our findings showed that there is a significant relationship between competition and cooperation styles of conflict management with job satisfaction (p According to the results of the present research, managers must recognize the methods of conflict management and also use a special way to increase job satisfaction and efficiency in their healthcare centers based on the environmental conditions and moral characteristics of their employees.

To err is human but the delivery of healthcare is an enormous responsibility and detection and measurement of medical events is the main component of patient safety. Root cause analysis (RCA) is one of the very useful tools that facilitates the environment in order to get people ideas and is beyond involving a person or individuals. The present study aims the root cause analysis of an adverse event in one of the hospitals in Iran.
This study is a qualitative survey and the main steps of it are as follows: defining event, team formation, data collection using deferent methods (brainstorming, interview, documents reviewing, analysis of changes, nominal group and fish bone diagram), identifying the root factors and causes and ultimately providing and offering the solutions.
Findings: The seven root causes of this event were as: cluttered treatment room, taking the patient’s IV line in sitting position, patient reception in addition to the beds approved, the limited space of the treatment room, the maximum elapsed time of nurse in documentation, placing the patient alone in the treatment room and rapid preparation of the patient. Then, suggestions for removal of any of the root causes were presented.
Change of system approaches, organizational changes and the establishment of standards in each system is one of the most important issues in prevention of the future events. All of the hospital authorities and managers must use the approach of RCA in risk management in their organization as each system may have some underlying problems that aren’t found in other systems.

A military hospital plays a significant role during the crisis because of the specific security aspects. This study aimed to assess the clinical skills of nurses in crisis handling in military hospitals.
This cross-sectional study was conducted in November 2014 in military hospitals of Kerman city. The study involved the nurses and paramedics population at work in these hospitals. Totally, 170 nurses were included by random clustered sampling method. The self-structured questionnaire was used to collect the data. The analysis of data were done by descriptive statistics, Mann-Whitney, and Kruskal-Wallis tests using SPSS software
The study showed that the clinical skills of nurses to provide services in times of crisis on the criteria valued at moderate level (83.78 ± 14.72). The skill levels were good, moderate, and low in 17.70%, 51.13%, and 31.17% of nurses, respectively.
The results revealed that our study population had moderate clinical skills in crisis and they require additional training and necessary skills in crisis situations.

Hospitals to improve the quality of health care and reduce the time and cost in providing health care should follow a strategic plan. Implementing strategies in hospitals is not possible easily and managers of hospitals face with barriers for implementing them. The aim of this study is to identify barriers to implementation of the strategic plan in the military and civilian hospitals.
This cross-sectional study was performed on senior managers, middle and executive in three military and three selected civilian hospitals of kerman in 2014. The total number of samples was 25 persons that had been selected as census. the instrument used, was a questionnaire that consists of two parts, the first part includes demographic specification and the second, consists of 4 areas, the human, process, structural, and institutional factors. Data was analyzed with SPSS 21.
The results showed that barriers to implementation of the strategic plan in military and civilian hospitals is related to structural, human, processes and institutional factors respectively. There is no significant difference between the barriers to the implementation of the strategies in the military and civilian hospitals (P>0.05).
Structural factors, are the most important barrier in lack of strategies implementation in hospitals and managers should coordinates Structures with strategies in medical centers under their management.

Occupational errors are inevitable in all jobs. Preparing health service in healthcare centers integrates with risk resulted from occurrence of medical errors for receivers. Occurrence of medical errors in healthcare centers is very important due to sensitive nature it has for health and safety of patients. The purpose of this study is to identify barriers of the lack of error reporting by nurses.

This is a descriptive, cross-sectional study. The studied population was nurses and nurse assistants who were working in Hospitals of Kerman. Barriers of error reporting by nurses were measured by using Likert five-point scale. Data were analyzed using by SPSS 17.

Results related to lack of reporting medical errors are associated to managerial area (3.67±1.07), fear of reporting outcomes (3.56±1.08), moral factors (3.51±1.03), reporting processes (3.26±1.11) and environmental factors (3.3±1.05) respectively. Also, there was no significant relation between education, type of ward, type of employment (official, contractual) and type of hospital and lack of errors reporting via nurses (P>0/05).

It is essential to managers do a serious action in terms of priorities toward removing barriers and reducing error reporting, and attempt to improve patient safety culture.

The main purpose of nursing is medical care and improving human health. However, nurses medical errors has negative impacts on their function and result of medical care for its recipients. During the delivery of health care, Incidence of medical errors can have grave consequences for patients. The solution to identify and manage clinical errors, are reporting and registration by nurses. The aim of this study was to identify barriers to self- reported error by nurses in the Police hospitals. This cross-sectional study was conducted in Police hospitals. Samples selected by quota method and randomly. 273 samples recruited for the study and the instrument was a questionnaire that was made by researcher consists of three parts. Firstly, included demographic information, the second part consists of 4 areas: managerial factors, fear of the reporting consequences, reporting processes, ethical components) and finally it was involved closed questions. Obtained information were analyzed by using descriptive and inferential statistical methods, the correlation coefficient, and chi- 2 with SPSS 21. According to the results, barriers to self- reporting errors by nurses are respectively related to fear of the reporting consequences (51.12±11.97), managerial factors (33.5±7.23), reporting processes (23.15±5.07) and ethical factors (21.89±4.92). Also there was no significant relation between clinical errors with gender, occupational category, type of employment and education(P>0.05). Since then, fear of the consequences of reporting is the important barrier of self- reported error by nurses, managers should provide the career support, educate scientifically and continuously to the nurses, and reduce their concerns in this case.

processes re-engineering is one of the best ways that leads to reduce the time, costs and finally earn the satisfaction of stakeholders by reforming method of carrying out activities. This study aimed to reform approval process of research projects in clinical research unit of Baqiyatallah (as) hospital.
Material and This qualitative action research study was performed in 2015 in the research department of Baqiyatallah Hospital. The sample size included all process owners and partners. Data were included documents and interviews to identify bottlenecks. All work stages of status quo were recorded. After that, the streamlining process were also recorded using standard diagram optimized workflow. Results were analyzed with Excel 2007.
Process activities were classified in six parameter: decision, archive, delay, inspection, transportation, and operations. All current approval process were carried out by 83 activities. By implementing reengineering and simplifying it, were reduced to 63 activities.
Re-engineering and simplification of the process lead to reduce activity, saving time and reducing waste time researchers.

Strategic plan in hospitals will not be run spontaneously and managers encountered with some barriers in order to have a successful strategic planning implementation. This study aimed at recognizing the barriers of strategic plan implementation from hospital manager's perspective. This cross-sectional study was performed in all Kerman hospitals in 2014. Fifty three individuals including chairmen, internal administrators, quality improvement managers, matrons and strategic plan executers participated by census sampling method. Data was collected using a questionnaire including demographic information and human, processes, structures and institutions factors affecting the strategies implementation. Data analysis was performed by SPSS software version21. Study results revealed that the barriers to strategic plan implementation were structural factors (27.71±6.68), process agents (19.54±10.06), human factors (19.09±5.37) and institutional factors (15.73±4.52) respectively. There was no significant association between management background and barriers of strategic plan implementation in hospitals (P > 0.05). In order to achieve desired results, chairmen and hospitals managers should be entirely conscious about barriers /failure factors of strategic decisions concerning foresight and appropriate managing or approaches change during strategic management process implementation.

Peripartum Cardiomyopathy (PPCM) is a life-threatening heart disease which appears with heart failure and function reduction of left ventricular in late pregnancy or in the first five months postpartum in women with no history of heart disease. Case Report: The report is about the fourth pregnancy of a 31-year-old woman who has had 3 healthy children and has not been observed by any Gynecologists and Obstetrics or health center during pregnancy and admitted to hospital for delivery. According to her medical history، the mother had no disease and had Normal Vaginal Delivery (NVD) in previous pregnancies. The patient with placental abruption، Fetal distress and failure of progression diagnosis was transferred to the Operating Room (OR) for Caesarean Section (CS). After Caesarean Section، she was involved in dyspnea and acute pulmonary edema during recovery. Having been diagnosed with postpartum cardiomyopathy by cardiologist، the patient was transferred to ICU and died less than 24 hours. Physicians، evaluate to the cardiologist. Physicians، midwives، nurses، and also patients should be aware that a pregnant mother could be at the risk of a severe cardiomyopathy with acute onset heart failure، despite her clear medical history of heart problems. In Prenatal care، therefore، it is necessary for physicians and midwives to pay attention to the symptoms of dyspnea on exertion and functional class of pregnant mothers and in case of reduced performance، the mother must be referred to the cardiologist.

Vitamin D deficiency causes growth retardation and diseases such as rickets, osteomalacia and osteoporosis. It also reduced bone density and increases the risk of fractures.
This cross-sectional study was performed in the summer in the Seyyed Al Shohada (AS) hospital of Kerman in 2015. The sampling method was census and all of the ladies personnel who working in the office and treatment departments, were selected for this study. The number of participants that their blood samples were taken to measure 25 (OH)Vit D, were 204 people and response rate was determined 74.72 percent. Data analysis was conducted with SPSS 21 software and using descriptive statistics and T Test.
A total of 80.96 percentages of people had vitamin D deficiency that 30 percent of people with severe deficiency and 42.53% of them had slight vitamin D deficiency and the remaining, the serum level of vitamin D was between 25-30 ng/ml. There was no significant association between units and levels of vitamin D. (P>0.05)
The results of this study indicate that there is severe vitamin D deficiency among the staff and requires planning and appropriate decisions making by managers to promote the health of employees.