h .ashrafizadeh

Ensuring patient safety is the first vital step in improving the quality of healthcare services. Patient safety is defined as an event that prevents unwanted injuries to a patient due to functional and unintentional actions. Safety standards are a set of requirements that are critical to implementing patient safety programs at hospitals. These standards provide an operational framework to help the hospitals fully match with the dimensions of patient safety in order to provide quality and patient-centered services. Therefore, 100% compliance with the required standards of patient safety-friendly hospital should be the priority of every hospital. The COVID-19 pandemic is one of the emerging infectious diseases that has affected the whole world in recent months. As its outbreak is an unexpected event or sequence of events of enormous scale and overwhelming speed, it has led to a high degree of uncertainty and has posed a variety of challenges to healthcare systems. Therefore, the realization of this important issue is felt more than ever in the structures and processes of each hospital of the healthcare system, in order to successfully control and efficiently manage this disease and preserve national assets. Therefore, this study aimed to determine the compliance of Imam Khomeini Hospital of Tehran with the patient safety-friendly hospital standards with respect to COVID-19 pandemic in 2020.

This descriptive-analytical cross-sectional study was conducted from September- December 2020 in Imam Khomeini Hospital Complex of Tehran during COVID-19 pandemic. 266 nurses with inclusion criteria were selected via stratified random sampling. For this purpose, the required list of 1,200 nurses was received from the nursing office of the complex. 866 nurses from 50 different wards were selected from the list based on the inclusion criteria. Then, the nurses who were in the same wards were placed in one stratum, so that the existing 50 wards including emergency department, operating room, ICU, CCU, NICU, dialysis, internal ward, surgical ward, infectious disease wards, oncology, pediatric ward, VIP and diagnostic wards were finally placed in 13 strata. Therefore, 292 samples were selected based on the quota of nurses from 13 existing strata via simple random sampling to provide a specified sample size of 266 nurses with an additional 10% to manage their attrition. Online sampling was performed by sending the link of the questionnaires through the virtual network of the study. The questionnaires included nurseschr('39') demographic information and patient safety-friendly hospital standards (Parvizi et al), including 27 items and five dimensions. The minimum score was 27 and the maximum score was 135. A higher score from the point of view of the research unit meant that the hospital was more in line with the standards of a patient safety-friendly hospital. Item 21 was scored in reverse. Scores 108-135 showed high compliance, scores 80-107 indicated moderate compliance, and scores 27-79 indicated the poor compliance of the hospital with the standards of patient safety friendly hospital. The internal consistency of the instrument was determined to be 0.934 using Cronbachchr('39')s alpha. After introducing the researcher and explaining the research objectives to the research units, data were collected. Data were analyzed using descriptive statistics including absolute and relative frequency distribution, mean and standard deviation in SPSS software version 16.

The mean and standard deviation of the age of nurses was 38.6 ± 7.94 years and most of them (90.2%) were female. The mean and standard deviation of the total length of service as a nurse and the length of service in the current ward was 13.87 ± 7.41 and 6.87 ± 5.80 years, respectively. ICU nurses had the highest frequency, 25.6%, compared to other hospital wards, and also rotating shifts with 42.4% had the highest frequency. The level of compliance with the standards of patient safety friendly hospitals was 97.35 ± 16.59 from the perspective of most nurses (61.7%) (80-107), and 3.58 ± 0.62 based on a Likert scale, which indicates moderate compliance. Continuing education dimension with the average compliance equal to 3.87 ± 0.69 had the highest mean and governance and leadership with the average compliance equal to 3.41 ± 0.71 had the lowest mean scores. Mean scores of dimensions of a safe environment, participation, and interaction with patients and the community, safe clinical services were 3.45 ± 0.67, 3.44 ± 0.85, and 3.71 ± 0.7, respectively.

Based on the findings of the present study, the level of compliance with the standards of a patient safety-friendly hospital was moderate in the Imam Khomeini Hospital complex during the coronavirus pandemic. The highest and lowest levels of compliance were related to the dimension of continuing education and the dimension of governance and leadership included in the standards of patient safety-friendly hospital. To improve the current situation, purposeful and evidence-based management of organizational resources, attention to "barriers to achievement" dimensions of patient safety, institutionalizing patient safety culture and promoting safety, attention and focus on patient safety indicators, continuous and effective training of educational staff needs are needed to improve the safety of beneficiaries, especially during the COVID-19 pandemic. Relying on the results of the present study, managers can take appropriate corrective measures to achieve 100% compliance with patient safety-friendly hospital standards and national accreditation standards, and achieve patient safety goals and provide quality and patient-centered services in the healthcare system. The results of the present study can provide a basis for examining the patient safety status and monitoring it in future researches. It is recommended that future researchers, in order to ensure patient safety and monitor the quality of healthcare and patient-centered services, analyze non-compliance in mandatory, basic, and advanced standards of patient safety-friendly hospitals using PSFHI checklist of the World Health Organization through the process of observation, interview, and review of documents in the Imam Khomeini Hospital complex.

Assessment and application of new educational approaches are essential to the enrichment of educational programs. Problem-based learning (PBL) is a novel educational approach, which is based on the principle of using problems as the starting point for the acquisition and combination of new knowledge. The present study aimed to systematically review the studies on PBL in nursing education in Iran.  In this comprehensive review, all the articles published in Persian focusing on PBL in nursing were evaluated. The articles were retrieved by searching in databases such as Iran Medex, Magiran, Google Scholar, Iran Research Institute for Information Science (Irandoc), and Scientific Information Database (SID) using various keywords, including learning, teaching, problem-solving, PBL, problem-oriented, and nursing for the articles published during April 2001-2018.  In total, 45 articles were retrieved using the mentioned keywords. After a thorough review, 31 articles were selected based on the research objectives, which were published in Persian in national journals, and their full texts were accessible. The selected articles had five main themes, including the effects of problem-solving training on the ability of nursing students in the country, perceptions of nursing students toward PBL, influential factors in PBL, comparison of education based on PBL with other educational methods, and experiences of nursing students with PBL.  According to the results, several studies have confirmed the efficacy of PBL in nursing education and the empowerment of students, urging the extensive adoption and comprehensive incorporation of this approach into nursing education. Although few studies contradicted the positive impact of this educational approach, most of the studies in this regard indicated the satisfaction of nursing students with the use of PBL in their courses.