zahra khatirnamani

Head nurses, as operational managers of hospitals, require robust communication skills, comprehensive leadership knowledge, and proficient conflict management strategies. By utilizing appropriate management techniques based on these skills, head nurses can actively contribute to enhancing efficiency, improving performance, and delivering high-quality services within the hospital setting. This study aimed to investigate the relationship between communication skills, conflict management, and leadership style among head nurses.

A cross-sectional study was conducted in 2021, involving 166 head nurses employed across 16 hospitals affiliated with Golestan University of Medical Sciences in Iran. The sampling method employed was a census approach, encompassing the entire population of interest. After obtaining ethical approval, data were collected using established instruments, including Robbins' Evaluation of the Conflict Resolution Questionnaire, Queendom's Interpersonal Communication Skills Test, and Bass and Avolio's leadership style Questionnaire. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests were utilized to analyze the collected data. The significance level was set at 0.05.

The findings revealed that the total score of communication skills, particularly the dimensions of emotional control and listening skills, exhibited a significant positive association with the overall score of conflict management and its three distinct strategies. Moreover, a significant positive relationship was observed between the ability to receive and send messages and the contingent leadership style (P-value = 0.043). Conversely, the orientation strategy demonstrated a negative impact on leadership quality, as it was found to diminish leadership quality across all dimensions for head nurses. Furthermore, the control strategy exhibited a significant negative correlation with the charismatic leadership style (P-value = 0.037). Lastly, the overall score of conflict management displayed a significant negative association with the charismatic leadership style (P-value = 0.031).

The assessment of head nurses' communication skills indicated an average proficiency level. The prevailing leadership style adopted by supervisors was charismatic, while the predominant conflict management strategy employed was non-confrontation. It is recommended that effective plans aimed at improving communication skills, fostering effective leadership, and enhancing conflict management be implemented within hospital departments to enhance the current situation. This can be achieved through organizing impactful training workshops and utilizing supportive and motivational mechanisms.

Human resource productivity serves as a crucial metric for evaluating organizational effectiveness, particularly in the healthcare sector where the quality of service directly impacts community well-being. This study aims to assess the human resource productivity as perceived by healthcare employees in Gorgan City, utilizing the Achieve Model framework.

This descriptive cross-sectional study involved 313 employees from various sectors of the Golestan Province health department, including urban and rural health service centers in Gorgan City. A stratified random sampling technique was employed to ensure representation across different groups. Data collection was facilitated through a validated questionnaire based on the Achieve Model of human resource productivity. Statistical analyses were conducted using SPSS-23, employing both descriptive and inferential statistics to draw meaningful insights from the data.

The analysis revealed an average productivity score of 79.81±15.09 among healthcare staff in Gorgan, indicating that overall productivity levels fell within an average range. Notably, the highest scores were attributed to the dimensions of ability, feedback, adaptability, understanding, and knowledge. Conversely, dimensions associated with organizational support and motivation scored the lowest, highlighting potential areas for improvement. Furthermore, significant relationships emerged between various demographic factors - such as education level (p=0.020), workplace setting (p<0.001), and occupational group (p=0.001) - with productivity in the ability dimension. Age (p=0.027) and work experience (p=0.007) also demonstrated significant correlations with the understanding and recognition dimension.

It is crucial to understand the factors that impact employee performance and productivity, considering their significant role in organizational productivity.

 Human assets are the most important resources of health systems to achieve universal health coverage. The purpose of this study was to investigate the applicability of the public health bachelor's education program through the eyes of health experts.

 In this cross-sectional descriptive study, 296 public health experts working at Golestan University of Medical Sciences were included. The data collection tools encompassed demographic characteristics as well as the valid and reliable job description questionnaires, determining the appropriateness of educational program goals with professional needs, and to find out the factors affecting the quality of programs and educational needs. The collected data were analyzed using SPSS (v.23) through descriptive statistics (mean and standard deviation for quantitative data and number and percentage for qualitative data). Compliance with ethical considerations was considered in all stages of the study implementation.

 From the experts’ point of view, the use of theory courses in professional performance was evaluated as 48.3% moderate, and the use of internship courses in professional performance was 42.6% high. Almost, 93.9% of experts put forward the importance of "experienced professors and trainers" on the quality of educational programs. The courses of biophysics, biochemistry, and principles and basics of sociology were considered the least useful. On the other hand, active and passive immunity, the national program to fight non-communicable diseases, and the national program to fight communicable diseases were seen as the most useful courses from the experts' point of view.

 In order to improve the quality of education, it is necessary to reduce less-useful courses and instead prioritize high-useful ones. More emphasis on practical skills and special attention on training in the field can lead to more qualitied training of graduates in accordance with the society needs.

The goals of the family physician program include creating a referral system in the country, increasing accountability in the health market, increasing people's access to health services, reducing unnecessary costs in the health market, and increasing service coverage. This study was conducted with the aim of evaluating the implementation of the family medicine program from the point of view of managers and staff experts with a process approach in 2022.

In a descriptive-analytical study, 231 heads of health centers of the city and deputies, heads of technical and administrative units (managers) and experts of technical and administrative units (staff experts) in the west of Golestan province participated by census method. The data collection tool was the valid and reliable questionnaire of Abedi et al. In order to analyze the data, descriptive statistics and inferential statistics methods such as Pearson's correlation coefficient, independent t test and one-way analysis of variance were used in SPSS-23 software.

The overall score of the questionnaire was 332.53 ± 56.25, which is slightly higher than the average. The highest average score among the dimensions related to the process area was 4.99 ± 0.85. The highest scores were in the area of the structure related to the design and compilation of the electronic health record, in the area of the process related to the implementation of family doctor services in the form of the electronic health record, and in the area of results related to the level of knowledge of the health team.

The implementation process of the family physician program in the west of Golestan province was evaluated slightly higher than the average level in general and separately in terms of structure, process and results. In order to improve the current situation, it is necessary to solve the financial problems of the implementation of the program and the full implementation of the referral system should be prioritized in the programs of health managers.

Health workers should be trained based on the real needs of the society in terms of quantity and quality, so that af ter graduation, they can be employed in organizational positions related to their field of study and solve the health problems of the society by providing relevant services within their scope of duties. The purpose of this study was to explain the required knowledge and skills for public health undergraduates.

This qualitative study was conducted with the content analysis approach and by holding three focus group discussion sessions with 30 health network managers; managers, heads and experts of the technical groups of the deputy of health and the headquarters of health networks, and health care workers of comprehensive urban and rural health service centers in Golestan province. Data analysis was done using thematic content analysis method and MAXQDA software.

After merging the similar codes with each other, finally 55 codes were extracted and classified into 19 subthems and finally categorized into 4 thems. Management information needed by public health graduates included work mission in health, planning and supervision, work ethics and executive processes. Specialized and field information included re-emerging and emerging diseases, population youth, crisis management, mental health, reproductive health, aspects of social health and immunization. The practical skills of individual development included teamwork, communication skills and expression techniques, attracting social participation, using virtual networks and familiarity with information technology. Skills needed to work in the health system included regional situation assessment, operational planning, and first aid.

The required knowledge of public health students can be provided by including the results of the study in the educational curricula and in accordance with the new instructions. Also, the combination of practical skills with theoretical topics during academic semesters and paying more attention to internship courses can train public health students according to the needs of the health system.

Perceived mental workload is a set of factors that affect the mental processes of information processing, decision-making and individual reactions in the work environment. Patient safety refers to the prevention of injuries caused by medical errors that occur due to negligence in the performance of duties. The present study was conducted to determine the perceived workload and its relationship with the culture of patient safety in nurses.

  This analytical cross-sectional study was conducted among the nurses of Shahid Sayad Shirazi and 5 Azar teaching hospitals in Gorgan city in 2022. In total, 280 nurses of the mentioned hospitals participated in the study. The random stratified sampling was applied and the ethics code was obtained. The data were collected by means of mental workload and patient safety culture questionnaires and it was analyzed using descriptive and inferential statistics methods in SPSS-24 software.

The average age and standard deviation of the nurses was 34.9 ± 9.2 years. Most of the nurses had a bachelor's degree (90.4%) and were married (71.6%). The average score and standard deviation of perceived workloads was 73.80 ± 14.74. The overall score of patient safety culture was 3.30 ± 0.26. There was no significant relationship between perceived workload and patient safety culture (P = 0.204).

The perceived workload was high among the nurses and the safety culture status was moderate.

Organizational commitment has been considered as the objective and efficient achievement of the organization's goals and values, the achievement of the individual's role in relation to the goals and values, and the achievement of the organization for its own sake. This study was conducted to investigate the quality of work life and organizational commitment and their relationship with each other.

A descriptive-analytical cross-sectional study was conducted in 2022. 280 employees of the health service delivery levels of Gorgan City participated in the study in a random stratified method. The data were collected using valid and established questionnaires of Walton's quality of work life and Allen and Mayer's organizational commitment and were analyzed with descriptive methods and statistical tests in SPSS-23 software.

The average age of the participants was 40.11 ± 9.04 years. The majority of participants were female (69.3%) and the rest were male. In general, 18.9% of people had a low quality of work life (QWL), 66.8% had an average QWL, and 14.3% had a high quality of life. Also, 11.1 percent of people had low organizational commitment, 77.1 percent had medium organizational commitment, and 11.8 percent had high organizational commitment. There was a statistically significant relationship between the QWL and organizational commitment (P-Value = 0.001).

The QWL and organizational commitment of employees were evaluated at moderate levels, and with the increase in the QWL, organizational commitment also increases.

Medications are the most common therapeutic intervention, and the safe use of medication and the existence of processes to improve the safety of medicine are of prime importance. Since nurses have a major role in implementing medication orders, they play a vital role in promoting safety and reducing medication harm to patients. Therefore, the present study was conducted to determine the barriers to reporting medication errors by nurses of teaching hospitals affiliated with Gorgan, Iran, in 2021.

In this cross-sectional study, 340 nurses from Gorgan teaching hospitals were selected by a randomized stratified method in 2021. The data collection tool was a demographic information checklist and a valid questionnaire of barriers to reporting medication errors. The collected data was analyzed using SPSS software (version 16). Moreover, descriptive statistics, Kolmogorov-Smirnov tests, Spearman, Mann-Whitney, and Kruskal-Wallis correlation coefficients were used.

The average age of the nurses was 33.11 ± 7.36 years, and 290 (85.3%) participants were female. The average score of reporting obstacles in the area of "fear of management factors" was higher than other areas (3.20±0.50), followed by the areas of "fear of reporting consequences" (3.17±0.35) and "factors related to the reporting process" (2.87±0.63) were in the next ranks. The highest average in the areas of "fear of the consequences of reporting", "factors related to the reporting process" and "fear of managerial factors", were respectively related to "fear of legal issues" (3.94±1.11), "unclear definition of medication error" (3.54±1.05), and "disproportionality of the officials' reaction with wrong hierarchy of importance" (3.75±0.96). The service sector had a significant relationship with the overall score of barriers to reporting medication errors (P=0.020) and the area of fear of managerial factors (P=0.017) in a way that the barriers to reporting medication errors by the nurses of the Emergency Department were higher than the other parts.

Among all reporting barriers, "fear of legal issues" had the highest score. Due to the existence of factors such as fear of judicial issues and the inappropriate reaction of hospital officials, it is suggested to define the error reporting process and how to handle medication errors and train hospital managers on how to deal with the person at fault.

 Studies have shown that excessive use of social networks may cause mental disorders. This study was conducted to elucidate the relationship between the use of cell phone’s social networks and mental health.

 A cross-sectional study was conducted in 2022, in which totally 250 staff members of Golestan University of Medical Sciences participated. Proportional random stratified sampling method was used. The data collection tool was a checklist of demographic variables. Additionally, valid and reliable questionnaires on the use of mobile cell phone’s social networks and mental health were exploited. The data was analyzed with the help of descriptive and inferential statistics in SPSS software (v.24) and statistical tests were considered significant at P<0.05. Compliance with ethical considerations was considered in all stages of the study implementation.

 The average age of employees was 41.07±6.8 years and their average work experience was 15.04±6.93 years. About 56.8% of participants were women and the rest were men. WhatsApp was the most commonly used social network by study participants (44.8 percent). The average score of using mobile social network and mental health was 21.81±5.74 and 35.17±6.20 respectively. The use of social networks revealed a statistically significant association with the total score of mental health (P < 0.001).

 The amount of social networks use was reported at a low level and the mental health of employees needs serious interventions. Considering the existence of a relationship between the engagement in social networks and mental health, the controlled use of social networks can prevent employees' mental health from being compromised.

The emergency department (ED) of hospitals is of special importance due to receiving a high number of critically ill patients. This study aims to determine the prevalence and costs of non-urgent visits to the ED of public hospitals in Golestan, Iran.

This is a descriptive cross-sectional study. The study population includes all patients referred to the ED of hospitals affiliated to Golestan University of Medical Sciences in 2019. Patients who did not require emergency care and were in the fourth and fifth levels of triage were considered patients with non-urgent emergency needs. The cost of ED services were extracted from the hospital information system and using the top-down costing method. To describe the data, descriptive statistics were used in SPSS software, version 23.

Out of 519,204 patients referred to the EDs, 218,037 (42%) had non-urgent visits. Among these patients, 43% were male and 57% were female. The total cost of services for non-urgent ED visits was 43,856,887,000 Iranian Rials. For patients with the fourth level of triage, it was 42,094,000,000 Iranian Rials, and for those with the fifth level of triage, the cost was 1,762,887,000 Iranian Rials.

The number of non-urgent visits to the ED of public hospitals in Golestan is considerable. It can lead to a significant waste of hospital resources. Reducing unnecessary ED visits in hospitals can reduce the costs of the health system and improve the quality of hospital services.

High perceived organizational support can make employees feel that they belong to the organization and have less intention to leave their jobs. This study aims to determine the relationship between turnover intention and perceived organizational support in nurses working in hospitals in Gorgan, Iran.

This cross-sectional study was conducted in 2021 on 293 nurses from 16 hospitals affiliated to Golestan University of Medical Sciences who were selected by stratified sampling method, proportional to the population. The data collection tool was a three-part questionnaire including demographic/occupational form, Kim et al.’s turnover intention questionnaire (TIQ), and Eisenberger et al.’s Perceived Organizational Support Questionnaire (POSQ). The data were analyzed using SPSS software, version 16. 

The mean scores of TIQ was 39.91±12.18 and the mean score of POSQ was 23.66±6.6. There was a negative significant relationship between turnover intention and perceived organizational support (P<0.001).

The turnover intention and perceived organizational support of nurses in Gorgan are at a moderate level. As the nurses’ perceptions of organizational support decrease, their turnover intention can increase. It is necessary to create a supportive environment for nurses, in such a way that this support be tangible and understandable to them and can cause job satisfaction and prevent them from leaving the job.

occupational hazards in nurses are very high, which leads to increased absenteeism from the workplace, more visits to the doctor, reduced service provision, loss of working hours and disability. Improper safety climate can be one of the causes of occupational accidents. This study was conducted to determinate the prevalence, causes of occupational hazards and the existing safety climate in Gorgan educational hospitals from the nurses' point of view.

This was a cross-sectional study and was conducted in teaching hospitals of Gorgan city. 267 nurses participated in the study by stratified random sampling. The data were collected using valid and reliable questionnaires on the frequency of occupational hazards, causes of occupational hazards, and safety climate and were analyzed using Spearman, Mann-Whitney, and Kruskal-Wallis correlation coefficient tests.

In terms of physical injuries, 94% of nurses had suffered from musculoskeletal disorders. 90.3% expressed that they were threatened and verbally and physically attacked by the patient and his companions. The large amount of nursing work (61%) was the main and most common cause of occupational injuries in the workplace of nurses. The average score of the existing safety climate was 3.10 ± 0.6.

A high percentage of nurses reported physical and mental injuries caused by work, and the safety atmosphere among nurses was relatively moderate. To reduce physical injuries, nursing managers must pay attention to injury prevention methods and how to deal with this problem.

The notion of educational service quality is multifaceted and arises from the perceived variance between students' expectations from the educational system and the services they actually receive. The progression of universities has shifted from a quantitative phase to a qualitative one, and as such, it has become necessary to assess the quality of university services. This research was conducted to evaluate the educational service quality at Gorgan Dental School.

A cross-sectional descriptive study was conducted in 2021, among dental students attending Gorgan Dental School, Golestan University of Medical Sciences. Data were collected using the SERVQUAL model questionnaire, which was devised considering the five domains of service quality. Descriptive statistics and inferential statistics were used in SPSS 23 to analyze the data.

 A total of 103 students, with an average age of 23. 09±3. 31 years, participated in this study. Most of the students were female (59%) and the rest were male (44%). The average overall score of expected service quality was 4.52±0.49 and the overall average score of perceived service quality was 3.09±0.71. The overall average gap in service quality was -1.44±0.79. The greatest gap was noticed in the responsiveness domain (-1.58±1.05) and the least gap was found in the tangible domain (-23.1±0.92).

There was a gap in all aspects of the quality of educational services and related terms, which shows that the expectations of students have not been completely met. In order to resolve this gap, meticulous planning and effective management of educational services should be enacted.

Coronavirus disease 2019 is a new viral disease and in a short period, it has affected the world in various economic, social, and health aspects. This disease had a high mortality rate at the time of its occurrence. This article aims to determine the related factors to the survival time of inpatients with COVID-19 in northern Iran.

In this retrospective study, the data of 3480 patients with laboratory confirmation of the virus caused by COVID-19 infection in 17 hospitals covered by Golestan University of Medical Sciences from February 20 to July 20, 2020 were used. For all patients included in the study, until the end of the study, the follow-up has been done through the hospital information system unit. Statistical analysis was performed using R statistical software version 3.6.2 with a survival package. 

Out of 3480 definitive patients with COVID-19, the average age of the patients was 52.93±19.20 years and 51.1% of them were women. A total of 77.6% of patients recovered and 22.4% died at the end of the study (781 patients, 22.4%). The median survival time among deceased patients was less than one day (interquartile range [IQR]: 0–5) days. Patients with an age group above 49 years had a 2.1 times higher chance of death than other patients. Patients who had no history of hospitalization in the intensive care unit (ICU) had a 1.77 times higher chance of death than other patients. Patients who did not use ventilators had a 1.21 times higher chance of death than other patients.

Finally, according to the results of this study, in the early days of hospitalization, it is necessary to investigate the spread of COVID-19 in people younger than 49 years, hospitalized in intensive care unit (ICU), and hospitalized in other cities.

Many health policies are not implemented or incompletely implemented after approval. This issue significantly reduces the popularity and responsiveness of the top managers of the health system and leads to service disruption in the target community. Therefore, this study was conducted to explain the existing challenges in the implementation of health policies.

A qualitative study was conducted in 2021. The participants in the study were 20 scientific and executive experts. The data was collected using an interview guide and the in-depth individual interview method and was analyzed using the content analysis method using thematic analysis with Graneheim and Lundman's approach.

The challenges include the policies formulation (lack of evidence-informed decision-making, lack of attention to the details of the implementation, the change of the initial text of the policy, conflict of interests, unclarity the executives, the lack of proper integration between the political and technical components of the policies, the weak participation of the main stakeholders, the lack of the same understanding of policies concept between policy makers and executives and lack of budget forecasting), challenges of policies implementation (uncertainty about roles of executive organizations, lack of executive attachment, conflict of interest,  lack of project management, change of formulated policies with change of executives, little belief among executives, lack of executive guarantee, lack of operational plan) and challenges of policies evaluation (Inadequate supervision and the absence of an informational and supervisory dashboard).

Using effective solutions to solve the challenges extracted in the stages of formulation, implementation and evaluation of health policies can lead to achieving the goals of the formulated policies and improving the health of the society.

Workplace violence in the healthcare system has become an important policymaking issue in recent years and is considered one of the most complex issues for the governmental system. Due to the lack of a similar study in Golestan province, this study was conducted to determine the level of exposure to workplace violence against nurses and the factors related to it.

This cross-sectional study was conducted in hospitals affiliated with Golestan University of Medical Sciences in 2021 Where 293 nurses were included after random stratified sampling. The data collection tool was demographic and occupational variables as well as the workplace violence questionnaire and data analysis was done by descriptive statistics methods and Mann-Whitney, Spearman, Kruskal-Wallis, and Chi-square tests in SPSS-23 software at a significance level of 0.05.

The average age of the nurses participating in the study was 33.93 ± 7.16 years and their average work experience was 9.82 ± 6.32 years. Among the subjects, 82.6% were women and the rest were men. The prevalence of workplace violence was 86% in one year. Mental and physical violence with a frequency of 79.5% and 42.7%, respectively, had the highest occurrences. Also, 57.7% did not report any act of violence. In front of these acts of violence, the most reactions were inviting the attacker to calm down (42.3%), discussing the issue with colleagues (23.5%), and not taking any specific action (19.5%). There was a significant relationship between physical violence and gender (P-value=0.024) and department of hospital (P-value=0.003). Sexual violence was also significantly related to department of hospital (P-value=0.046). Also, there was a significant relationship between racial violence and gender (P-value=0.001), department of hospital (P-value=0.028), and work shift (P-value=0.005).

According to the results, the prevalence of workplace violence was generally high in one year, but most of the nurses did not report any act of violence. Therefore, medical policymakers and hospital managers should consider improving nurses' communication skills, and security measures, training staff on anger management, and reducing nurses' workload.

Work stress is a negative physical and mental reaction that is the second most common work-related problem after musculoskeletal disorders. Fatigue is a state that occurs during a work period and because of that, a person loses his efficiency. This study was conducted to determine the relationship between job stress and job fatigue in nurses.

It was a cross-sectional descriptive-analytical study that was conducted in teaching and therapeutic hospitals of Gorgan city including Sayad Shirazi Hospital, 5 Azar Hospital, and Taleghani Hospital in 2021.277 nurses were included in the study after random stratified sampling. Data were collected by OSIPOW job stress questionnaires and Swedish SOFI job fatigue questionnaires.

The mean score of job tension was 180.05 ± 23.4 that was classified as moderate to severe.    The highest score was related to the role workload dimension and the lowest was related to the physical environment dimension. The mean score of job fatigue was 53.18 ± 22.5 and was evaluated at a lower than average level. The highest score was related to the dimension of lack of energy and the lowest was related to the dimension of physical effort.

Considering the relationship between job stress and job fatigue, it is suggested to provide the necessary infrastructure and facilities to reduce the stress in nurses and provide training on how to deal with the stress to the hospital staff.

Nurses are the main group of care providers in healthcare institutions. The migration of nurses is worrying and has reached an alarming point in recent years. This study was conducted to determine the willingness of nurses to migrate and to assess its relationship with social capital.

This was a cross-sectional study. The statistical population was all the nurses working in educational and therapeutic hospitals of Gorgan, Iran in 2021. After random stratified sampling, 503 nurses were included in the study Data were collected by Chub Basti's Desire to Emigrate Questionnaire and Putnam's Social Capital Questionnaire. The data was analyzed with the help of descriptive and inferential statistics methods in SPSS-24 software and significance level was set at 0.05.

The overall score of the questionnaire of willingness to migrate (0.67 ± 0.16) was relatively higher than the average level. The greatest impact on the desire to migrate was related to the dimensions of pull factors or attraction of the origin, push or repulsion factors of the origin, pull factors or attraction of the destination, and finally related to the dimension of the desire to migrate. The average score of social capital was 2.98 ± 0.56. The general score of willingness to migrate and all its dimensions had an inverse and significant relationship with the overall score of social capital and its dimensions so that as social capital and its dimensions’ decreased, the desire to migrate was increased.

With the reduction of social capital in the nurses, the desire to migrate increases. To reduce the desire to migrate abroad, the need for increasing social and institutional trust through proper performance and solving structural problems seems essential.

Nurses' fatigue is defined as a mental and multidimensional feeling of fatigue that is physically and mentally penetrating and may even remain despite periods of rest. In addition to fatigue, nurses suffer from lack of sleep and its poor quality more than other occupational groups. This study was conducted to determine the relationship between occupational fatigue and sleep quality in nurses.

This was a correlational and cross-sectional descriptive study that was conducted at Golestan University of Medical Sciences, Golestan, in 2021. A total of 277 nurses were included in the study after random stratified sampling and obtaining the code of ethics. The required data were collected by Swedish Occupational Fatigue Inventory and Pittsburgh Sleep Quality Index, and analyzed in SPSS-23 software using descriptive statistics and Spearman correlation, Mann-Whitney, and Kruskal-Wallis tests.

The mean scores of the nurses' age and work experience were obtained at 28.75 ± 4.8 years and 5.66 ± 4.6 years, respectively. In total, 68.6% of the nurses were women. The mean of the total occupational fatigue score was 53.18 ± 22.5, which was evaluated at a lower-than-average level. The mean of nurses' sleep quality was 18.14 ± 1.77, which indicated poor sleep quality in nurses. There was an inverse and significant relationship between the score of occupational fatigue and all its dimensions and sleep quality.

The level of occupational fatigue in nurses was lower than the average and their sleep quality was poor, and with the increase in occupational fatigue, the quality of sleep decreased. It is suggested to implement individual and organizational solutions to reduce and eliminate occupational fatigue and improve sleep quality.

The assessment of the length of hospital s tay until recovery of patients with Covid-19 and its related factors in different areas can help manage the treatment process and prepare for the epidemic. This s tudy aimed to model the survival time until the recovery of COVID-19 definite patients.

This descriptive-analytical s tudy was retrospective. The s tatis tical population included all COVID-19 definite hospitalized in the educational and medical hospitals of Goles tan University of Medical Sciences from 20 February to 20 July 2020. The outcome variable was discharging confirmed cases of Covid-19. All analytical tes ts and charting were performed in R3.6.2 software.

From a total of 3480 confirmed patients, 77.5% recovered, and 22.5% experienced death at the end of the s tudy or were undergoing treatment. The median length of hospitalization in patients was 6 (IQR: 3-10) days. The mean age of all patients was 52.93±19.20 years; 58.2% of patients were over 49 years old, and half of the population were male. Women infected with Covid-19 survived and recovered 1.16 times more than men. Patients with an age group above 49 years of age had more recovery than their counterparts aged under 49 years.

As evidenced by the obtained results, apart from older adults, the prevalence of the disease needs to be evaluated more closely in young people and men, and these people should be monitored and screened frequently.

One of the characteristics of the favorable situation in the university is the fulfillment of students' expectations from the process of educational services. This study aimed to determine the gap of quality of educational services in the medical school of Golestan University of Medical Sciences. This study was a cross-sectional study that was performed by the descriptive-analytical method. Hence, 179 students studying in Faculty of Medicine during 2021 through an accessible way were entered the study. The data collection tool was adjusted according to the SERVQUAL model questionnaire, too. Moreover, among all students, 62% were male and the mean age was 23.64 ± 3.28 years. The result showed that the overall gap in service quality was -1.43 ±0.94, whereas the largest gap in the confidence dimension was -1.51 ±0.96. The biggest gap in the tangible dimension was related to "the existence of modern and efficient equipment in the faculty"; in the dimension of assurances related to "performing activities by teaching staff at the time promised"; in the dimension of accountability related to "easiness of students' access to authorities to convey opinions and suggestions about education issues"; "; in the guarantee dimension related to "preparing students for future employment by professors and counselors by providing theoretical and practical training in the faculty"; and finally the empathy dimension was related to "education staff treatment of students" In all aspects of providing educational services, there were seen some shortcomings that necessitated planning to reduce or eliminate them. To be more aware of the educational needs of students, periodic surveys have been needed to identify the deficiencies as soon as possible and to take the necessary measures to improve the situation.

Chronic respiratory diseases impose a significant socioeconomic burden on individuals and communities and are severely overlooked compared to other non-communicable diseases, such as cardiovascular disease, cancer, and diabetes. This study aimed to investigate the mortality rate and years of life lost due to respiratory diseases in northern Iran.

The documentary research method was used and data were collected using the census. The population included all deaths registered in the Department of Health, Golestan University of Medical Sciences in Iran during 2014-2018.

Between 2014 and 2018, 2462 deaths due to respiratory diseases were recorded in Golestan Province, of which 1416 people (57.5%) were men and 1046 people (42.5%) were women. The Mean±SD age of death was 62.28±26.29 years, with an Mean±SD of 62.56±25.32 years for men and 61.90±27.56 years for women. The highest number of deaths due to respiratory diseases in all the studied years was in men and women aged 80 years and above (28.7% and 31.1%, respectively). Approximately, 6864 years of life were lost due to premature death during this period, with men (3511 years, 7.2 per 1,000) contributing more than women (3353 years, 7.2 per 1,000). 

Given the rapid increase in population and given that the crucial risk factors for respiratory diseases are smoking, exposure to pollutants, and allergens, more comprehensive research seems necessary throughout Iran. In addition, this study was designed before the onset of the COVID-19 pandemic, and due to changes that this pandemic has caused in the mortality rate, therefore, it is recommended to investigate the trend of mortality by respiratory diseases during this pandemic.

The payment system of specialist physicians has significant effects on the country's health costs and the provision of medical care at a fair, sufficient and high-quality level. This study was conducted to design the payment system's implementation guidelines for providing specialized services in the electronic referral system.

A qualitative study was conducted in 2021. The participants were hospital managers, top managers and experts in charge of health, treatment and development departments of Ministry of Health and Golestan University of Medical Sciences, Health Insurance Organization of Golestan province, specialist physicians and faculty members. Fourteen focus group discussion and six in-depth individual interviews were conducted. The content analysis method was used to analyze the data.

The requirements for the establishment of an efficient and effective payment system were classified into 6 main themes (legal, political, managerial, executive, economic, cultural and social) and 32 subcategories. The executive mechanism was classified into 3 main themes (executive structure, executive process and monitoring and evaluation method) and 16 subclasses.

The implementation of the designed instruction can lead to increasing the access and benefit of services, improving the quality of providing specialized services, cost management and finally increasing the satisfaction of service providers and receivers.

Organizational culture is a set of basic assumptions that the employees of an organization create when facing issues in order to adapt to the environment and achieve internal coherence. Responsibility and accountability of individuals is also one of the important indicators of mental health. This study was conducted to determine the relationship between organizational culture and employees’ responsibility.

The present cross-sectional study was conducted in 2021. In total, 191 employees of Golestan province health deputy, Gorgan city health center, comprehensive urban and rural health service centers participated in the study. Random stratified sampling method was used. Denison's organizational culture and Carroll's accountability questionnaires were used to collect data. Data were analyzed using SPSS-23 software. Ethical considerations were also observed at all stages of the study.

The overall score of organizational culture was below average. Only in the dimension of team orientation, the mean scores were higher than the average and in other dimensions it was below the average. The overall score of responsibility as well as altruism dimension was above average and in other dimensions less than average. In general, no statistically significant relationship was observed between the organizational culture and the employees' responsibility in the levels of providing health services in the health centers of Gorgan city.

The necessity of strengthening organizational culture in a scientific, practical and practical way is sensible. Managers of healthcare organizations should increase the responsibility of employees by providing incentives and welfare facilities.

The primary health care program for the suburbs is being implemented in Iran after the Health Transformation Plan where services are delivered with the priority of outsourcing and purchasing services from non-governmental sectors. In this program, different payment methods have been used. This study aimed at addressing the challenges associated with payments made to urban primary health care providers in Iran.

This qualitative study was conducted using a framework analysis approach through semi-structured interviews with 30 experts and service providers. Data were analyzed using MAXQDA.10 and Gale framework analysis method.

The study showed that lack of proper financing of the program is one of the most important challenges of the payment system. Other challenges included insufficient and late payments to providers, impossibility of recording all activities and inability to exchange data between electronic information registration systems (both horizontally and vertically), improper contracting method, incompatibility of service package volume with the amount of payment, the impossibility of applying the monitoring result on the amount of payment due to paying the minimum amount of labor law payment, and inflexibility of payment instructions.

The payment system for urban primary care providers does not have a suitable structure in various dimensions, including financing, payment, contracting method, data registration system, and monitoring and evaluation system. If these problems continue to exist, providers would leave the service system and the quantity and quality of services are reduced.