جستجوی مقالات مرتبط با کلیدواژه « مدیریت خطر » در نشریات گروه « پزشکی »

Background and

The physical location of colleges is vulnerable to natural disasters and accidents. Therefore, it is necessary to develop a preparedness and response plan. The present study aimed to assess the readiness of accident risk management and passive defense in the Faculty of Nursing and Midwifery at Mazandaran University of Medical Sciences.

This study applied an action research approach. The data collection procedure was performed by evaluating the readiness of the faculties of the University of Medical Sciences in managing the risk of accidents and passive defense. Data were analyzed using the descriptive statistics of frequency, percentage, mean, and standard deviation. Then the results were discussed in the risk management and passive defense committee of the faculty. After several consecutive brainstorming sessions, the solutions were proposed in order to fix the weaknesses.

In the initial evaluation, the level of preparation in the faculty was considered to be low (˂39%). The possibility of fire and the vulnerability of the building in terms of structural safety were determined to be the most risky factors in the college. After improving the risk management process, the faculty's level of preparedness was determined to be average (40-60%).

The current action research approach improved the safety of the college. No budget allocation for safety measures and the time-consuming communication process between different departments are the major obstacles to achieving optimal safety in educational spaces.

Background and Object: 

Considering the high prevalence of covid-19 in the Iran and generally in Mazandaran province, the most important strategy for managing the crisis is the participation of citizens in different dimensions. Therefore, the present study was conducted with the aim of identifying and analyzing the factors affecting the level of community participation in the management of the Covid-19 crisis, which can be a road map for future planning in managing similar crises.

The present study was performed with a qualitative approach using content analysis by the conventional method in Mazandaran province. The data were collected through in depth semi structured interviews with 34 participants through a purposeful sampling method and analyzed simultaneously.

From data analysis, 3 main themes including 1) beliefs and attitudes with 3 sub-themes of perceived threat, perceived fear and anxiety, and perceived self-efficacy, 2) the main theme of drivers/facilitators with 9 sub-themes of informing, culture building and networking, capacity building/ jihadi and voluntary actions, inter-sectoral coordination, social trust, social responsibility, social resilience, compensatory/financial policies of the government and strategies for changing processes and policies in crisis management, and 3) and the main theme of barriers and challenges of community participation with 5 sub-themes of psychological challenges, social/cultural challenges, economic challenges, health challenges and management challenges is extracted.

The themes discovered based on the viewpoints of the Mazandarani citizens obtained valuable information about the factors affecting the level of community participation in the management of the Covid-19 crisis, which can be taken into account in planning and preventive measures.

Background & Aims :

Risk management in academic research, courses, and degrees is crucial in universities. However, there is no evidence for risk management in most aspects of university management. This study was conducted to determine the risk management Evaluation from the Staff's Perspective of Iran University Medical Sciences In 2021.

Materials & Methods:

 This is a descriptive cross-sectional study. The research samples were 224 staff of the Iran University of Medical Sciences selected by the available sampling method. The data collection tool was a risk management questionnaire. Risk management was classified into six dimensions. The first dimension is related to the level of employees' knowledge of risk management. The second dimension of risk management status. The third dimension includes policies and procedures. The fourth dimension is related to training status. The fifth dimension was the position of risk management, and finally, the sixth one was monitoring, analysis, evaluation, and risk control. In total, the questionnaire was examined in 45 questions on a 5-point Likert scale and was classified into three levels: poor (score less than 3), moderate (score 3 to 4), and good (score more than 4). The data were analyzed using SPSS software, version 26. The numerical indices of minimum, maximum, Mean±SD for the quantitative variables of the research were used. Friedman test was used to examine the relationship between domains and independent t-test, and analysis of variance and Pearson correlation coefficient was used to investigate the relationship between individual variables and risk management.

Results:

The results showed that most employees (59.4%) were women and the majority (48.7%) were 45-36 years old. The majority of employees (72.8%) were married. Most of the participants (54.4%) worked in administrative headquarters. More than half of the employees (53.1%) had a university degree at the undergraduate level, and only 12.5% of them had completed risk management courses. The results showed that the total score of risk management was 2.44±0/82. The Friedman test result showed a statistically significant relationship between employees' knowledge of risk management and all areas of risk management (p = 0.00). Statistical tests showed that risk management had a statistically significant relationship with the variables of gender (P = 0.02), risk management (P<0.001), and education (P=0.02). The mean score was higher in men than women, and also in employees who had passed the risk management course was higher than other employees. Two-to-two Tukey comparison also showed that the average score obtained by employees with master's degree education was significantly higher than an associate degree (P=0.03). At other levels, this difference was insignificant.

The results showed that, generally, from the perspective of the Iran University of Medical Sciences staff, risk management at this university is poor. In this regard, the development of educational programs, the adoption of policies and procedures, and the establishment of monitoring programs to implement risk management should be seriously pursued at the university.

An accurate evaluation of hospitals' performance in dealing with disasters can be a major role in improving hospital preparedness. The Hospital Disaster Risk Management Evaluation (HDRME) Model was developed and approved in 2018 using international models and the opinion of experts. This research was conducted with the aim of validating a questionnaire for evaluating disaster risk management in hospitals based on the standards and measures of this model.

In this validation study, a questionnaire based on the HDRME Model including 200 measures in 8 domains (management and leadership, risk assessment, planning, prevention and mitigation, preparedness, response, recovery, and key performance results) was designed. The face validity and content validity were verified both qualitatively and quantitatively (using experts’ opinions, CVR, and CVI). The reliability of the questionnaire was evaluated by Cronbach's alpha method and Inter class correlation coefficient (ICC). The questionnaires were completed by two surveyors separately and independently in 30 hospitals at Tehran University of Medical Sciences, and the results were compared and analyzed.

The face validity and content validity of the questionnaire were approved by experts. The results showed that Cronbach's alpha and Inter class correlation coefficient (ICC) was 0.99, which showed that the questionnaire had good reliability. The average score of the hospitals from the questionnaire was 36%. The highest score was related to the domain of prevention/mitigation (51/22) and risk assessment (44/81), and the lowest score was related to the domain of planning (24/75) and recovery (26/97).

The questionnaire designed from the disaster risk management evaluation model has good validity and reliability and could be used as a valid questionnaire to evaluate this issue in the country's hospitals.

 Hospital preparedness in disasters is an important role in maintaining and promoting community health. Hospital disaster risk management accreditation standards have been developed since 2016. This study was conducted to investigate the implementation of these standards in the country's hospitals to identify the strengths and weaknesses of hospitals and provide practical solutions.

 This descriptive cross-sectional study was performed in hospitals throughout the country. The results of the evaluation of the third round of accreditation in 2017 were used. Hospitals were evaluated by national accreditation surveyors of the Ministry of Health using a checklist related to accreditation standards and measures based on disaster risk management (seven standards and 37 criteria) and registered in the country's accreditation system. Descriptive statistics were used to analyze the data.

 The average score of the country's hospitals in the field of disaster risk management was 48.82. Zanjan (58.27) and Qazvin (56.44) provinces have the highest score and Ilam (25.36) and Lorestan (38.39) provinces have the lowest score. The highest score was in the first standard (disaster risk assessment and prioritization) with an average of 67.78 and the second standard (fire prevention and control) with an average of 67.05. The lowest scores were related to the fifth standard (reporting accidents and dangerous situations) (29.38) and the seventh standard (activating response systems) (32.33). More than 75% of the country's border provinces (Ilam, Kermanshah, Khuzestan, Kurdistan, Khorasan Razavi, North Khorasan, Sistan and Baluchestan, East and West Azerbaijan) have scored less than 50%.

 The results of this study showed that the average scores of the country's hospitals in disaster risk management was low and the country's hospitals, especially hospitals in border provinces, are not adequately prepared to deal with disasters. The biggest weaknesses of hospitals in the scientific formulation of preparedness and response programs are the lack of knowledge about the national instructions of preparedness and response, lack of education and training, non-structural vulnerability, and infrastructure of hospitals. Strengthening the safety and resilience of hospitals, improving the level of knowledge and skills of managers and staff, and improving the quality and continuous review of standards based on the challenges of the hospital, are among the strategies for developing and improving hospital preparedness for disasters.

Risk management is a useful tool for improving the quality of therapeutic services in hospitals. The aim of present study was to determine psychometric features of hospital risk management questionnaire.

In present descriptive-analytic study, 112 nurses working in educating hospitals of Ilam city were chosen by random sampling(2016 Des till 2017Mar). For data gathering, the 45-item hospital risk management questionnaire was used. The reliability and validity were measured by Cronbach alpha coefficient and exploratory factor analysis respectively. The scree plot was applied for determining the number of factors. Adequate number of samples for factor analysis was determined by Kaiser-Meyer-Olkin index and Bartlet test( P Value <0.001) we use the SPSS V19 Software.

Factor analysis revealed that the questionnaire comprised of 7 independent factors including the first (variance of 51.443), the second (variance of 8.926), the third factor (variance of 6.452), the fourth factor (variance of 3.999), the fifth factor (variance of 3.124), the sixth factor (variance of 2.840), and the seventh factor (variance of 2.459). The alpha Cronbach coefficient was acquired 0.809% for the dimensions. The KMO index of 0.76 ( P Value <0.001indicated adequate number of the sample.

From nurses’ perspective, the hospital risk management questionnaire can be recruited as a reliable and valid tool and can be considered as a practical guideline for measuring and assessing risk management.

Hospital disaster risk management accreditation standards have been developed since 2016. However, the country's hospitals are still not well prepared in this regard. This study aimed to identify the implementation challenges of the disaster Risk Management Program in the country's hospitals and provide solutions to improve it.

This study was conducted as qualitative research in 2019. Purposeful semi-structured interviews were conducted with 35 managers of disaster management centers of the Ministry of Health, medical universities, and hospitals in the country and continued until the saturation stage. Graneheim and Landman's contractual content analysis method was used for data analysis and MAXQDA 12 software was used for data management. Lincoln and Guba's criteria were used to ensure the accuracy and reliability of the data.

By analyzing the interviews, 6 main challenges (gap in the policy of the Ministry of Health, limited resources, weakness in planning, lack of coordination and information management, negative attitude at the managerial level, challenges of knowledge, skills, and attitude of human resources) and 31 sub-challenges in disaster risk management were identified in hospitals. Inadequate structures and weaknesses in planning at various levels, lack of transparency of laws, burnout of hospitals, weaknesses in the information management process, weaknesses in knowledge, skills and attitudes of managers and employees were the main side challenges. twenty-seven solutions were detected that reforming management structures, securing hospitals, effective and efficient management of resources, reforming policies, creating databases, and using new methods in training and practicing hospital preparedness were among the most important solutions presented.

The implementation of disaster risk management programs in the country's hospitals at the levels of policy-making, planning, and implementation is associated with challenges and problems. Paying attention to the structure and organization of disaster management at the Ministry of Health, universities, and hospitals, reforming the structure, laws and national instructions and processes in the programs of the Ministry of Health can lead to improving disaster preparedness in hospitals.

The disasters and emergencies can pose major challenges to the health infrastructure. Hospitals are the main units for providing health services in response to disasters. Considering the vital role of military hospitals in responding to disasters, the present study was conducted with the aim of explaining the improving strategies of disaster risk management in military hospitals.

The present study is a qualitative research conducted in 2020-2021. The participants were 14 managers, staff, and specialists in the field of hospital disaster management who were included in the study by purposive sampling. Semi-structured interviews were used for data collection, and the contractual content analysis method based on the Granheim and Landman method was used to analyze them.

The topics raised by the participants in 5 categories and 18 subcategories including "Management and Leadership" (organization, planning, rules and regulations, communication and coordination, specialization, culture building, advocacy), "risk assessment" (Structural safety, non-structural safety, functional safety, environmental safety), "preparedness" (training, drill, surge capacity), "response" (resource provision, casualty management, volunteer management), and "recovery" (Measures based on sustainable development) were explained.

Applying improving strategies of hospital disaster risk management presented in this study can be useful and effective in improvement of the readiness of military hospitals in the face of emergencies and disasters.

Today, the effectiveness of an organization is directly explained by the quality of its human resources. One of the most challenging issues that the healthcare sector faces is human resource management risks. The aim of this study was to present an interactive and process model and plot the structural relationships of human resource risks in the healthcare sector.

This research was a quantitative research based on the structural-interpretive modeling method. Participants included 19 managers and human resources experts of medical centers in Kashan and Aran-Bidgol, who were selected by purposive and snowball sampling. In this study, the structural-interpretive modeling method was used to structure and plot the interactive relationships of 14 critical risks of human resources in the healthcare sector.

The 14 main risks of human resources in the health sector were classified into four levels using structural-interpretive modeling. Thus, the risks of ‘perspective based on the non-strategic role of the human resources unit’, ‘perspective based on the inefficient performance of the human resources unit’ and ‘risk of selection and employment’ are in the fourth level, and ‘financial’ and ‘behavioral’ risks are in the first level.

According to the structural-interpretive modeling method, the risk of inappropriate attitude towards the role and performance of human resource management and the risk of hiring and using human resources, as key and critical risks, are the driving force behind other risks in the field of human resources in the health sector. Therefore, to manage and reduce other risks in the field of human resources, it is necessary that we manage them in the healthcare sector.

Patient safety in general and medication errors in particular are the important indicators of hospital care quality. Risk management is an important and fundamental approach to preventing events caused by medication errors. The aim of this study was to determine the effect of risk management program on the rate of medication errors among intensive care unit nurses.

The present study was a non-randomized pre-test, post-test study with a control group, conducted in 2020 in two hospitals in Tehran. The hospitals were randomly assigned to either an experimental group or a control group. According to the inclusion and exclusion criteria, 150 nurses (75 nurses in each group) were selected by the convenience sampling method. For the experimental group, a risk management program was implemented. Data collection tools included the nurses’ demographic questionnaire, the 14-item Wakefield medication error self-reporting questionnaire, and the nurses’ medication quality checklist. Data was collected before and after the intervention and analyzed by the SPSS software version 16 using descriptive and inferential statistics.

The results of independent t-test showed no statistically significant difference between two groups in demographic information and the rate of medication errors before the study (P>0.05). After the intervention, difference in the rate of medication errors was statistically significant between the two groups (P<0.005), indicating a decrease in medication errors in the nurses of the experimental group compared to the control group. The results also showed that the rate of medication error observed in nurses was significantly higher than the error reported by them (P<0.001).

The results showed that the implementation of risk management program was effective in reducing nurses’ medication errors. Implementing a risk management program is recommended to nurses as a way to promote safe medication and achieve safe and desirable nursing care.

Due to the spread of COVID-19 worldwide (pandemic), various dimensions including the health and economy of communities have been affected. Protecting workers from COVID-19 contamination poses major challenges that need to be addressed in order to learn more about how the disease has spread and how to prevent it. Exposure to COVID-19 is a risk because it can cause disease. Risk analysis is the systematic use of available data to identify risks and assess risks to individuals, the environment, assets and values. After risk analysis, a risk assessment should be performed. Risk assessment involves comparing the results of risk analysis with risk acceptance criteria. After the risk assessment, risks that are unbearable should be eliminated or reduced using control measures. All of these steps in a system or activity and identifying and introducing risk control measures to reduce harm to people, the environment, assets and values ​​are called risk management. In the present review study, risk identification, assessment and risk management of COVID-19 in work environments were performed by categorizing studies. The results of this study can help experts in identifying the risks associated with COVID-19, risk assessment and provide risk control strategies in the context of risk management and provide them with useful information to do so.

Medical errors are those mistakes committed by healthcare professionals due to wrong execution of a planned healthcare action or execution of a wrong healthcare action plan whether or not it is harmful to the patient. Medical errors may cause patients to suffer and have huge financial costs for the healthcare system. Identifying and measuring medical errors and adverse events are essential for improving patient safety. The objectives of this research were to measure medical errors and adverse events rates, to identify their severity and also analyze their underlying causes in a general educational hospital in Tehran, Iran by using The Global Trigger Tool.

A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram.

 A total of 205 triggers were detected, and 60 adverse events were identified. About 15.9 percent of patients experienced an adverse event. The rate of adverse events was 19.1 per 100 admissions and 5.7 per 100 Admission days or hospitalization days. Almost half of the adverse events were in the E and F categories (temporary harm). Bleeding, nosocomial infections, and patient fall were the leading adverse events. Employees and working processes were the underlying causes of the medical errors and adverse events. The Global Trigger Tool found 100 times more adverse events than the voluntary reporting method.

The adverse event rate of this study was high. Hospital managers should take appropriate actions to reduce medical errors and adverse events and enhance patient safety. The Global Trigger is a Powerful, reliable, strong tool for identifying adverse events and measuring their severity.

Breast cancer is the most common malignancy and the second leading cause of malignancy in women, worldwide. Early diagnosis can lead to timely treatment and increase the life expectancy of patients. Various models have been designed to determine the risk of disease and identifying high-risk women. This study was performed with aim to evaluate the risk of breast cancer using different models in women of Kerman.

This cross-sectional study was performed on 454 women aged 35-75 years referred to comprehensive health centers in Kerman in 2018. The questions from the Gail and IBIS questionnaire were asked to assess the risk of developing 5-year and lifetime breast cancer risk. Data were analyzed by SPSS software (version 20) and Pearson correlation test. P<0.05 was considered statistically significant.

Mean of 5-year risk score for breast cancer was 0.81 ± 0.65% based on Gail model and 0.81 ± 0.58% based on IBIS model. Also, mean of lifetime risk based on Gail and IBIS models was 10.53 ± 5.52% and 11.28 ± 3.94%, respectively. There was a significant positive linear relationship between 5-year risk (r = 0.67) and lifetime risk (r = 0.51) on Gail and IBIS models (p<0.001).

In comprehensive health centers, risk assessment models can be used to identify high risk people for breast cancer. The Gail and IBIS models are relatively similar in risk prediction and their results are correlated.

Since society is the first respondent to every disaster, it is essential that the community’s ability to cope with such a situation increase. Given the importance of the role of society in the current approach to disaster risk management, the choice of the primary society is important in order to achieve greater success and acceptance in other societies. This study aimed to determine the importance of community selection criteria in community-based disaster risk management interventions.

Using the qualitative technique with the nominal group technique, community-based selection criteria for implementing a people-centered disaster management intervention from the viewpoint of the 12 different organizations in Kerman, which have been involved with risk management, have been developed through four stages of idea creation, idea registration, idea clarification, and prioritization, which was investigated.

In this study, 38 criteria for choosing a community were outlined in the idea of registration. At the stage of defining ideas, the four criteria were combined due to non-relevancy and five criteria due to similarities with other criteria. The remaining criteria are classified into four main categories: hazard and risk, organizational capacities, social capacities, and social indicators.

Due to resource constraints and the impossibility of implementing the program in all societies, it is necessary to define the criteria for selecting communities (as one of the stages of implementing a people-centered disaster management plan), by the matrix system, by rating the best locations from the target communities carefully, and according to the views society itself.