Challenges experienced by nurses in the implementation of a healthcare reform plan in Iran

Preferences of Iranian medical students for selecting the compulsory service plan packages: A discrete choice experiment

Background and Aims

Health policymakers face challenges in designing compulsory plan packages for medical students to encourage them to work in disadvantaged regions. Using a discrete choice experiment, this study assessed the preferences of medical students for selecting the compulsory service plan packages in Guilan Province, Iran.

Methods

In total, 374 medical students responded to a survey inquiring about salary, distance from their residency city, availability of welfare amenities, work difficulty, the developmental status of their workplace, contract duration, and preference for urban or rural work settings.

Results

The study revealed that students favor a compulsory service package that provides higher salaries and shorter contract duration. They also show a preference for working within their home province over other factors. For the opportunity to serve in their city of residence, they would forgo an average of US$77.93 per month.

Conclusion

While financial incentives were the primary consideration for medical students when choosing compulsory service packages, a range of nonfinancial factors significantly influenced their decisions as well.

Identifying unmet information needs of advanced cancer patients in Iran: An in-depth qualitative study

Background and Aims

One of the main vital needs for self-care in patients with advanced cancer is information need. Meeting this need has significant positive effects on improving their treatment and care. This study was conducted to identify the unmet information needs of patients with advanced cancer in Iran.

Methods

This exploratory study was performed from July to February 2021 in the Kerman University of Medical Sciences cancer treatment centers. Oncologists selected eligible patients by purposeful sampling method. Semistructured and in-depth interviews were conducted with selected patients to collect data. Interviews continued until data saturation. Each interview was audio-recorded and transcribed verbatim.

Results

In the interviews, 15 patients with advanced cancer ranging in age from 43 to 65 years participated. The most common type of cancer in women was breast (71.4%) and prostate (50%) in men. The two main categories of "types of unmet information needs" and "reasons for not meeting information needs" were extracted from the analysis of patient interviews, with six and four subcategories, respectively.

Conclusion

Cancer patients had a large number of unmet information needs. At the time of identifying the unmet information needs of cancer patients, the basic reasons for not meeting these needs should also be considered because cultural differences and social gaps in societies are inevitable.

A survey of nurses, midwives, and physicians attitudes in regard to health reform plan at Jahrom University of Medical Sciences in 2020

BACKGROUND

The health reform plan (HRP) is a plan to improve Iran's health systems that began in 2014. The three main approaches of this plan include financial protection of the people, creating justice in access to health services, and improving the quality of services. It predicted that the level of health system responsiveness would increase. Achieving this goal is possible only with the correct implementation. The best people to measure the correct implementation are nurses, midwives, and physicians. Hence, this study was conducted to assess the attitude of nurses, midwives, and physicians about the implementation of the HRP.

MATERIALS AND METHODS

This cross-sectional descriptive study was conducted in educational hospitals of Jahrom University of Medical Sciences in 2020. By convenience sampling method, 325 nurses, midwives, and physicians participated in this study. Sampling was done in all work shifts, and in all wards. A researcher-making questionnaire was used to collect data. The scoring did by the Likert scale from (completely agree = 4 to completely disagree = 1). Quantitative and qualitative face and content validity was calculated (IS: 0.84, CVI: 0.92, CVR: 0.87), and its reliability was calculated by Cronbach's alpha method (0.78). The data were analyzed by SPSS software version 16. Descriptive statistics, Mann-Whitney U-test, and Kruskal-Wallis test were used for the data analysis (P ≤ 0.05).

RESULTS

In the study, 90.15% agreed with the implementation of the HRP. There was no significant difference between the male and female (P = 0.063). There was a significant difference between the educational degree (P = 0.006), married and the single participants' attitude (P = 0.003), the nurses, midwives, and physicians (P = 0.001).

CONCLUSION

HRP is more successful in the field of financial protection, so policymakers should pay more attention to justice in access to health services and improving the quality of services fields.

Insecure Employment Contracts during the COVID-19 Pandemic and the Need for Participation in Policy Making

Job security influences the ability of nurses to provide high-quality nursing care. The Iranian health system has always faced nursing shortages, and the COVID-19 pandemic has worsened this situation. Although nurses have been labelled 'heroes' across the globe, many of them have been hired using insecure employment contracts. This commentary aims to describe issues surrounding job contracts for Iranian nurses during the COVID-19 pandemic and discusses how the current situation can be improved. Iranian nurses are at the frontline of the fight against COVID-19 and need to receive better support in terms of job security and dignity. They should participate more in policymaking activities to improve their job condition and prevent the development and implementation of the short-term and insecure job contracts that lead to job insecurity.

A critical analysis of Iran health system reform plan

INTRODUCTION

Iran's Health System Reform Plan (HSRP) were initiated in public and hospitals affiliated to Medical Sciences Universities in June 2015. The purpose of the present paper is to provide a critical analyse of the HSRP and its outcomes.

METHODS

The study was carried out as a review critical analyse in 2019. The pertinent articles were searched for in Science Direct, PubMed, Ovid, and Google Scholar using keywords "health sector," "reform plan," "health system reform," "health services," "health care system," and "Iran." Published articles in scientific national and international journals in Persian and English language, of which the full-texts were available, were entered into the study. Finally, from a total of 75 articles obtained, 45 studies were carefully reviewed.

RESULTS

Several factors, which impact in the success of Iran's HSRP such as social-economic and political outlooks, lack of official information and a comprehensive management system, in addition to failure to extend continuous performance control, economic sanctions against Iran. Other factors are limitations on financial transactions between Iran and the rest of the world due to the sanctions, relying merely on a few instructions, and negligence of the required infrastructures. In terms of advantages of the plan, relative decrease in patient's share in medical expenses, improvement of emergency wards, and relative decrease in the rate of C-section operations are notable.

CONCLUSION

Better implementation of Iran's HSRP entails the provision of resources and facilities such as stable and adequate resources, proper management of available resources, payment mechanisms reform, attracting, and facilitating private sector's participation.

Occupational stress and associated risk factors among nurses: a cross-sectional study

Background: Nursing can be demanding and stressful with occupational stress posing a serious threat to nurses and patient outcomes. Aims/Objectives: To determine the prevalence of nurses' occupational stress and its associated risk factors. Design: Cross-sectional survey design. Methods: Nurses in 115 tertiary-level hospitals in 13 provinces in Iran were surveyed from August 2016-December 2017. Demographic information and occupational stress were assessed. 5422 distributed questionnaires were distributed with 2895 of returned surveys analyzed. One-way ANOVA and multiple linear regression analyses identified risk factors for occupational stress. Results: Mean score for overall occupational stress was 3.48 indicating a stress level between moderate and high, with 78.4% of respondents reporting that their job was stressful. Nurses reported issues with shiftwork, staffing, pay, workplace discrimination, management, policy and excessive workloads as sources of occupational stress. Risk factors in the multivariate analysis for higher occupational stress were female gender (p = .002), being married (p = .008), having lower educational levels (p < .001), increased work hours (p <.001), and working in emergency (p = .025), general wards (p = .012) and teaching hospitals (p < .001). Conclusions: The high prevalence of occupational stress amongst nurses in Iran demonstrates the extent of the issue, with recent reforms not effectively addressing occupational stress. The risk factors identified allow for more targeted interventions.

Quality of work life and factors associated with it among nurses in public hospitals, Iran

BACKGROUND

There is an acute shortage of nurses worldwide including Iran. Quality of work life is important for nurses as it affects the safety and quality of care provided for patients as well as organizational factors. The aim of this study was to describe the status of quality of work life and to explore its predictors among nurses in Iran.

METHODS

A cross-sectional study was conducted on 2391 nurses in 85 Iranian public hospitals, selected through the convenience sampling. Data were collected using demographic information and the quality of work life questionnaires.

RESULTS

The mean score for total quality of work life was 2.58, indicating a low level of self-reported quality of work life, with 69.3% of nurses dissatisfied with their work life. The major influencing factors were inadequate and unfair payment, lack of solving staff problems by organization and poor management support, job insecurity, high job stress, unfair promotion policies, and inadequate involvement in the decision-making. Significant predictors in the multivariate analysis for lower quality of work life were male gender, being single, older age, having lower educational levels, and working in teaching hospitals.

CONCLUSION

The quality of nursing work life was at a low level and needs improvement interventions. The predictors identified allow for more targeted interventions. Nursing managers and policymakers should develop and implement successful strategies appropriately to improve the quality of work life. This includes the payments, organizational and managerial support, job security, fair promotion policies, and measures to reduce job stress.

Health care reform in Iran: Implications for nurses' moral distress, patient rights, satisfaction and turnover intention

AIM

The aim of the present study was to assess the implications of Iran's recent health care reforms on nurses' experience of moral distress, their perceptions of the respect for patient rights and the relationship of these variables to job and income dissatisfaction and turnover intention.

BACKGROUND

Health systems around the world are reforming themselves to adapt to meeting the future needs of increasing patient care to an ever-growing population.

METHODS

This was a cross-sectional correlational study. The participants were 276 nurses at six large private and public hospitals in Tehran, Iran.

FINDINGS

Negative correlations were reported between turnover intention and respecting patient rights (r = -0.560, p < 0.001), satisfaction with job (r = -0.710, p < 0.001) and satisfaction with income (r = -0.226, p < 0.001). The correlation between moral distress intensity (r = 0.626, p < 0.001) and frequency (r = 0.701, p < 0.001) was positive with turnover intention.

CONCLUSIONS

Moral distress was significantly correlated to poor respect for patient rights, poor job satisfaction and income satisfaction and was a major predictor of turnover intention.

IMPLICATIONS FOR NURSING MANAGEMENT

Health system reform must take into account the concomitant increasing workload and its negative impact in order to ensure that reform does not lead to unintentional detrimental outcomes of increased moral distress, decreased satisfaction and increased turnover rates among nursing personnel.