Background Although the Depression Anxiety Stress Scale-21 Items (DASS-21) has been used in different countries and translated into different languages, the Persian version of this scale has not been validated for healthcare professions in Iran. Therefore, the purpose of this study was to examine the psychometric properties of the Persian version of DASS-21 for nurses. Methods This cross-sectional study was conducted among 1135 nurses working in public hospitals, who were selected through convenience sampling. DASS-21, which consists of 21 items and three dimensions (depression, anxiety, and stress), has been translated into Persian, and there is an online version available. A confirmatory factor analysis (CFA) was performed to examine the factor structure of this scale. Cronbach’s alpha coefficient was also measured to establish internal consistency. Besides, the intraclass correlation coefficient (ICC) was calculated to assess the test-retest reliability. Results The Cronbach’s alpha coefficient was acceptable for anxiety (0.79), stress (0.91), and depression (0.93). An acceptable test-retest reliability (0.740-0.881, P < 0.01) was also reported for DASS-21 and its three dimensions. The results of CFA showed acceptable model fit (χ2/(df) = 1457/(186), P < 0.001), root mean square error of approximation (RMSEA = 0.078), Tucker-Lewis index (TLI = 0.906), comparative fit index (CFI = 0.917), and standardized root mean square residual (SRMR = 0.047). Fifty-seven nurses were included in the test-retest. The ICCs for all dimensions ranged from 0.75 to 0.86, indicating the acceptable test-retest reliability of the scale. Conclusion The Persian version of DASS-21 showed good psychometric characteristics, and it was confirmed as a valid and reliable tool for evaluating depression, anxiety, and stress among Iranian nurses. However, further validation studies of the Persian DSASS-21 are needed among other healthcare professionals, including physicians, midwives, and allied health professionals.

Background: Accreditation is usually a voluntary plan supported by a non-governmental institution and trained evaluators that examine the competency of organizations providing health service according to pre-specified performance standards. Objectives: The current study aimed to determine the degree of establishment of accreditation standards using logical framework of Zachman. Methods: This descriptive research was conducted during year 2015. The population of the study included people involved in the establishment of accreditation standards. Sampling was conducted in the form of complete enumeration according to 36 standards of accreditation. The instrument used for data collection was the "Logical framework of Zachman". Columns of framework consisted of people involved in conducting the work (Who), the purpose of the work (Why), strategy of the work (What), work time (When), and sub-system of doing work (Where) and way of doing work (How), and rows of framework included the view of hospital chief, director/assistants of hospital, officials and personnel. Test chi-square was used to compare between accreditation standards text and studied hospital gap. Descriptive statistical method was used for variables. Results: People involved in doing work and sub-systems of doing work at the hospital were consistent with specified accreditation standards. In 27% of the standards, time interval of doing work in the hospital was not conducted according to accreditation standards. In terms of way of doing work, 25% of standards had not been established, and 26% of them had been established incompletely. During interviews, it was found that 59% of personnel of purpose of doing work, and 94% of them are not informed about the strategy of doing work, according to accreditation standards in the hospital. Conclusions: Uncertainties in the accreditation standards in dimensions of purpose, people involved, strategy and time interval of doing work, respectively, led to a lack of understanding the intention of author/developers of standards by personnel. As a result, this led to lack of complete establishment of accreditation standards in the studied hospital.

Background: While the ultimate goal of health care is to maintain or improve the health status, features of care, including the quality of hotel services, are important to enhance the quality of health care services. Due to the limited resources of the health system, it is important to recognize the strengths and weaknesses of health service providers for policy-making and allocating resources in line with customers’ expectations. Objectives: The current study aimed at ranking the dimensions of hospital hoteling services from patients’ perspectives using the importance-performance analysis (IPA) method in Tehran, Iran. Methods: In this cross-sectional study, 440 patients were enrolled through multi-stage random sampling. The data collection tool was a questionnaire consisting of 44 items in six dimensions. Its internal reliability was determined based on Cronbach’s alpha coefficient (α = 0.97). The IPA method was used to prioritize the dimensions. Data were analyzed using descriptive statistics and the paired t-test at a significance level of < 0.05. Results: In all aspects of hoteling, there was a significant difference between the performance of hospitals and the expectations of patients. The highest and lowest gaps between performance and expectation were related to the economic-financial and performance-process factors, respectively (P < 0.05). Based on the IPA matrix, the "physical-structural" and "economic-financial" factors were the major weaknesses, and the "need to allocate more resources" and "human-behavioral" factors were recognized as the most strong points. Considering that the dimensions of "cultural-religious” and "safety-security" were located in the third quadrant of the IPA matrix, these dimensions did not require additional resources. Conclusions: The existence of a gap between hospital performance and patient expectation in all the hoteling dimensions indicated that the performance of hospitals in providing hoteling services was not proportional to the importance of these factors from the viewpoints of patients. The "physical-structural" and "economic-financial" factors were the major weaknesses of the hospitals studied. Therefore, it is necessary to pay more attention and allocate resources to these dimensions. Efforts should be continued to maintain and upgrade the status quo regarding the human-behavioral factors to boost patient satisfaction and improve the quality of hoteling services.

Introduction and aim: To improve the individuals' health, reforms should be made in the health systems. As a result, assessing the impacts of reforms is a way to evaluate the effectiveness of the health system. The aim of this study was to study the relationship between the kind of delivery and the five indexes of mother and baby's health before and after implementing the health reform plan in selected hospitals of Azarbaijan Sharghi, Iran. Issues and methods: This descriptive-analytical study was conducted in 2017. The study was conducted among eight educational, medical, and private hospitals. Before and after the program, 800 files were selected using simple random sampling method. The researcher made a check list with confirmed validity to extract the data. The data were analyzed using descriptive statistics and T-tests by SPSS-22.  Results: The average age of mothers in the two intervals was 27 years. Most participants did not deliver before and their education was diploma or lower. The rate of natural delivery from 34.5% (before the plan) reached 44.2% (after the plan)(p<0.05). The rate of mothers and babies' mortality reduced from 0.3 and 0.8 to 0 and 0.5, respectively. Mothers and babies' mortality and stillbirth had no significant difference based on the kind of delivery (p>0.05). Conclusion: Findings indicated significant increase of natural delivery after the reform plan in health system. Moreover, the rate of mothers and babies' mortality decreased. These results can guide the policymakers for deciding about the course of plan and its review.