No abstract

ObjectivesHospitals as integrated parts of the wide-ranging health care systems have dominant focus on health care provision to meet, maintain and promote people's health needs of a community. This study aimed to assess the service quality of teaching hospitals of Yazd University of Medical Sciences using Fuzzy Analytical Hierarchy Process (FAHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS).MethodsA literature review and a qualitative method were used to obtain experts' viewpoints about the quality dimensions of hospital services to design a questionnaire. Then, using a self-made questionnaire, perceptions of 300 patients about the quality of delivered services were gathered. Finally, FAHP was applied to weigh each quality dimension and TOPSIS method to rank hospital wards.ResultsSix dimensions including responsiveness, assurance, security, tangibles, health communication and Patient orientation were identified as affecting aspects of hospital services quality among which, security and tangibles got the highest and lowest importance respectively (0.25406, 0.06883). Findings also revealed that in hospital A, orthopedics and ophthalmology wards obtained the highest score in terms of quality while cardiology department got the lowest ranking (0.954, 0.323). In hospital B, the highest and the lowest ranking was belonged to cardiology and surgical wards (0.895, 0.00) while in hospital C, surgical units were rated higher than internal wards (0.959, 0.851).ConclusionFindings emphasized that the security dimension got the lowest ranking among SERVQUAL facets in studied hospitals. This requires hospital executives to pay special attention to the issue of patients’ security and plan effectively for its promotion.

Background: Refugees’ access to quality healthcare services might be compromised, which can in turn hinder universal health coverage (UHC), and achieving Sustainable Development Goal (SDG), ultimately. Objective: This article aims to illustrate the status of refugees’ access to healthcare and main initiatives to improve their health status in Iran. Methods: This is a mixed-method study with two consecutive phases: qualitative and quantitative. In the qualitative phase, through a review of documents and semi-structured interviews with 40 purposively-selected healthcare providers, the right of refugees to access healthcare services in the Iranian health system was examined. In the quantitative phase, data on refugees’ insurance coverage and their utilization from community-based rehabilitation (CBR) projects were collected and analyzed. Results: There are international and upstream policies, laws and practical projects that support refugees’ health in Iran. Refugees and immigrants have free access to most healthcare services provided in the PHC network in Iran. They can also access curative and rehabilitation services, the costs of which depend on their health insurance status. In 2015, the government allowed the inclusion of all registered refugees in the Universal Public Health Insurance (UPHI) scheme. Moreover, the mean number of disabled refugees using CBR services was 786 (±389.7). The mean number of refugees covered by the UPHI scheme was 112,000 (±30404.9). Conclusion: The United Nations’ SDGs ask to strive for peace and reducing inequity. Along its pathway towards UHC, despite limited resources received from the international society, the government of Iran has taken some fundamental steps to serve refugees similar to citizens of Iran. Although the initiative looks promising, more is still required to bring NGOs on board and fulfill the vision of leaving no one behind.

Background Choosing a career in nursing is frequently a complicated decision that is influenced by multiple factors. Purpose This study was designed to identify and rank the main factors that influence individuals to choose to pursue a career in nursing. Methods This cross-sectional study was conducted at Mazandaran University of Medical Sciences, Iran. A comprehensive review of the literature was conducted to identify the factors that people consider when making a choice to pursue a career in nursing. The face and content validities of these factors were evaluated. A sample of 250 participants was invited to assess the factors using exploratory factor analysis. Finally, the analytical hierarchy process, in combination with fuzzy logic, was used to rank the criteria and related factors. Results Twenty factors were identified and extracted from 50 published studies. After confirming the face and content validity of each, these 20 factors were distinguished into four criteria, including (a) external motivation, (b) social dignity, (c) internal motivation, and (d) usefulness of discipline. Each criterion had an eigenvalue greater than 1. External motivation and usefulness of discipline were respectively identified as the most and least important criteria (38.60% vs. 16.11%) in terms of influencing individuals to pursue a nursing career. Conclusions/Implications for Practice The results of this study show that exposure to positive recommendations from family and friends, receiving positive information about studying nursing, positive perceptions regarding the general usefulness of nursing knowledge, and migration opportunities to other countries are the primary factors that influence individuals in Iran to pursue a career in nursing.

No abstract

Background: Several reasons account for nurses' intention to leave the nursing profession. Understanding these factors is a step towards reducing such incidents which pose a threat to the nursing profession. This study aimed to identify and rank the circumstances that influence the intention to leave the nursing profession in Iran. Methods: The present study is a cross-sectional analytical study, which employed four other methods to reach a sound conclusion in 2019.The electronic databases, including the Scientific Information Database, PubMed, Scopus, Science Direct, OVID, Cochrane Library, CINAHL,, were searched for studies published from the year 1998 to December 2018 for scientific studies conducted among factor associated intention to leave in Iran. The Exploratory Factor Analysis (EFA) method was then used to extract hidden factors and determine the hierarchical structure of the review's findings. Using the combination of Analytical Hierarchy Process and Fuzzy Logic, the weight of each one of the factors that affect the intention to leave the nursing profession was then calculated. Finally, the accuracy of the results of the Consistency Ratio and Fuzzy analytic hierarchical process (FAHP), was calculated and evaluated. Results: The electronic search delivered 100 studies, from which we identified and extracted 26 most occurring reasons for the desire to leave the nursing profession. Based on the EFA results, we identified four criteria (personal, managerial, organizational, and side issues) with eigenvalues ​​higher than 1. The first criteria (personal issues) scored the highest (53.39 %), while side issues scored the lowest (13.40 %) as reasons accounting for the intention to leave the nursing profession. Conclusion: Job stress, the lack of freedom and independence in the clinical environment, discrimination, and the probability of catching an illness have higher prominence in influencing nurses' tendency to leave work. These factors can be mitigated by altering managerial techniques within organizations.