Background:The fatal pandemics of infectious diseases and the possibility of using microorganisms as biological weapons are both rising worldwide. Hospitals are vital organizations in response to biological disasters and have a crucial role in the treatment of patients. Despite the advances in studies about hospital planning and performance during crises, there are no internationally accepted standards for hospital preparedness and disaster response. Thus, this study was designed to explain the effective factors in hospital performance during biological disasters.Methods: Qualitative content analysis with conventional approach was used in the present study. The setting was Ministry of Health and related hospitals, and other relevant ministries responsible at the time of biologic events in Islamic Republic of Iran (IR of Iran) in 2018. Participants were experts, experienced individuals providing service in the field of biological disaster planning and response, policymakers in the Ministry of Health, and other related organizations and authorities responsible for the accreditation of hospitals in IR of Iran. Data were collected using 12 semi-structured interviews in Persian language. Analysis was performed according to Graneheim method.Results: After analyzing 12 interviews, extraction resulted in 76 common codes, 28 subcategories, and 8 categories, which are as follow: detection; treatment and infection control; coordination, Resources; training and exercises; communication and information system; construction; and planning and assessment.Conclusion: Hospital management in outbreaks of infectious diseases (intentional or unintentional) is complex and requires different actions than during natural disasters. In such disasters, readiness to respond and appropriate action is a multifaceted operation. In IR of Iran, there have been few researches in the field of hospital preparation in biologic events, and the possibility of standardized assessment has be reduced due to lack of key skills in confronting biological events. It is hoped that the aggregated factors in the 8 groups of this study can evaluate hospital performance more coherently.

Introduction: Anxiety is one of the factors which increase mortality in patients with cardiac diseases. The aim of this study is the effect of acupressure on Patient's anxietywho candidate for coronary angiography Materials and Methods: This is a randomized controlled clinical trial study which was done at 1393. A total of 60 patients with age of 35-80 years old; literate, without history of using acupressure, with previous history of coronary vessels angiography, mental illnesses, drug addiction, anatomical and skin problem in P6 point and Thumb of two hands; were selected and randomly divided in two groups. Intervention group received pressure on the P6 point of two hands and control group received pressure on the Thumb of two hands. The interventions were performed in the morning day of angiography. Before and 30 min after intervention Spielberger state anxiety questionnaire was filled out by the patients then data were statistic analyzed.Results: Intervention and control groups didn't have any meaningful differences in demographic characteristics, anxiety level (p> 0/05). After intervention independent T test results presented meaningfully differences in anxiety level (p =0/001). Discussion and Conclusion:According to meaningful reduction which was seen in anxiety level; may say acupressure is a suitable method for patient's candidate for coronary angiography anxiety reduction.

Background: Nurses are considered key members to respond to incidents and disasters. As many patients are hospitalized during the coronavirus disease (COVID-19) pandemic and nurses are directly in contact with these patients, their preparedness enables them to respond to this situation more effectively and protects their health. Therefore, the present study aimed to design and validate a questionnaire to measure the nurses’ preparedness in response to COVID-19 in Iran in 2020. Methods: This study was a mixed research aiming to develop and validate a psychometric research instrument in 2020. Based on the review of the literature regarding COVID-19 and other viral respiratory infections, the items were extracted, rewritten, and validated. In the quantitative phase, the validity of the questionnaire was evaluated in terms of face, content, and construct validity and its reliability was evaluated based on internal consistency and stability (Cronbach’s alpha and Intra-class Correlation Coefficient (ICC)). To fill out the questionnaire, the nurses were selected by random sampling. Data analysis was done by the SPSS software, version 23. Results: The designed questionnaire included nine dimensions and 50 items. The dimensions included 1. Incident Command System (ICS), 2. risk assessment and management, 3. information and communication management, 4. psychological approaches, 5. personal protective equipment, 6. prevention of contamination, isolation, and quarantine, 7. education and training, 8. patient management, and 9. features of the new coronavirus. The content and face validity of the questionnaire were approved by the specialists and experts of nursing and health in disasters and emergencies. The Content Validity Ratio (CVR) was >0.7 for all items. The Content Validity Index (CVI) was also approved for all items. The Cronbach’s alpha coefficient and ICC were respectively 0.71 and 0.72 for the total questionnaire. The total score was determined based on five ranges, including 50-89 (very low preparedness), 90-129 (low preparedness), 130-170 (medium-level preparedness), 171-210 (high preparedness), and 211-250 (very high preparedness). Conclusion: Nurses preparedness to respond to this pandemic requires multilateral measures. Measuring the nurses’ preparedness can clarify the challenges in hospital measures taken to respond to this crisis. Evaluating the nurses, determining the challenges and priorities, and finding solutions to resolve them can improve the nurses’ performance in providing healthcare services. Preparation of nurses during pandemics can reduce the damages to this group and maximize their efforts to protect the patients. Thus, health planners and policymakers should try to promote the nurses’ awareness and preparedness.

Objectives: Two of the 5 great earthquakes have occurred in Iran between 1990 and 2005. Informal volunteers’ management is a determinant factor in disaster management. This research was conducted to investigate the management challenges of informal volunteers after the Kermanshah earthquake. Methods: The study is qualitative, done by content analysis. Data were gathered by observation and semi-structured interview. Results: Analysis of 12 interviews resulted in 4 main categories (inappropriate dispatch, volunteers’ inefficiency, decrease in volunteers’ incentive, deficiency of welfare services) and 11 subcategories. Discussion: To avoid mistrust and decrease in motivation, proposed actions are: standardize information collection, apply effective communication, create registration networks and accreditation of certificates and expertise, and perform periodic drills. Conclusion: We recommend the start of extracurricular programs and applying potential volunteers within the preparedness phase, and follow-up at the beginning of the response phase. Decrease of motivation to participate in future events needs to be studied more comprehensively.

Background: A large number of natural disasters, including floods and earthquakes, occur in Iran annually. Recognition of the factors influencing the civil-military coordination in natural disasters is amongst the prerequisites in disaster management. Experts' perspectives towards coordination in these disasters can also be indicative of the importance of this subject. Given the fact that no studies have been carried out regarding the relationship between the civil and military forces in the aftermath of natural disasters in Iran, these factors can be recognized according to individuals' and experts' viewpoints. Objectives: The present study aimed at extracting the factors influencing the civil-military coordination in the course of natural disasters in Iran through interviewing experts in 2019. Methods: The present qualitative research was conducted through semi-structured and in-depth interviews with 20 key informants who were selected via snowball, convenience, and purposive sampling methods. A session was also held with the presence of the panel of experts. The data were analyzed using thematic analysis in order to extract the factors influencing the civil-military coordination in natural disasters in Iran. Results: The factors influencing the coordination between the military and civil organizations were categorized into personnel, stuff, and system issues (structure). In addition, 33 subcategories were also identified. The specialists emphasized that holding instructional courses and regular and periodic exercises could enhance coordination in response to disasters. Conclusions: The present study showed that coordination between civil and military organizations in the management of natural disasters in Iran is faced with many challenges that should be overcome and reduced through providing organizational, political, and structural supports. Recognition of the factors influencing coordination can be effective in line with the correct management of natural disasters. Furthermore, organizations can be made readier for taking better measures in disasters according to the extracted factors. In order to provide a proper response to natural disasters, all coordination components should be elevated simultaneously and coherently.

IntroductionMilitary service is a stressful environment. Methods to reduce stress may result in the mental health promotion of military forces. There are various methods for relieving anxiety. Acupressure is one of them. Hence, this study was carried out to explore effects of acupressure at the P6 and LI4 acupressure points on the anxiety level of army soldiers.MethodsA randomised double-blind design was undertaken. A total of 120 Iranian army soldiers were randomly assigned to three groups, namely P6, LI4 and control. The P6 and LI4 acupressure points are effective in lowering the anxiety level. In the intervention groups, acupressure was applied at the P6 and LI4 points three times for 10 min at 30 min intervals. In the control group, the thumb pad, which is not an acupressure point, was pressed. The anxiety level of the subjects was measured before the intervention and 30 min after the last intervention. The instruments included a demographics questionnaire and the State-Trait Anxiety Inventory.ResultsThere was no significant difference between the three groups with respect to the anxiety level in the preintervention phase. However, the mean anxiety score in the P6 group decreased significantly from 53.35±9.7 to 49.02±9.3 (p=0.005). The mean anxiety score in the LI4 group also decreased significantly from 53.37±8.39 to 45.47±8.16 (p<0.001). In the control group, there was no significant difference between the preintervention and postintervention phases (p=0.16). In the postintervention phase, the analysis of variance test showed a significant difference between the three groups in terms of the anxiety level (p=0.04).ConclusionsAcupressure can reduce soldiers’ anxiety at the acupressure points, especially at the LI4 point. It is recommended that this simple and cost-effective intervention be used to relieve soldiers’ anxiety in stressful situations.Trial registration number20150715023216N4.

Infectious disasters have specific features which require special approaches and facilities. The main challenge is the rate of spread, and their ability to traverse the Earth in a short time. The preparedness of hospitals to face these events is therefore of the utmost importance. This study was designed to assess the preparedness of countries facing biological events worldwide. A qualitative systematic review was done from PubMed (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, Amsterdam, Netherlands), Web of Science (Thomson Reuters, New York, NY), ProQuest (Ann Arbor, MI), and Google Scholar (Google Inc, Mountain View, CA). Two journals were searched as key journals. The search period was from January 1, 2007 to December 30, 2018. Twenty-one (21) documents were selected including 7 (33%) from Asia, 7 (33%) from Europe, 4 (19%) from USA, 2 (10%) from Africa, and 1 (5%) multi-continental. Forty-six (46) common sub-themes were obtained and categorized into 13 themes (infection prevention control, risk perception, planning, essential support services, surveillance, laboratory, vulnerable groups, education and exercise and evaluation, human resource, clinical management of patients, risk communication, budget, and coordination). Not all articles discussed all the identified categories. There is an extended process required to reach complete preparedness for confronting biological events, including adequate and well-managed budget. Medical centers may have trouble dealing with such events, at least in some respects, but most developed countries seem to be more prepared in this regard.

Objective: This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts. Methods: This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis. Results: A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories. Conclusions: The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.