Overcoming the Barriers to Insulin Initiation in Type II Diabetic Patients: Clinical Evidence Available to Nurses
Mahboobeh
Firooz
Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran.
author
Es-hagh
Ildarabadi
Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran.
author
Seyed Javad
Hosseini
Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran.
author
text
article
2018
eng
The prevalence of diabetes has been on a growing trend worldwide; accordingly, it has increased from 4.5% in 1980 to 8.5% in 2014 (1). The aim of controlling diabetes is to achieve a hemoglobin a1c (HbA1c) level of lower than 7%. However, this target cannot be fulfilled in almost 50% of the diabetic patients. Poor blood glucose control is a risk factor for the complications associated with diabetes mellitus (2, 3).Oral hypoglycemic drugs are typically used to control this disease. In case of failure in achieving the normal blood glucose level, another oral drug or insulin may be required (4(.According to the literature, only 20% of the diabetic patients are interested in insulin initiation. Furthermore, insulin initiation in these patients is challenging for the health care providers (5).The barriers to insulin initiation can be categorized in terms of their relationship with the health care providers and patient.According to the previous studies, the barriers related to the health care providers include the fear of hypoglycemia, lack of sufficient time to educate the patients, patient's low socioeconomic status, lack of sufficient knowledge and experience, absence of a common language with the patients, and poor patient-staff relationship.On the other hand, the barriers related to the patients entail inconvenience and limitation in lifestyle, loss of independence, social embarrassment, poor self-efficacy, needle phobia, depression, failure to receive convincing answers from the health care providers about the benefits and risks of insulin, incomplete conceptualization of diabetes, use of traditional herbal treatments, and fear of weight gain due to using insulin (3, 4, 6-9). Regarding this, delay in insulin initiation is a common practice.Research has shown that around 50% of the patients with poor diabetes control do not initiate insulin therapy timely, and that even insulin initiation is delayed for 3-5 years after receiving no response from oral hypoglycemic drugs. Therefore, this issue requires the direction of special attention because except for a few barriers, including low socioeconomic status, the rest of the aforementioned barriers can be altered and resolved by the health care providers (8).Nurses are among the most important members of the health care providers, who are in contact with patients.They are the ones who should provide the diabetic patients with knowledge and specialized skills to educate and motivate the patients regarding insulin consumption.In this respect, they can contribute to the fulfillment of treatment objectives, which include the reduction of complications and achievement of a suitable HbA1c level (10).In addition, there is a need for evidence-based scientific documents as a basis for delivering essential education to the patients.In order to achieve this evidence, an electronic search was conducted using the international databases, including the web of science (ISI), Pubmed, Scopus, and Google Scholar, with the keywords of “initiate or starting”, type II diabetes”, and “insulin”. The search results indicated that the number of interventional studies investigating the field of nursing and “insulin initiation” was very limited.Accordingly, among the Persian electronic databases, such as SID (Scientific Information Database) and Magiran, only one “descriptive, cross-sectional” study was found (11).Using various studies, the barriers to insulin initiation were listed and investigated. The review was indicative of the implementation of only a few nursing interventions to overcome these barriers. Considering the importance of insulin initiation and the significant role of nurses as the facilitators of this process, there was a gap in the interventional studies targeted toward guiding the nurses in the clinical practice in this regard.Consequently, the researchers are suggested to give more attention to this dimension of diabetes management and take more effective and practical steps to overcome the barriers to insulin initiation in type II diabetic patients.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
6
v.
1
no.
2018
634
635
https://psj.mums.ac.ir/article_10569_9b028901206382605c7d940591a4b757.pdf
dx.doi.org/10.22038/psj.2018.10569
Evidence on the Patient Safety Culture and Nursing Work Environment in Iran
Abdolah
Khorami Markani
Department of Nursing, Urmia University of Medical Sciences, Khoy University of Medical Sciences, Iran, Khoy.
author
Leila
Mokhtari
Department of Nursing, Urmia University of Medical Sciences, Khoy University of Medical Sciences, Iran, Khoy.
author
Zahra
Khanalilo
Student Research Center, Urmia University of Medical Sciences, Khoy University of Medical Sciences, Iran, Khoy.
author
text
article
2018
eng
Introduction: Patient safety is a universal concern with numerous gaps requiring research. Nurses are the largest workforce in healthcare system and play a pivotal role in the profitability and patient safety indices in hospitals. The present study aimed to evaluate the perception of nurses toward the patient safety culture and nursing work environment in Iran. Materials and Methods: This cross-sectional study was conducted on 100 nurses in Khoy, located in West Azerbaijan, Iran. Data were collected using the hospital survey on patient safety culture (HSPSC), which was completed by the participants during July 1st-30th 2017. Data analysis was performed in SPSS version 19.Results:Positive response rate was 7-82% for 42 items in the HSPSC. The highest positive response rate was in the item "When one area in the ward becomes very busy, others help out." (82%), whereas the lowest rate was in the item "We have enough staff to handle the workload." (7%). In addition, the lowest positive response rate belonged to the dimension of ‘staffing’ (21%), while the highest rate belonged to the dimension of ‘teamwork within units’ (76%).Conclusion: According to the results, nurses had a positive perception toward teamwork. However, they believed that the number of the staff to manage the workload was insufficient and occasionally caused poor interactions among the staff. As an external quality evaluation tool, accreditation could be applied to develop the patient safety culture. Therefore, further investigation is recommended regarding the influence of hospital accreditation on the patient safety culture in Iran.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
6
v.
1
no.
2018
636
643
https://psj.mums.ac.ir/article_10103_9b888e98e255ca28a783e467f3672078.pdf
Perspectives of Multidisciplinary Staff toward the Improvement of Communication and Patient Safety by Safety Huddles
Aishwarya
Venkataraman
International and Private Patients Service, Great Ormond Street Hospital, London, UK.
author
Rory
Conn
Darzi fellow in Quality Improvement and Patient Safety, Great Ormond Street Hospital, London, UK.
author
Rachel
L Cotton
Imperial College London, UK.
author
Sally
Abraham
International and Private Patients Service, Great Ormond Street Hospital, London, UK.
author
Maria
Banaghan
Quality Improvement Team, Great Ormond Street Hospital, London, UK.
author
Bridget
Callaghan
Clinical Lead for SAFE project, Great Ormond Street Hospital, London, UK.
author
text
article
2018
eng
Introduction: Evidence in the literature shows that healthcare utilizing deliberate discussion linking events (HUDDLEs) for patient safety could enhance inter-professional relationships through improved communication, thereby increasing the situational awareness of healthcare professionals. The present study aimed to assess the perspectives of frontline staff toward the impact of safety huddles on patient safety and explore further strategies to improve their delivery in order to enhance the situational awareness of patient safety.Materials and Methods: Safety huddles were implemented in two inpatient wards at Great Ormond Street Hospital (GOSH), a tertiary children’s hospital in London, UK. A staff survey was conducted at two intervals (18 and 30 months) before the initiation of the huddles using a questionnaire to evaluate the perceptions of the staff toward the huddles. The questionnaire was devised and scored based on Likert scales and free-text responses.Results:The healthcare staff believed that safety huddles played a critical role in highlighting the problems of patients and identifying clinical deterioration. Moreover, they could improve the communication within the healthcare team, reduce anxiety, and enhance team cohesiveness.Conclusion: According to the results, safety huddles had an extremely positive influence on frontline staff. Therefore, they could be implemented in healthcare settings to increase situational awareness and improve teamwork and communication, thereby enhancing patient safety. Considering their positive impact, safety huddles were introduced to the other wards and specialties across GOSH as well. In addition, safety huddles were incorporated into the RCPCH S.A.F.E program as a key intervention to improve situational awareness.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
6
v.
1
no.
2018
644
649
https://psj.mums.ac.ir/article_10728_8d5c106a284b7611f404b77945a52995.pdf
dx.doi.org/10.22038/psj.2018.10728
Awareness and Attitude of the Managers in Teaching Hospitals of Tabriz University of Medical Sciences towards Health Promoting Hospitals
Masumeh
Gholizadeh
Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
author
Ali
Janati
Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
author
Yalda
Mousazadeh
Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
author
Mahlaga
Solahay Kahnamuee
School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
author
Mohamad Reza
Narimani
School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
author
text
article
2018
eng
Introduction: The mission of health promoting hospitals is to change the treatment-based attitude to health-based and health promoting attitude to patients, personnel, clients and all groups of the society. The present study was conducted to investigate the awareness and attitude of the managers of teaching hospitals in Tabriz City towards health promoting hospitals.Materials and Methods: The present study was descriptive-analytic research. The study population included all the bosses and managers at different levels of teaching hospitals in Tabriz City. A researcher-made questionnaire was used to data collection. Data were analyzed using SPSS19 Software, descriptive statistics, t-test, analysis of variance (ANOVA) and Spearman’s correlation coefficient test.Results:In the studied teaching hospitals, awareness and attitude of managers were significantly higher than mean. In addition, there was significant relationship between managers’ awareness and their attitudes (P<0.013). The results of ANOVA test showed that there was significant difference between the awareness of managers having 6-10 years of work experience and managers who had 11-15 years of work experience (P<0.01).Conclusion: The results of present study showed that the awareness and attitude of managers towards health promoting hospitals were at desirable level. This could be a basis for informing other personnel and establishing health promoting policy in hospitals. Regarding the readiness of hospitals, it seems necessary to determine a given and specific framework and policy in the Ministry of Health in order to establish health promoting hospitals.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
6
v.
1
no.
2018
650
655
https://psj.mums.ac.ir/article_10570_7bce8dd2299ca553415b299fb5d2fbeb.pdf
dx.doi.org/10.22038/psj.2018.10570
Reasons for Discharge against Medical Advice among Patients Admitted to Ghaem Research-Training and Medical Center of Mashhad, Iran, in 2015
Marjan
Vejdani
Iranian Research Center on Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar. Iran
author
Yasamin
Molavi Taleghani
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
author
text
article
2018
eng
Introduction: Discharge against medical advice (DAMA) indicates the existence of serious problems in the quality of hospital services, which can exacerbate the disease and increase the risk of hospital readmission. This study was targeted toward examining the reasons for DAMA among the patients admitted to Ghaem Hospital of Mashhad, Iran, in 2015.Materials and Methods: This cross-sectional, descriptive study was conducted on 6,645 patients discharged from the Ghaem Hospital of Mashhad with their own personal desire in the first 9 months of 2015. Data collection was performed using the information recorded in the health information system of the hospital; in addition, the required information which was not available in this system were obtained via making a telephone call with the respondents. The data were analyzed using descriptive statistics in SPSS, version 22.Results:Out of the 53,558 patients admitted to Ghaem Hospital of Mashhad in the first nine months of 2015, 6,645 (12.4%) cases were discharged with their own desire. Regarding the reasons of DAMA, 13.1% and 86.7% of the patients had called for DAMA due to the reasons related to hospital and personal issues, respectively. Accordingly, the main reasons for DAMA were categorized into patient- and hospital-related reasons, including patient's personal and family reasons (41.8%) and overcrowding of wards (6.6%), respectively.Conclusion: Improved communication between physician and patient, patient’s increased awareness regarding the probable complications of early discharge, improved quality of hospital services, use of clinical aids, and designing green space and a pleasant environment are the recommended strategies to reduce the rate of DAMA.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
6
v.
1
no.
2018
656
661
https://psj.mums.ac.ir/article_10104_e1309303e41c003b386132ed7a705c99.pdf
Associations of the Quality of Work Life and Depression, Anxiety, and Stress in the Employees of Healthcare Systems
Ehsan
Bakhshi
Healthcare Center, Islamabad-e-Gharb Health Care Network, Kermanshah University of Medical Sciences, Kermanshah, Iran.
author
Ali
Moradi
Faculty of Humanities, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran.
author
Mohammadreza
Naderi
Healthcare Center, Islamabad-e-Gharb Health Care Network, Kermanshah University of Medical Sciences, Kermanshah, Iran.
author
Reza
Kalantari
Department of Ergonomics, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran.
author
text
article
2018
eng
Introduction: Human resources are an important asset to any organization, and it is essential to preserve their health in order to achieve organizational goals. The present study aimed to investigate the associations between the quality of work life (QWL) and depression, anxiety, and stress in the employees in the healthcare system of Islamabad-e-Gharb Health Care Network, Iran.Materials and Methods: This cross-sectional, descriptive-analytical study was conducted on 158 healthcare network employees using the census method. Data were collected using Walton’s quality of work life evaluation and depression, anxiety, and stress scale (DASS). Data analysis was performed using descriptive statistics, Spearman’s correlation-coefficient, Mann-Whitney U test, and Kruskal-Wallis test.Results:Mean and standard deviation of QWL, depression, stress, and anxiety were 80.45±17.70, 4.9±4.1, 6.34±4.2, and 3.7±3, respectively. Significant negative correlations were observed between QWL and depression (r=-0.255; P=0.001), anxiety (r=-0.260; P=0.001), and stress (r=-0.242; P=0.002). Each of depression, stress, and anxiety had individually no significant correlation with age, work experience, number of child, gender, work pattern, second job and level of education (P> 0.05). However, the relationship between depression and marital status was significant such that depression is found higher among single persons (P= 0.026). As was the correlation between residential status and stress (P=0.03) in which the stress was higher in tenants compared with residence owners. It also appeared that having a refractory patient at home has significantly associated with stress (P=0.027) and anxiety (P=0.045).Conclusion: According to the results, improving the QWL is essential to mitigating the rates of depression, anxiety, and stress in healthcare providers.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
6
v.
1
no.
2018
662
667
https://psj.mums.ac.ir/article_11176_86e1aaf320da9d53623598413b18d00a.pdf
dx.doi.org/10.22038/psj.2018.11176
Patient Preferences for the Notification of Skin Biopsy Results: A Retrospective Review
Fiona
Cunningham
Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
author
Grant
Wylie
Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
author
text
article
2018
eng
Introduction: Skin cancer screening clinics constitute a major part of general dermatologists’ workload. Patient preferences for the communication of histological results following skin biopsy have not been properly explored in the literature. Primary care physicians locally report their increased workload with the patients who seek these results directly. The present study aimed to ascertain the preferences for the notification of skin biopsy results among the patients referring to our department and explore this process from their perspective.Materials and Methods: Interviews were conducted with departmental clinical staff to determine the important factors to investigate regarding the biopsy experiences of patients, and the subject matter was generally discussed with the patients. Afterwards, a retrospective study was designed using a questionnaire, which was posted to 100 consecutive patients. Data of the questionnaires were recorded and analyzed.Results:Our findings suggested the need for the greater involvement of the patients in selecting the most appropriate approach for the notification of biopsy results. Moreover, a proportion of the patients were found to benefit from anxiety evaluation at the outset of the treatment so as to identify the high-risk cases for postoperative anxiety.Conclusion: According to the results, changing the methods of result notification may facilitate a patient-centred approach to identify potentially anxiety-provoking and life-changing processes. It is recommended that further investigation be conducted to explore the postoperative psychological states of patients prior to receiving test results for comparison with our findings.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
6
v.
1
no.
2018
668
670
https://psj.mums.ac.ir/article_10106_b3be6a4c1cd2d32445b080f9618c8471.pdf
dx.doi.org/10.22038/psj.2018.10106
Stigma as a Barrier in the Emergency Section for a Patient with Neuroleptic Malignant Syndrome: A Case Report
Forouzan
Elyasi
Psychiatry and Behavioral Sciences Research Center, Addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
author
Mohsen
Fazlali
Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran.
author
Seyed Mohammad
Hosseininejad
Department of Emergency Medicine, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
author
text
article
2018
eng
Introduction: Stigma is defined as a set of negative attitudes and beliefs toward specific conditions, such as mental disorders. Mental disorders are among the most stigmatizing conditions throughout the world. In general, the principle of stigma involves the physical health of the patients with mental conditions.Case: In this article, we presented the case of a 28-year-old single, male patient with paranoid schizophrenia and neuroleptic malignant syndrome. Stigma was a significant barrier in the emergency sections of the psychiatric and general hospitals.Conclusion: According to the results, the curricula of health education must be revised in undergraduate and postgraduate levels.
Journal of Patient Safety & Quality Improvement
Mashhad University of Medical Sciences
2345-4482
6
v.
1
no.
2018
671
673
https://psj.mums.ac.ir/article_10726_dc86cf92f87ae170f013b89880419e21.pdf
dx.doi.org/10.22038/psj.2018.10726