Provision Of Quality Healthcare Services Research Articles

Pharmaceutical sector: Packaging requirement in serialization

Access to healthcare is a fundamental right for every individual, and it is the responsibility of governments to ensure the provision of quality healthcare services and infrastructure to their citizens. Over the past few decades, both governments and the healthcare industry have been grappling with the challenge of minimizing the adverse effects on public health caused by counterfeit medicines. According to the World Health Organization, approximately four out of ten medicines in developing and impoverished countries are either fake or potentially adulterated, leading to significant economic losses and reducing funds allocated for research and development (R&D) by organizations. Preventing counterfeit medicines from entering the supply chain poses a significant challenge for governments and regulatory authorities. Consequently, there is a concerted effort to establish stringent guidelines aimed at thwarting criminals and counterfeiters from infiltrating markets with fake medications. The healthcare industry recognizes the necessity for strict regulations and secure technologies to ensure the provision of safe and authentic drugs to patients. In the United States, the FDA has outlined a ten-year roadmap to implement drug traceability measures. Additionally, the Healthcare Distribution Alliance (HDA) has mandated the inclusion of multiple barcodes and human-readable data in product packaging hierarchy. Furthermore, the FDA is actively engaged in a pilot project with leading pharmaceutical manufacturers and wholesalers to explore the utilization of blockchain technology within an interoperable digital network for securing the transfer of digital traceability data among authorized trading partners.

Efficiency and Performance of Top Indian Pharmaceutical Firms: A Comparative Analysis

The Indian pharmaceutical industry has made significant strides in the past five decades and is an important contributor to the provision of quality healthcare services in any economy. This paper studies the efficiency of selected top ten pharmaceutical companies by applying Data Envelopment Analysis (DEA) under constant return to scale (CRS) model and variable returns t ale (VRS) model. The inputs used in the study are assets, salaries, and wages. The outputs used are Return on Asset, and Net Profits. The study found Divis Laboratories and Sun Pharma to be most efficient under CRS and Sun Pharma was found to be most efficient under VRS models during 2019 – 2023. Seven pharmaceutical companies were working under Increasing returns to scale, two were working under constant returns to scale and one was performing under decreasing returns to scale. Return on assets, Net Profit margin and Return on Capital Employed Ratio were used to study financial performance of the pharmaceutical companies. Abbot India had the highest return on assets (17.948%). Divis Labs had the highest Net Profit Margin (27.76%). Mankind Pharma led in Return on Capital Employed (27.524%), This result further adds to the result provided by DEA. Companies found to be efficient by DEA were found to have high performance standards. Also, through the regression analysis the impact of variables Return on Capital Employed (ROCE) and Net profits margin (NPM) on Return on Asset (ROA) was studied. Returns on Assets (ROA) are 93.6% dependent on Net profits margin and Return on Capital Employed. There is significant (p-value = 0.000) relationship between Return on Asset (ROA), Net profits margin (NPM) and Return on Capital Employed (ROCE).

Healthcare Public Relations – A Pilot Study in Romania

Communication is a critical component in the process of providing quality healthcare services and products. The role of public relations (PR), as a strategic, proactive, and responsible type of communication, is to establish and maintain a positive reputation and relationships with the public, based on trust and mutual understanding. Given the complex approach and process of this activity, when properly applied, PR can bring benefits to all stakeholders in the healthcare sector, contributing positively to its overall realities and outcomes. This paper presents the results of an exploratory pilot study aimed at identifying the coordinates of PR in the Romanian health sector by investigating perceptions on health public relations (HPR), its potential, challenges and opportunities, and stakeholders in healthcare. It is based on qualitative research, using interviews with a mixed group of professionals from the public and private sectors (doctors, medical service coordinators, medical professors, managers, and owners of entities that provide health services and products, and strategic communication professionals working for companies in healthcare). The results are discussed alongside relevant findings provided by previously published studies. In the final part of the article, the author proposes a PR model for entities in the medical area. It emphasizes that HPR should not only be used as a tactical tool or alternative to marketing efforts, nor only intended to manage an undesirable image or deliver damage control after an inconvenient situation or crisis. Instead, HPR services are at their true potential when a strategic approach is applied proactively, based on complex research and planning, designed to engage stakeholders and motivate them towards collaborative communication and sustained effort, based on partnership, for efficient and effective results in the health sector.

Effect of work stress on service delivery of health workers in University of Benin Teaching Hospital, Benin City Nigeria

The study examined work stress and service delivery among health workers in University of Benin Teaching Hospital Benin City. The study adopted descriptive research method. Data were collected through questionnaire, focus group discussion guide, in depth interview and secondary sources. The study revealed that work overload has nexus with service delivery of the health workers of University of Benin Teaching Hospital. The study recommended among other things that University of Benin Teaching Hospital (UBTH) should deploy more student doctors in their residency programmes who would be closely supervised by their superiors in order to reduce the workload on existing doctors in their provision of health services. The work schedule for medical and health workers at the University of Benin Teaching Hospital (UBTH), should be made more flexible to accommodate the peculiarities in female medical personnel, especially married women, nursing mothers and those that are pregnant. The government should do better in the disbursement and payment of hazard allowances to medical and health workers in order to encourage their selfless services to God and humanity through the provision of quality healthcare services.

Maintaining altruism among nursing professionals

The demanding hospital work environment has increased the need for organizational citizenship behaviour (OCB). It’s essential to maintain the altruistic behaviour of nursing professionals towards each other to enhance the patient experience and provide quality healthcare service to patients efficiently. This quantitative study explored the relationships between OCB constructs based on social identity theory (SIT) and system justification theory (SJT). This study is empirical and cross-sectional in nature; structural equation modeling is performed on two hundred twenty-two nursing professional responses, using IBM AMOS V.22 to test the hypothesized model. Conscientiousness has a mediating effect on the relationship between civic virtue and altruism (Indirect effect=0.19, Boot SE=.057, lower-level confidence interval (LLCI)=.0940, upper-level confidence interval (ULCI)=.3144). Moreover, sportsmanship had a mediating effect on the relationship between civic virtue and altruism with an Indirect effect=-0.06, Boot SE=.023, LLCI=-0.1159, ULCI=-0.0222). The results supported the hypothesis that civic virtue and altruism are directly related and found that conscientiousness and sportsmanship mediate the relationship between civic virtue and altruism. The findings suggest that employees with higher sportsmanship tend to reduce their altruistic behavior in the long run.

Implementasi Data Mining dengan K-Means Clustering untuk Memprediksi Pengadaan Obat

Community Health Center is one of the institutions that provides healthcare services. To ensure the provision of quality healthcare services, the Community Health Center management must be able to effectively manage medicine inventory to avoid the risks of shortages or excess stock. Therefore, the purpose of this research is to observe and perform clustering of medicine demands at Puskesmas Mandala using the K-Means Clustering technique. The data used includes medicine demand data from January to December 2023 at the health center. In its implementation, the RapidMiner application or software is utilized to perform clustering using the K-Means Clustering algorithm. The available medicine data will be grouped into 3 clusters: cluster 0 for high medicine demands, cluster 1 for moderate medicine demands, and cluster 2 for low medicine demands. Out of the 28 test data used, the results show the first cluster consisting of 24 items, the second cluster consisting of 3 items, and the third cluster consisting of 1 item with a Davies Bouldin Index value of 0.276. From this research, the Puskesmas can continue to procure medicine for the types classified under high-demand clusters to ensure that the medicine needs are consistently met.

Pengembangan Sistem Cerdas Berbasis Data Mining untuk Meningkatkan Akurasi Prediksi Kebutuhan Obat di Puskesmas Parit Rantang

Effective inventory management is crucial in providing quality healthcare services. Predicting drug needs in the pharmacy warehouse is vital to ensuring adequate availability for patients. This study developed and implemented a prediction system using Artificial Neural Network (ANN) method to forecast drug requirements. Training data comprised drug usage from January 2020 to July 2023, while testing data covered drug usage from August to December 2023. Through several experiments, the best model identified was 12-6-1, with a Mean Absolute Percentage Error (MAPE) of 6.817 and an accuracy of 93.18%. Predictions for Paracetamol drug usage in August were 4603, whereas the actual usage was 4785. This system is expected to enhance drug inventory management efficiency, reduce costs, and improve drug availability for patients.

Leveraging ICT for improved quality services in secondary healthcare facilities in Nigeria: Evidence from Kogi State

This study focused on investigating the relationship between Information and Communication Technology (ICT) and the provision of high-quality healthcare services. The research employed a survey research design and concentrated on secondary healthcare facilities within the state. A total of 273 healthcare personnel were randomly selected from these facilities using a simple random sampling technique. Data was collected through a well-structured questionnaire. The secondary information was provided through the Kogi State Strategic Health Development Plan, textbooks, journal articles, conference papers, theses, and the internet. The gathered information was analysed using descriptive statistics and linear regression. Data on respondents’ demographic characteristics and ICT utilisation were presented using simple percentages in tables. The findings of the study demonstrated that the adoption of ICT significantly influences the delivery of quality healthcare services in secondary healthcare facilities. Specifically, the utilisation of ICT can enhance patient safety by facilitating comprehension of medical information, enabling online treatment evaluations, monitoring patient progress, and predicting potential medical complications. Based on the results, it can be concluded that improving ICT adoption is crucial for enhancing and sustaining the provision of quality healthcare services. Therefore, the study recommends that the management of secondary healthcare facilities should prioritise efforts to enhance ICT adoption within their operations. The practical implication of the study is that incorporating ICT in healthcare practices can contribute to more informed decision-making and proactive measures, ultimately fostering a safer and more effective healthcare environment in secondary healthcare facilities.

Building Nurse Competency Strategy at Public Health Center in Indonesia: A Descriptive Qualitative Approach

Background:Nurses play a crucial role in providing quality healthcare services to the community, particularly in public health centers in Indonesia. This study aims to explore the building of nurse competency strategies in the public health setting. Methods: Aqualitative research design with a descriptive approach was utilized. Data collection techniques through interviews. The informants consisted of fifteen people, with key informants in the primary setting, and were analyzed using a descriptive-qualitative approach with content analysis techniques. Results:The study results showed that two categories have arisen: the spiritual approach and the technological approach. The research findings on developing the competency of nurses in health services can be realized through education and training based on spiritual and technological aspects of building the competency of nurses. Improving nurse competence can be done through spiritual and technology-based education and training. Conclusion:By implementing the proposed strategies, it is hoped that nurses will be better equipped to provide high-quality care to the community, ultimately improving health outcomes and well-being. The implementation of public health nurses cannot be separated from the role of nurses in a public health center. Community health nurses in a public health center have at least six roles and functions, namely, as nursing case finders, health educators, coordinators and collaborators, counselors, and role models.

Do public healthcare programs make societies more equal? Cross-country evidence on subjective wellbeing

BackgroundUniversal health coverage (UHC) aims to provide quality healthcare services and safeguard the population from the financial burden of catastrophic health expenditure. Its primary objectives are to improve longevity and enhance overall quality of life. This study investigates the relationship between UHC and the inequality in subjective wellbeing (SWB) and explores whether public health programs can reduce social inequality. By employing SWB inequality as a measure, we go beyond the conventional income-centric approach to assess social inequality.MethodsThe SWB data used in this study are derived from the repeated cross-sectional survey obtained from the European Values Study (EVS) and the World Values Survey (WVS). We adopt an observational study design and employ statistical techniques, such as ordinary least squares, Oaxaca–Blinder decomposition, and the recentered influence function (RIF). The RIF, in particular, allows us to characterise the entire distribution of SWB, rather than focusing on a single point.ResultsUHC programs are negatively associated with SWB inequality (-0.070, significant at 5%). The negative association is observed at the 5th, 50th, and 75th percentiles of the SWB distribution, whilst the association becomes positive at the 95th percentile. UHC programs do not contribute to the SWB inequality gap.ConclusionsUHC programs exhibit an inequality-reduction property when the inequality is not severe or when countries are more equal. However, their effectiveness diminishes in the presence of extreme inequality. Health programs do not contribute to the existing SWB inequality gap between developed and developing countries. Strengthening the two dimensions of the UHC program (i.e., service coverage and financial protection) will ensure better health and wellbeing for all, and potentially foster a more equal and inclusive society.

Effects of utilization of basic health care provision fund on service delivery in primary health centres in Osun State

Background: One of the daunting challenges militating against the provision of quality healthcare services at the various primary health centres hindering the successive provision of sustainable and equitable PHC services. This study aimed to assess the effects of the utilization of the basic health care provision funds on service delivery in primary health centres in Osun State. Methods: A descriptive cross-sectional study was adopted for this study among 384 respondents selected using multistage sampling methods from different LGAs in Osun State between June 2023 and February 2023. The research instrument was a semi-structured questionnaire analysed with SPSS version 25.0. Univariate and bivariate analysis were done as appropriate and a p value of <0.05 was taken as statistically significant. Results: The study found that the majority (93.2%) of BHCPF-supported PHCs received monthly releases. Most patients (98.2%) were satisfied with service delivery, which influenced patient utilization of PHC facilities, albeit without statistical significance. Conclusions: Most (90%) of the facilities provided most services in the component of PHCs, but less than one-third offered mental and dental health services. Implementing these services in BHCPF-supported PHCs is recommended.

Evaluation of metabolic parameters among health workers in terms of adherence to Mediterranean diet

Abstract Background The certain occupational risk factors, such as physical and mental stress from working conditions and poor diet, make healthcare workers(HCWs) a vulnerable group for obesity and non-communicable diseases(diabetes, dyslipidemia, etc.). Adopting a healthy and sustainable diet is very important in terms of both health and environmental impacts. The aim of this study was to evaluate metabolic parameters among HCWs in terms of adherence to the Mediterranean diet, which is shown to be a healthy and sustainable dietary model. Methods This cross-sectional study included 372 HCWs. The data collection tool consisted of the sociodemographic information of the participants, Mediterranean Diet Adherence Scale(MEDAS) questions, body mass index(BMI) and metabolic parameter information obtained retrospectively from hospital data. BMI≥30 kg/m2 and 25-29.9 kg/m2 were considered obese and overweight, respectively. Descriptive and inferential statistics were performed. Results 71% of the participants stated that they had not heard of the concept of ‘sustainable nutrition’ before. Of the HCWs who participated in the study, 65.3% were overweight or obese. It was found that 59.7% of the HCWs showed low adherence to the Mediterranean diet and 39.5% showed moderate adherence. Men(p < 0.001), those with high school education or less (p = 0.030) and those who did not think that they ate healthy(p = 0.001) had significantly lower compliance with the Mediterranean diet. BMI(p = 0.022) and HbA1c(p = 0.049) parameters were significantly lower and HDL parameter(p = 0.015) was higher in HCWs with moderate and high adherence to the Mediterranean diet. Conclusions It was observed that the frequency of hearing the concept of ‘sustainable nutrition’ and compliance with the Mediterranean diet was low among healthcare professionals. Also, it was found that the frequency of obesity, dyslipidemia, and high diabetes-related parameters were increased in those with low adherence to the Mediterranean diet. Key messages • National, EU and global policies should be developed to increase compliance with healthy and sustainable diets among health workers who play a key role in the provision of quality healthcare services. • Plans and programs to increase adherence to Mediterranean-type dietary patterns will bring significant increased health benefits related to non-communicable diseases and its risk factors.

Strategies to Reduce Maternal Death Rate and Improve the Provision of Quality Healthcare Services in Selected Hospitals of Vhembe District Limpopo Province.

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in the maternal mortality rate was reported between 2020 and 2021, with Limpopo ranking fourth highest out of nine provinces. The Vhembe district maintained its position as the third-ranked area with a notably elevated maternal mortality rate. This study aimed to explore the strategies used to reduce the maternal death rate and improve the provision of quality maternal healthcare services based on participant experiences in selected hospitals of the Vhembe district, Limpopo Province. One hospital was purposively sampled from every four municipalities. A qualitative approach using a phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data, complemented by the use of an audio recorder, continuing until data saturation was reached. Data saturation was reached at the 20th participant; however, the researcher continued until 28 sampled participants were interviewed. An interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). The results indicate that, despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as the lack of material resources, shortage of staff, incompetent staff and poor infection control, affect the quality of maternal health services in the Vhembe district. The Limpopo Department of Health and hospital management should ensure that hospitals have all the necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

How effectively are social accountability mechanisms being applied in mental health services within the newly federalized health system of Nepal? A multi-stakeholder qualitative study

BackgroundThe burden of mental health problems and inequalities in healthcare has emerged as critical issues, in Nepal. Strengthened citizen-driven social accountability (SA) is an effective strategy for building equitable health systems and providing quality healthcare services to all, yet SA in mental health is an under-researched area in Nepal.ObjectiveThis study explores changes in mental health service delivery in the re-configured federal health system and discusses the functioning and effectiveness of SA in the federalized context of Nepal.MethodThis case study research used a qualitative approach to data collection. We conducted Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) with local stakeholders including people with experience of mental health problems. The audio-recorded interviews and discussions were transcribed and analyzed using a thematic content method.ResultsA total of 49 participants were recruited, and 17 participated in interviews and 32 participated in six focus group discussions. From the data, eight themes emerged: Policy challenges in mental health, Governance and service delivery, Tokenism in the application of social accountability processes, Weak role of key actors in promoting accountability, Complaints and response, Discriminatory health and welfare system, Public attitudes and commitment towards mental health, and No differences experienced by the change to a federal system. It was found that existing health policies in Nepal inadequately cover mental health issues and needs. The prevailing laws and policies related to mental health were poorly implemented. There is a lack of clarity at different levels of government about the roles and responsibilities in the delivery of mental health services. Poor intra- and inter-governmental coordination, and delays in law-making processes negatively impacted on mental health service delivery. SA mechanisms such as social audits and public hearings exist within government health systems, however, application of these in mental health services was found poor. Rights-holders with mental health problems had not experienced any change in the provision of healthcare services for them even after the federalization.ConclusionMental health is insufficiently addressed by the health policies in Nepal, and SA mechanisms appeared to be rarely institutionalized to promote good governance and provide effective healthcare services to vulnerable populations. The provision of more equitable services and honest implementation of SA tools may foster greater accountability and thereby better service delivery for people with mental health problems.

Impact of healthcare service quality on older people's satisfaction at geriatric medical centers: a rapid review.

Older adults are concerned about the quality of care as many of them are vulnerable to the co-occurrence of geriatric syndromes and age-related diseases due to accumulated impairments in multiple systems. Literature indicates that though people are living longer, they are not necessarily living healthier, which creates the need for providing quality healthcare services specifically to address the needs of this population. B This rapid review investigates the impact of healthcare service quality on older people's satisfaction at geriatric medical centers. The rapid review includes 11 articles from searches on PubMed, PsycINFO and Google Scholar. The reviewed studies indicate that the quality of healthcare services to older adults enhances their satisfaction at senior facilities and produces positive patient outcomes. A thematic analysis of these studies revealed four major themes related to the review topic: perceived quality of healthcare services, patients' quality of life, patient satisfaction, and provider-patient communication. Nurses should provide high-quality care to older adults in geriatric settings to improve patients' and their families' satisfaction. Nurses should target quality leadership, implement quality improvement, and communicate effectively. Nurses should also offer patient-centered care by involving family members in care planning.

Knowledge, Perceptions and Attitudes of eHealth and Health Technology among Nursing Students from Gauteng Province, South Africa.

The use of technology in healthcare settings was identified as a crucial priority in many countries to provide quality healthcare services. eHealth or digital health technology is found to have a positive influence on improving the efficiency and quality of healthcare services. It has been proven to provide opportunities to strengthen health systems. This study aims to assess eHealth literacy, pre-existing knowledge and the nursing students' perceptions and attitudes towards eHealth. A quantitative, descriptive, cross-sectional survey was used in this study. The population of this study comprised 266 nursing students in the undergraduate programme of the Department of Nursing, among which 244 consented to participate in the study. A standardised and self-administered tool was utilised to collect data from nursing students across the four levels of study. Results showed that students in level four exhibit high scores of knowledge in the use of eLearning technology as compared to first-entry university nursing students. Nursing students used the internet frequently, especially to access social media and search for health and medical information for their study. Attitudes towards eHealth and technology were also found to be positive. The study recommends that digital literacy should be enhanced in the nursing education curriculum in other to further strengthen the knowledge and skills towards the use of eHealth and health technology among nursing students.

Experience of nurses using the basic nursing science in performing nursing care for patients at RSUD Dr. Soedomo Trenggalek, Indonesia

Introduction: The provision of humanistic and professional nursing care services needs to be carried out comprehensively, and it must cover patients’ bio-psycho-socio-spiritual aspects. This indicates nurses have to integrate all the basic nursing science, including physiology, anatomy, pharmacology, and pathophysiology, while carrying out their duties. This integration helps to provide the best care for their patients, but they often uncertain about the basic science approach to use. Therefore, this study aimsto explore the experience of nurses using basic nursing science in caring for patients with chronic diseases.
 Design and Methods: In-depth interviews were conducted with 5 nurses working in chronic disease wards for at least 5 years. Each respondent was then interviewed using a self-constructed questionnaire.
 Results: All respondents agreed that basic nursing science is important in providing quality healthcare services. Furthermore, six themes were identified using the thematic analysis, namely (1) the process of collecting patient data, which was more focused and organized; (2) required for establishing the nursing diagnosis; (3) useful for determining the nursing care plan; (4) it is a basis for implementing nursing actions; (5) provides a basis for monitoring and follow-up; (6) and teamwork between health personnel is more effective.
 Conclusions: Based on the interview results, nurses need knowledge and skills in basic nursing science while caring for patients with chronic diseases. Furthermore, basic nursing sciences lay the foundation for nurses while assessing patients, diagnosing, planning the care, implementing nursing actions, evaluating patients’ condition, and collaborating with other health personnel.

Digital health information technology utilization for enhanced health services delivery in Africa: Unravelling barriers to adoption among Primary healthcare providers

In tandem with the current drive to achieve the SDG 2030 goals, the Universal Health Coverage (UHC) is been projected as a strong propelling strategy with key indicators, all aimed at achieving universal access to health services without having to endure financial difficulties in individual countries. Currently, Africa is lagging in meeting the targets of the UHC with between 5% -25% coverage across countries.
 Adoption of new innovations are critical for the actualization of Universal Health Coverage in Africa. Digital health technology offers one of such novel approaches to providing quality healthcare services and can help countries achieve the Universal Health Coverage targets. It has been suggested that digital health provides an opportunity to overcome the longstanding problems of inefficiency of health information gathering, sharing, and access. In addition, literature is already replete with various factors that can aid countries to achieve UHC and one of such factors is the urgency of generating valid and quality evidence to inform decision-making.
 Although the Primary Health Care remains at the core of the achievement of Universal Health Coverage, the utilization of digital health technologies remains very poor at the grassroots in Africa and this poses a huge barrier to effectiveness and quality of healthcare delivery. Given the foregoing, it is obvious that there is an urgent need to understand the landscapes, issues and barriers to utilization of digital health at the Primary Health Care levels. However, there remains a paucity of data to support evidence-based decision making about full implementation of digital health services across the continent while also taking into cognisance the peculiarities of individual countries.
 Hence, there is a critical need to determine the current levels of knowledge, skills, attitude, practice and readiness to adopt digital health in service delivery by healthcare workers at the Primary Health Care levels across the continent. The generation of such data from major stakeholders such as health workers and health managers, providers among others will provide important evidence needed for attaining optimal utilization of digital health in the context of health for all. 
 Summarily, a clear understanding of the contextual and implementation bottlenecks highlighted from such assessment(s), especially as it relates to individual African countries, will go a long way to guide decisions to address the low utilization of digital health technologies in health services delivery in Africa.
 Source of funding
 This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
 Acknowledgement
 The authors acknowledge the support of the Department of Environmental Health Sciences, University of Ibadan and contributions of Prof. G.R.E. E Ana, Prof. M.K.C. Sridhar, Dr. E.C. Uwalaka, Dr. O.T. Okareh and Dr. O.M. Morakinyo, in the writing of this paper
 CO is supported by Consortium for Advanced Research Training in Africa (CARTA) which is funded by the Carnegie Corporation of New York (Grant No--B 8606.R02), Sida (Grant No:54100029), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z).
 Conflict of interest statement
 The authors declare that they have no known competing financial interests or personal relationships that could have influenced the writing of this paper.
 Author contributions
 CO: Conceptualization; CO, PO and OF: Writing- Original draft preparation, CO, PO and OF: Writing- Reviewing and Editing.

A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses’ Perspectives toward Nurse Practitioners’ Roles in Saudi Arabia

Nurse practitioners' roles need to be clearly defined in Saudi Arabia. Therefore, we aimed to explore potential factors that impact nurses' perspectives toward nurse practitioners' roles and whether they are interested in becoming nurse practitioners. A mixed-methods study design was employed using a questionnaire and focus groups. The survey was sent to nurses working at a public hospital in the Riyadh region. Participants (N = 77) reported that having more nurse practitioners would improve quality of care and patient safety. Additionally, most participants stated that an increased supply of nurse practitioners would have a positive impact on effectiveness, equity of care, and healthcare costs. In regression analysis, participants with favorable perspectives towards nurse practitioners were significantly more likely to have interest in becoming nurse practitioners (odds ratio [95% confidence interval]:1.04 [1.01-1.07]). In the qualitative domain, three positive factors were identified: effective collaboration with other staff, better contribution to quality care and patient safety, and better contribution to evidence-based practice. Two barriers were also determined: lack of motivation to become a nurse practitioner and unclear scope of practice. Results showed that nurse practitioners can provide quality healthcare services that meet patients' different needs. The growing role of this speciality warrants further research to show its value in daily practice.

Relationships Between Lifestyle, Quality of Life, Organizational Culture and Job Satisfaction Among Nurses Related to Health Promoting Hospital (HPH) Standards.

Providing quality healthcare services through health promotion activities to patients, hospital-based professionals and the wider community is the goal of the health promoting hospital (HPH). There is, however, no formal structured pathway for "universally" providing health promotion services in hospitals. Accordingly, this study was conducted with the aim of presenting a model designed to promote and increase health-related satisfaction of hospital-professionals in health-promoting hospitals (HPHs) in Iran-as a potential tool to guide international HPH standards. Lifestyle, quality of life, organizational culture, and job satisfaction were measured using standardized questionnaires in specialized hospitals in Hamadan, Iran. A structural equation model (SEM) using partial least squares (PLS) software (version 2) was used to determine the validity and fit of the conceptual framework/model. The study revealed that several factors were identified as strong predictors of job satisfaction and wellbeing, including various dimensions of lifestyle such as spiritual health, physical activity, stress management, and interpersonal communication, dimensions of quality of life including physical and mental aspects, and organizational culture. The values of predictive relevance (Q2) for physical and psychological dimension of life quality, organizational culture, and job satisfaction were estimated to be 0.101, 0.250, and 0.040 and 0.251, respectively. Conclusively, the study found a goodness of fit (GOF) value of 0.415, indicating that the model had a high predictive power and fit well. Based on these results, it is suggested that implementing HPH interventions that focus on the outcomes of this model could lead to increased job satisfaction and wellbeing in hospitals. Additionally, the model could serve as a useful indicator of HPHs.