Treatment Staff Research Articles

Unravelling the “Black Box”: Treatment-Staff Perceptions of Hermon Prison’s Drug-Rehabilitation Program

This current qualitative study analyzed treatment-staff perceptions of the advantages and weaknesses of Israeli’s primary prison-based drug rehabilitation program, as implemented in Hermon Prison in Israel. Semi-structured interviews were conducted with 12 social workers and recovery mentors who worked as therapists in Hermon Prison during the research period. The analysis showed that the main advantages described were that the program was varied (included psychotherapy, education, vocational training, and work) and required a 1-year stay in a therapeutic community setting, with intensive exposure to eclectic psychotherapy methods and was delivered in a prison that is organizationally and architecturally designed to serve treatment goals. The primary weaknesses that the therapists perceived were shortages of treatment staff (staff turnover was high), individual psychological therapy and of follow-up treatment in the community. The research suggests that reducing these deficiencies may improve the program’s effectiveness, and it offers an initial theoretical model for creating an effective drug rehabilitation program.

Trust and collaboration between patients and staff in SUD treatment: A qualitative study of patients' reflections on inpatient SUD treatment four years after discharge.

Background and aim: Substance use disorder (SUD) is multifactorial, complex, and involves the severe problematic use of alcohol, prescription drugs, and other substances. People with SUD have long histories of perceived stigma, marginalisation, exclusion, social isolation, and shame. Moreover, patients with SUD are often treated as untrustworthy and incapable of actively participating in their treatment planning, even by healthcare and social services workers. Methods: Through in-depth interviews with former patients who have undergone SUD treatment, we explored their reflections on the treatment content. Interpretative phenomenological analysis revealed that some informants experienced aspects of the treatment as valuable, whereas others considered the same treatment useless or harmful. Results: Essential aspects of treatment were developing self-esteem and optimism about the future, developing strategies for coping with stress and challenging emotions and situations, developing relationships with family and friends, and preparing for life after inpatient treatment. Relationships with staff were described as crucial in all parts of the treatment. Conclusion: In conclusion, we suggest that a transition to a more collaborative treatment philosophy would be ethically and professionally valuable for providing support and treatment and enhancing patients’ perceptions of empowerment, inclusion, participation, and well-being on their terms, in cooperation with supportive others.

The Social Support Needs of Family Caregivers of Patients With Multiple Sclerosis: A Qualitative Study

Objective: Multiple sclerosis (MS) is one of the most common chronic progressive neurological diseases. It is the non-traumatic cause of neurological disability in adults. This disease increases the patient’s need for care due to the progressive course of disease that intensifies the symptoms over time. Family caregivers of these patients have different challenges and needs for caregiving. The present study aims to investigate the supportive needs of family caregivers of patients with MS in Iran. Materials & Methods: This is a qualitative study conducted in MS Association of Isfahan, Iran in 2018-2019 for 8 months. Participants were selected by a purposive sampling method who included 8 patients, 13 family caregivers, and 4 treatment staff. Semi-structured interviews were used to survey the supportive needs of caregivers. Interviews took about 30-60 minutes. Sampling and data collection were saturated after 25 interviews. We used Guba and Lincoln’s criteria (credibility, dependability, transferability, and conformability) to evaluate and validate the data. The contract content analysis technique was used to analyze the data. Results: The results of analysis yielded 795 initial codes. After merging these codes based on common features, 562 codes were remained. The supportive needs of family caregivers of MS patients were presented in three main categories (creating interaction opportunities to reduce isolation, empathetic interaction with peers and treatment staff, and financial support) and nine sub-categories. Conclusion: Most of the family caregivers of MS patients in Iran do not receive adequate social and systemic supports from health care providers and do not have access to support resources. Policymakers and health caregivers should provide the required supporting programs for these caregivers so that they can optimally play their role in caregiving MS patients, especially at home, while receiving appropriate social and systemic supports.

Attitudes and beliefs among Georgia addiction treatment staff about medication for opioid use disorder in adolescents, young adults, and adults: a multi-mixed methods study

ABSTRACT Background Adverse consequences, including non-fatal overdose and death, are prevalent in adolescents and young adults with opioid use disorder (OUD). Barriers toward medication for opioid use disorder (MOUD) have been identified in adult populations but are poorly understood in youth. Objective This exploratory multi-mixed methods study examines beliefs and attitudes of addiction treatment program staff about the use of MOUD in youth. Methods A 40-item survey was distributed electronically to 299 addiction treatment programs in Georgia from May 2020 to January 2021. Participant (N = 215; 74% female) attitudes regarding the use of MOUD in three age groups (adolescents (aged 16–17), young adults (aged 18–25), and adults (aged 26+) on a 6-point Likert scale were compared using paired samples t-tests. A series of one-way ANOVA analyses examined differences in attitudes and beliefs across participant characteristics. Verbatim responses to qualitative survey questions were analyzed using a coding reliability approach to thematic analysis. Results Participants were less likely to support MOUD in adolescents (M = 3.68, SD 1.5) compared with young (M = 4.38, SD 1.36, t = 8.19, p < .001, d = .51) and older adults (M = 4.64, SD 1.3, t = 9.83, p < .001 d = .74). Participants endorsed higher response rates for the use of both naltrexone and buprenorphine over methadone in young adults. A total of 1,412 text responses were reviewed. Participants highlighted barriers to acceptance and use of MOUD in adolescents including safety concerns and impact on brain development. Conclusions The results support a comprehensive approach to reducing the barriers to using medications to treat OUDs in adolescent populations. Formal and focused continuing education to correct attitudes and beliefs about MOUD treatment for adolescents is necessary.

Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder

Emergency departments (EDs) are increasingly initiating treatment for patients with untreated opioid use disorder (OUD) and linking them to ongoing addiction care. To our knowledge, patient perspectives related to their ED visit have not been characterized and may influence their access to and interest in OUD treatment. To assess the experiences and perspectives regarding ED-initiated health care and OUD treatment among US patients with untreated OUD seen in the ED. This qualitative study, conducted as part of 2 studies (Project ED Health and ED-CONNECT), included individuals with untreated OUD who were recruited during an ED visit in EDs at 4 urban academic centers, 1 public safety net hospital, and 1 rural critical access hospital in 5 disparate US regions. Focus groups were conducted between June 2018 and January 2019. Data collection and thematic analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework with evidence (perspectives on ED care), context (ED), and facilitation (what is needed to promote change) elements. A total of 31 individuals (mean [SD] age, 43.4 [11.0] years) participated in 6 focus groups. Twenty participants (64.5%) identified as male and most 13 (41.9%) as White; 17 (54.8%) reported being unemployed. Themes related to evidence included patients' experience of stigma and perceived minimization of their pain and medical problems by ED staff. Themes about context included the ED not being seen as a source of OUD treatment initiation and patient readiness to initiate treatment being multifaceted, time sensitive, and related to internal and external patient factors. Themes related to facilitation of improved care of patients with OUD seen in the ED included a need for on-demand treatment and ED staff training. In this qualitative study, patients with OUD reported feeling stigmatized and minimized when accessing care in the ED and identified several opportunities to improve care. The findings suggest that strategies to address stigma, acknowledge and treat pain, and provide ED staff training should be implemented to improve ED care for patients with OUD and enhance access to life-saving treatment.

Investigating the Role of Empathy in Psychological Capital Impact on Stress Caused by Contracting COVID-19 in Nurses: A Case Study of Nurses of Tehran Oil Hospital

Background: Rapid transmission and sudden outbreak of new coronavirus have caused widespread stress among the community and treatment staff. Regarding the consecutive peaks of the disease, its persistence stress, in the long run, creates destructive effects and leads to physical weakness and psychological complications. Hence, the present study seeks to find proper ways to promote psychological capital and reduce the stress of contracting COVID-19 with the mediating role of empathy. Materials and Methods: The present research was an applied and analytical study. It is a cross-sectional study conducted in 2020. The study’s statistical population comprised 510 nurses working in Tehran Oil Industry Hospital. Using a simple random sampling method and Krejcie and Morgan table, a sample of 160 was selected. The data collection tool was a standard questionnaire whose validity and reliability have been confirmed. For data analysis, we used the structural equation modeling method and the Pearson correlation test to examine the relationship between variables. Results: The findings showed the significant and direct effect of psychological capital on empathy and a significant inverse impact of both empathy and psychological capital on the stress of contracting COVID-19 in nurses. The mediating role of empathy in the relationship between psychological capital and contracting COVID-19 stress was also confirmed. Conclusion: Accordingly, by promoting the components of psychological capital in nurses, the hospital managers can prepare them for daily stress during the coronavirus epidemic. Also, by strengthening the empathy indicators in employees along with psychological capital, the tensions related to this disease can be overcome more than ever.

The effect of education based on the health belief model in improving anxiety among mothers of infants with retinopathy of prematurity.

Due to the role of education in improving anxiety and essential skills of mothers for caring for their infants, this study aimed to investigate the effect of education based on the health belief model (HBM) on anxiety among mothers of infants with retinopathy of prematurity (ROP). This randomized controlled clinical trial was performed on 67 mothers with premature infants admitted to the ROP unit of Khatam Al Anbia Eye Hospital in Mashhad, Iran from 2019 to 2020. Participants were randomly allocated to intervention and control groups. Intervention was designed based on HBM during six sessions, each of 45-60 minutes duration. The control group received routine educations according to the hospital policies. The maternal anxiety, adherence with follow-up examinations and the rate of neonatal retinal vascularization were evaluated using an HBM- based questionnaire and State-Trait Anxiety Inventory questionnaire and checklists, respectively. Data was analyzed by using SPSS software, version 16, using Chi-squared test, Fisher's exact test, independent t test, and Mann-Whitney U test. Based on our findings, no significant difference was observed between the two groups before the intervention regarding the mean score of maternal anxiety (P = 0.141). However, after intervention, the mean score of maternal anxiety decreased significantly from 67.0 ± 6.3 to 38.5 ± 6.6 in the intervention group and increased from 69.8 ± 3.1 to 68.3 ± 3.4 in the control group (P < 0.001). In the intervention group, the mean scores of model constructs (perceived susceptibility and severity, perceived benefits, barriers, self-efficacy and cue to action) increased significantly after intervention (P < 0.001). Education based on HBM appear to be an efficient method to improve maternal anxiety among mothers of infants with retinopathy of prematurity. Accordingly, nurses and treatment staff can provide interventions in the NICU based on the HBM to the parents of hospitalized and premature infants.

Suggestions for changing professional ethics educational system

Background: Professional ethics is of great importance in health-related fields, and observation of professional ethics by the treatment staff will lead to increased patient satisfaction. Legislators have attempted to improve adherence to professional ethics by compiling codes of ethics and holding professional ethics classes in universities. Despite these efforts to develop such codes of ethics, treatment staff do not always fully comply with professional ethics, leading to decreases in patient satisfaction. Methods: Based on the authors’ experiences and related studies, we present several suggestions for improving the observation of professional ethics among treatment staff. Results: Strategies that can help improve ethical-behavioral patterns among treatment staff are as follows: Changing university entrance examinations, increasing professional ethics credits, teaching ethics regardless of religion, teaching the history of medicine, logotherapy of students during their university years, training in psychology as the core of medical education programs, and reformulating the incentive and punishment system. Conclusion: It is required to make specific changes in the selection method and training of treatment staff to enhance client satisfaction. These recommendations are given according to the health system of Iran, but they can also be used in other countries.

Predicting vulnerability to stress based on psychological capitals and personality traits in the treatment staff of Corona

Background and purpose: Considering the importance of maintaining the medical force and keeping this group healthy as people who protect the health and well-being of other members of society, it is necessary to investigate the level of their anxiety and psychological pressure as well as the relative factors so that based on the results, steps can be taken to maintain and improve their mental health. Therefore, the present study aimed to predict vulnerability to stress based on psychological capital and personality traits in the treatment staff of Corona. Methodology: The research method was a correlation-descriptive type. The statistical population of the present study included all the treatment staff of the hospitals dealing with Corona in Tehran in 2020, and 228 people were selected as a statistical sample using the convenience sampling method. The data collection tool included the short-form Neo McCree and Costa (1985) personality questionnaire, the Luthans et al. (2007) psychological capital questionnaire, and the Seyed Khorasani and Sediqani (2008) stress syndrome measurement scale. Results: Pearson's correlation coefficient and regression analysis showed that personality traits and psychological capital have a correlation coefficient of 0.62 with the vulnerability to the stress of corona treatment staff. This means that 39% of the total variance of the stress vulnerability of the Corona treatment staff is explained by personality traits and psychological capital (P&lt;0.05). Conclusion: The results showed that among the personality traits, neuroticism, openness to experience, agreeableness, and conscientiousness, and among the psychological capitals, self-efficacy and optimism could predict the vulnerability to stress of the corona treatment staff.

Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives

BackgroundThe majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with buprenorphine. These changes have the potential to mitigate barriers to care or to exacerbate pre-existing treatment inequities. The objective of this study was to qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, opioid use disorder (OUD) treatment provider perspectives about and experiences with telehealth during the COVID-19 pandemic, and to assess their desire to offer telehealth to patients at their programs in the future.MethodsWe interviewed 22 OUD treatment prescribers and staff working outpatient programs offering OUD treatment with buprenorphine in Philadelphia during July and August 2020. All participants worked at low-barrier treatment programs that provide buprenorphine using a harm reduction-oriented approach and without mandating counseling or other requirements as a condition of treatment. We analyzed the data using thematic content analysis.ResultsOur analysis yielded three themes: 1/ Easier access for some: telehealth facilitates care for many patients who have difficulty attending in-person appointments due to logistical and psychological barriers; 2/ A layered digital divide: engagement with telehealth can be seriously limited by patients’ access to and comfort with technology; and 3/ Clinician control: despite some clinic staff beliefs that patients should have the freedom to choose their treatment modality, patients’ access to treatment via telehealth may hinge on clinician perceptions of patient “stability” rather than patient preferences.ConclusionsTelehealth may address many access issues, however, barriers to implementation remain, including patient ability and desire to attend healthcare appointments virtually. In addition, the potential for telehealth models to extend OUD care to patients currently underserved by in-person models may partially depend on clinician comfort treating patients deemed “unstable” via this modality. The ability of telehealth to expand access to OUD care for individuals who have previously struggled to engage with in-person care will likely be limited if these patients are not given the opportunity to receive treatment via telehealth.

Likely behaviours of people under emergency circumstances in hospitals: A cross-sectional study.

Hospitals, which play an important role in reducing injuries and casualties, must be prepared for a crowd of people in emergencies. The present study aimed to survey and collect data on the likely behaviours of people under emergency circumstances in hospitals in order to improve emergency response plans in these places. The target population was all individuals present in three hospitals from Tabriz (including patients, companions and treatment staff), and the sample size was 1145. A questionnaire was administered to this population in order to collect the data. The comparison of different groups was performed based on participants' gender and their role. Results showed that, in general, everyone in the surveyed hospitals is more likely to choose a reactive strategy rather than a preventive strategy as well as a cooperative strategy rather than a competitive strategy, and less willing to use lifts during emergencies. Comparing different strategies utilized by different people resulting from ordered logit models revealed that there are significant differences in evacuation strategies between men and women as well as between treatment staff and all respondents. Men were more likely to select a proactive strategy rather than a reactive strategy compared to women. Also, the treatment staff group were more likely to employ a cooperative strategy and less likely to use a competitive strategy compared to other people. In view of the role of hospitals, the results of this study can play a major role in policy-making to predict the behaviour of different individuals in healthcare settings and perform needs assessment to consider the necessary facilities or raining required for different people in various countries.

Emergency medicine: past, present, and future challenges

Emergency medicine: past, present, and future challenges

Knowledge, Attitude, Practice of Iranian Physicians about COVID-19 in Iran

As a result of the global crisis caused by the coronavirus outbreak in late December 2019, Iran was also severely affected. The three provinces of Tehran, Mazandaran, and Gillan were high-risk cities exposed to infection and grievously damaged. Therefore, we decided to look at the level of knowledge, depth of attitude, and quality of physicians' practice in these three provinces. The most significant goal was to assess the level of KAP relative to the COVID-19 virus to provide comprehensive information to identify the strengths and weaknesses of the treatment staff to better cope and more effectively prevent and control critical situations.&#x0D; For research methodology, a cross-sectional study was performed on a sample of 300 people using a self-made questionnaire. An online questionnaire via virtual networks and a paper questionnaire were also distributed by the principal author in medical hospitals, which included four sections: demographic information, knowledge, attitude, and practice. Cronbach's alpha confirmed the validity and reliability of each component. The final results prove that the knowledge of physicians was acceptable and significant at the level of 0.05. Physicians' attitudes showed a level of fear and anxiety that was significant according to a one-sample t-test and chi-square (Sig &lt;0.05). In order to rank the physicians' practice, a T-test was used, and the results of the Friedman test in the first stage of the Chi-square test showed that the significance level is 0.05. Looking at the research results, it can be said that the development of educational programs can have a beneficial effect in increasing physicians' knowledge and controlling the disease as effectively as possible. Also, due to the attitude associated with stress and fear, it can be seen that providing laboratory and treatment equipment has been one of the concerns of physicians.

Interinstitutional beam model portability study in a mixed vendor environment.

A 6 MV flattened beam model for a Varian TrueBeamSTx c‐arm treatment delivery system in RayStation, developed and validated at one institution, was implemented and validated at another institution. The only parameter value adjustments were to accommodate machine output at the second institution. Validation followed MPPG 5.a. recommendations, with particular attention paid to IMRT and VMAT deliveries. With this minimal adjustment, the model passed validation across a broad spectrum of treatment plans, measurement devices, and staff who created the test plans and executed the measurements. This work demonstrates the possibility of using a single template model in the same treatment planning system with matched machines in a mixed vendor environment.

Viable medical waste chain network design by considering risk and robustness.

Medical waste management (MWM) is an important and necessary problem in the COVID-19 situation for treatment staff. When the number of infectious patients grows up, the amount of MWMs increases day by day. We present medical waste chain network design (MWCND) that contains health center (HC), waste segregation (WS), waste purchase contractor (WPC), and landfill. We propose to locate WS to decrease waste and recover them and send them to the WPC. Recovering medical waste like metal and plastic can help the environment and return to the production cycle. Therefore, we proposed a novel viable MWCND by a novel two-stage robust stochastic programming that considers resiliency (flexibility and network complexity) and sustainable (energy and environment) requirements. Therefore, we try to consider risks by conditional value at risk (CVaR) and improve robustness and agility to demand fluctuation and network. We utilize and solve it by GAMS CPLEX solver. The results show that by increasing the conservative coefficient, the confidence level of CVaR and waste recovery coefficient increases cost function and population risk. Moreover, increasing demand and scale of the problem makes to increase the cost function.

Psychological Effects Resulting From COVID-19 and Rehabilitation Intervention: A Review of Literature

Background and Aims: Considering that only about a year and a half have passed since the COVID-19 epidemic and the priority of the health care system has been to pay attention to symptoms and physical problems of this disease to prevent its further spread, there is insufficient evidence about psychological issues resulting from COVID-19. The purpose of this study was to partially review psychological problems caused by COVID-19 in patients and treatment staff and rehabilitation strategies to solve this problem. Methods: A search through in Medline, Web of Science, PubMed, and Scopus databases was performed by combining keywords related to COVID-19 (such as coronavirus), restrictive measures (such as quarantine, segregation, social distancing), and psychological outcomes (such as psychosis, depression) and instructions (such as guidance, management, rehabilitation). All articles were written in English and aimed at the psychological disorders and factors associated with the coronavirus. Given that only about a year and a half has passed since the introduction of COVID-19, the period of the reviewed articles was selected between 2019 and 2021. Results: Reviewing related studies, 18 original articles were considered. Overall, the literature showed that COVID-19 had changed the lifestyle. COVID-19, in addition to physical symptoms and mortality, has adverse psychological effects such as anxiety, depression, loneliness, stress, fear, and excitement. However, these symptoms are not very severe in most cases. Psychological problems can be more severe in specific groups, such as pregnant women or people with underlying issues. In countries with a history of epidemics, internet-based systems have been developed to assess and treat psychological problems in patients with COVID-19. Rehabilitation intervention can also positively improve the patient's breathing, thereby reducing psychological issues. Conclusion: COVID-19 can cause psychological problems for the patient and physical symptoms. On the other hand, changes in people's lifestyles following the outbreak of COVID-19, such as travel restrictions, quarantine, social distancing, and business sluggishness, may also contribute to the psychological disorders following the COVID-19 pandemic. The psychological problems caused by COVID-19 in some special groups, such as pregnant women, health care providers, and children, need to be addressed. Rehabilitation interventions and raising public awareness can effectively improve the psychological situation.

Experiences and interactions with treatment staff: reactions from state prison inmates

Incarceration should allow inmates an opportunity for rehabilitation and correcting their criminal thinking and inappropriate behavior that contributed to their imprisonment. The current study gathered data from a Prison Culture Questionnaire administered to inmates from a state correctional system. The analysis examined inmates’ perceptions of treatment staff who were employed in the prison. This was an exploratory analysis. Overall, responses to Likert-scale items revealed that inmates believed treatment staff were fair, polite, respectful, helpful, good communicators, interested in listening to their concerns, understood living in prison was stressful, and had a good working relationship with them; however, they were undecided about whether treatment staff showed compassion, could reduce conflict, enforced rules consistently, were good role models, explained their decision making, cared about the impact of their behavior, or valued inmates as human beings. Also, findings from a content analysis revealed five broad themes about inmates’ experiences and interactions with treatment staff (competent professionals, critical and inappropriate, respectful, minimal contact, and hybrid/mixed responses). Responses provided by male and female inmates about their experiences and interactions with treatment staff were similar; however, several gender-specific findings were uncovered. A narrative compiling the most comprehensive inmate responses is shown.

A Prospective Randomized Controlled Trial to Compare the Use of Conventional Dark-Ink Tattoo and Ultraviolet-Ink Tattoo for Patients Undergoing Breast Radiation Therapy

PurposePermanent tattoo marks used in radiation therapy remain for the duration of treatment and essentially for the rest of the patient's life. This study compared the initial positioning setup errors and body image perception between patients with ultraviolet (UV) and conventional dark ink tattoos. Methods and MaterialsThirty-four patients from February 2018 to March 2019, who underwent radiation therapy (RT) to the breast or chest wall for ductal carcinoma in situ or breast cancer were prospectively recruited and randomized (1:1) to receive either conventional dark ink or UV ink tattoos. Each patient received the assigned tattoos during computed tomography (CT) simulation and initial treatment setup shifts were compared. A 9-item body-image survey was administered to all patients at 3 time points: CT simulation, last week of RT, and 6 weeks post-RT. Feedback from CT and treatment staff in terms of setup time and challenges were collated. ResultsThe median age of the patient cohort was 46 years old. No statistically significant difference was observed between the mean setup errors for the conventional dark ink group (0.11 cm inferior, 0.01 cm left, 0.11 cm posterior) and UV ink group (0.01 cm superior, 0.01 cm right, 0.06 cm posterior; P = NS). Similar responses were observed in the body-image survey between the 2 groups across all time points (P = NS). The majority of the patients (dark ink 82.3% vs UV ink 88.2%) did not feel less sexually attractive as a result of the tattoo at 6 weeks post-RT. At 6 weeks post-RT, patients in both groups were satisfied with the appearance of the tattoo and did not feel cautious about their choice of clothes (82.4% vs 88.2%; P = NS). In addition, 88.6% of staff (n = 35) felt minimum effect of UV ink on the overall setup time, and 94.3% found no difficulty localizing the UV ink tattoos during patient positioning. ConclusionsNo difference in setup accuracy was found using UV ink tattoos, and it could be implemented clinically with minimal effect on the existing workflow. Patients expressed high satisfaction and self-confidence with the use of UV ink tattoos.

بررسی رعایت حریم خصوصی بیماران در بخش اورژانس: یک مطالعه مرور سیستماتیک

Introduction: Patient care is the main goal of the emergency department and its staff and respect for patient privacy is an essential part of the care process. Although many studies have examined patients' perceptions of their privacy, fewer studies have specifically addressed this issue in the emergency department, which is often a busy area and may pay less attention to privacy. The purpose of this study is to systematically review studies that have studied patient privacy in the emergency department. Methods: This study is a systematic review of published studies on patient privacy in the emergency department conducted according to PRISMA teachings. To answer the study questions, the sources of electronic databases MEDLINE, Embase, ScienceDirect and PsycINFO, and SID and Persian sources were searched with appropriate keywords. Criteria for eligibility of studies for review in this study were English or Persian language and study in the emergency department. No temporal or geographical restrictions were imposed. Results: 14 studies were included in this systematic review. The studies were published between 2003 and 2020. 2 studies of organizational intervention, and other studies were performed cross-sectionally. Most studies were performed in Iran (seven cases) and then two studies in Australia. The cumulative number of participants in all studies was 1406 patients. The main concepts presented that seemed to affect the level of patient privacy were divided into three general categories: factors related to the emergency environment, patient-dependent, and staff-dependent. Conclusion: In terms of factors related to the medical staff, there is a need to increase their awareness of the definitions of patients' privacy; Regarding the environment of the emergency department, it seems that the structure and design of the emergency department (including the type of separation of beds from each other by a room or curtain) should be revised in order to protect patient's privacy. Patient-related factors (including gender, culture) are not subject to change and are categorized only to determine the importance for further attention of the treatment staff.

Study of Obtaining Informed Consent in Pediatric Wards from the Viewpoint of Physicians and Children’s Parents

Background: Obtaining informed consent for diagnostic and therapeutic procedures is of great moral and legal importance, which is more important in the field of pediatrics due to its specific issues. Objectives: Obtaining informed consent in the pediatric field is specific because of many factors, including the age of the patients and the necessity of obtaining consent from parents or legal guardians. This study aimed to evaluate the process of obtaining informed consent from the viewpoint of substitute decision-makers (parents or guardians) and physicians. Attention to the differences between the views of these two groups by establishing appropriate and correct communication skills between them can lead to greater satisfaction and increased effectiveness of treatments. Methods: In this descriptive study, the data were collected through questionnaires completed by 188 parents and 23 physicians. Finally, the statistical analysis was conducted using the one-sample t test method in SPSS 16. Results: In 96.3% of the cases, parents believed that where the patient, their relatives, and the medical team disagreed about the kind of treatment, the final decision was made by the medical team. One-third of them did not receive enough information or received no information at all. Informing parents about other possible treatments, complications of the procedures, considering the patients and their relatives’ opinions for the final decision, informing the child about his/her disease and treatment plans, and informing the parents about the possible outcomes were not in the favorable range. Physicians believed that decision about the treatment was made based on the opinion of the parents and the clinical committee, and only in 3.4% of the cases, their opinion was the basis for decision-making. Conclusions: The results showed that there was a gap between the parents and physicians’ opinions about informed consent, as the physicians believed that they act as the patients’ parents wish and the parents believed that their opinion played no important role in the final decision regarding the health of their children. Thus, it seems necessary to institutionalize the culture of participatory decision-making by physicians and parents in decisions related to the diagnosis and treatment of children, and more emphasis should be placed on establishing the right relationship between treatment staff and patients and their relatives.