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Abstract Introduction: A positive organizational climate can emotionally encourage personnel to contribute in their organizational decisions, even though it can be an indication for their mental health too. In the other hands a negative organizational climate can be a source of pressure and mental stresses. The aim of the current study is to evaluate the above relationships. Materials and Methods: This cross – sectional study was carried out in 2002. The sample size was 176 person who were randomly selected from the Hospital workers in Ilam state Hospitals. The study was conducted using a standard question are for organizational climate and one for mental health (SCl- 90-R). The data were analyzed using Descriptive Statistics, Regression, T- test and Kruskal – Walis tests. Results: It was demonstrated that organizational climate had a statistically significant relation with mental health ( α= 0/05, P< 0/03 ). 5 out of 9 mental health disorders including obsessive – compulsory disorder ( P< 0/04) , depression ( P< 0/04 ) , anxiety ( P< 0/01 ) , phobia ( P< 0/01 ) and psychosis (P< 0/01) had a significant relation with organizational climate. A positive relation was seen for organizational climate and the income . Discussion: As organizational climate had a strong relation with many variables studied in present survey and since it was demonstrated that organizational climate had a significant relation with mental health, it is recommended that manager appointment system to be organized according to the organizational climate. This solution can promote the mental health of hospital workers by which the community mental health can be promoted.

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Introduction: Washing hand hygienically before having contact with patient is one of necessities for controlling of nosocomial infections because hands are main way for transferring of microorganism in hospital environments.In such a circumstance, if the protective agent contains pathogens, it can lead to nosocomial infections growth. Materials & Methods: In the study we dealt with microbial pollution of used liquid soaps in five hospitals of Ilam city in 2010. The samples were taken by sterile tubes containing physiology serum, after this they were cultivated on Differential and base the cultures. After 18-24 hours, the initials cultures were studied for the prtent of bacteria. In order to differential separation we used usual microbiology methods. Findings: In the study in respect of microbial pollution nearly 95% of samples were positive and 38.1% negative and 2.4% unknown. The most microbial pollution in all samples was for Pseud-omonas(22.6%) and the least was Klebsi-ella(8.3%). In different units of hospitals, there was a significant difference among the units(P=0.002), and also there was a significant among different hospitals and types of microbes(P=0.002). Discussion & Conclusion: It seems that the application of guidelines for how to use soaps and the conditions of hand washing has an important role in reduction of contamination, and with attention to the contamination of main reservoir, it is essential that contamination discussion of provided soaps in factory to be addressed certainly and in the case of having quality control problem, we do more attention on production lines.

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Introduction: Physical and verbal violence against nursing are very critical problems that could influnce the quality of nuring cares. The extent and causes of violence against nurses are not fully determined in Iran, yet. So, the present study investigated all kinds of violences in the training hospitals of Ilam city in 2012. Materials & Methods: In the discriptive research, 147 subjects of nursing staff who had experinced physical or verbal violences during 2012 were randomly selected from the training hospitals of Ilam city using an author-made questionary. Findings: About 88.7% and 23.1% of the studied subjects had experinced the verbal and physical violence, respectively. Also, 89.8% and 23.8% of the nurses had experi-enced the verbal and physical violence, respectively from the patient followers. Based on the results, the most common violences against male and female nurses were verbal and physical, respectively. Mo-reover, a meaningful relationship was found between the violences and the age of nur-ses. Discussion & Conclosion: The occurance of physical and verbal violence against the nursing staff is high. The situation warns to the scurity autorities of hospitals to pay more attention to the nursing staff. Also, the using of media and the training of medical personnel may be helpful to alleviate vila-nces against nursing staff.

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ABSTRACT Introduction The tendency towards the quality of the services has an important role in service industries such as banks, hospitals, clinics, transportations, etc., since the quality of the services is considered critical in achieving customer satisfaction and finally the survival and profitability of the organization. Materials & Methods The present applied research is a cross-sectional descriptive study that was conducted on 450 patients of the studied hospitals of Ilam and Kermanshah in 2011 using SERVQUAL questionnaire (1988) that its validity and reliability have been approved. Finally, T-Test and Friedman test on SPSS software were run to analyse the collected data. Findings The results showed that there is a significant difference between perceptions and expectations of the patients about five fold dimensions of the service quality (tangibility, reliability, assurance, responsiveness, and empathy) in the studied hospitals. The patients who consulted the hospital categorized the tangibility dimension as the most important one with 3.74 point and assurance the least important with 2.60 points. Discussion & Conclusion The results of the present study showed that by using SERVQUAL model, the managers of the hospitals are able to assess the quality of the services from the patients’ viewpoint as the most important and organized customers and that with appropriate planning and reforming the disorders, the improvement of the service quality will be possible.

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Introduction: In spite of the fact that many factors affect the performance of orga-nizations, it is quite doubtless that leade-rship is one of the most important factors for organizations succession. Hospitals as complicated organizations require an effici-ent leadership, at gross or small levels, and. This study aimed to assess leadership style in the educational hospitals of Iran, Tehran and Shahid Beheshti Universities of medi-cal sciences and explore its relationship with personality type based on the five-fac-tor personality model. Materials & Methods: The present study was a correlation one. Statistical society of the research included managers working in the educational hospitals of Iran, Tehran and Shahid Beheshti Universities of medic-al sciences. The data was collected by an appropriate questionnaire. Managers Lead-ership Style was measured by Rensis-Likert questionnaire. Also, managers’ personality type was assayed by five big factors of Mckry Dody Kastav. For validating the q-uestionnaires, a content and technical validating method was applied. The reliabi-lity of the questionnaires was estimated by test-pretest method. Findings: The findings of study showed that conscientiousness personality type was the most frequent types (36.4%) in comp-arison with other personality type. There was a significant relationship between pe-rsonality type and leadership style (P=0.06). Discussion & Conclusion: Given the relati-onship between personality type and lea-dership style, it may predict the managers’ leadership style by using of their perso-nality type.

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Introduction: Hospital waste contains biological agents and chemical compounds which are toxic and dangerous for health of patients, personnel and clients. Due to the presence of hazardous and infectious materials in the hospital waste, appropriate management should be applied to them. The aim of this study was to compare the waste management system in small and large hospitals of Tehran city in 2012. Materials & Methods: In this cross - sectional study the solid waste management in two large hospitals and three small hospitals in Tehran city in 2012, were compared. Hospital wastes was segregated and weighted initially, and then the percentage of infectious and non-infectious waste was determined. According to the World Health Organization questionnaire the status of hospital waste management and waste treatment facilities in these hospitals were evaluated. Findings: Average waste generated in large hospitals in 4.5 and small hospitals in 4.87 kg per day was in bed. Health level of storage systems and waste collection of hospital wastes were in 91.5% and 100% in large hospitals and 73% in small hospital, respectively. Biological indexes showed that waste disposed at large hospital 1 and small hospital 4 were not in a safe mode. Discussion & Conclusion: There is no significant difference between the amount of waste generation in small and large hospitals, but the amount of infectious wastes in small hospitals was in 1.75 times greater. Health level of waste collection and storage system was significantly higher in large hospitals. Hospital waste management in large hospitals was much better than in small hospitals.

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Investigation observation standards of security and dosimetry at x-ray imaging center hospitals Subsidiary Ilam University of medical sciences Jamal Amiri 1, Shahin Amiri2, Parvin Tork1,Mohmad hasan Abbasi 1, Seyed Pezhman Shirmardi *3 Introduction: Standards observation in imaging centers cause to patient dose reduction in patients and improving image quality. Identification standards and determine the gap own facilities with standard centers is a necessity for standardization. In this article, Standards level in imaging centers have been studied in Ilam province. Materials & Methods: Dose was measured in the controlled, monitored and uncontrolled region for each center. Czech list contains 210 items were prepared by using standard values in the world and Iran. Separately, Czech list were completed for each center. Level standard calculated at sections: building and construction, Preparation and usage of equipment, Protection of staff and patients, Patient rights and staff salaries for all hospitals and presented as percentage of standard. Level of patient information has been checked about radiation effects by using the questionnaire. Findings: Level of dose were standard in controlled monitored and uncontrolled region all of centers. Generally the level standards in Ilam imaging centers were obtained at sections: Building and construction 64.9 ℅, Preparation and usage of equipment 69.4℅, Protective staff and patients 80.03℅, Rights of patients 81.7℅ and staff rights almost 100%. Patient imaging centers were aware of effects of radiation on cell were 28%. Conclusion: In this study, the level of standard and distance to the full the level of standardization Were determined for all centers.The level of gap with completely standardization of imaging centers in the province is building and construction section35.1℅, preparing and application of equipment 30.6℅, Protection of staff and patients 19.97℅, Patient rights 18.3%. As well as patient imaging centers not informed about the effects of radiation on cells were 72%.

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Introduction: Infectious diseases among ho-spitals are a major healthcare problem in the world. Some of these infections are cau-sed by ingestion of contaminated foods in the hospitals. The aim of this study was to investigate the role of hospital foods in the transmission of clinically important bacteria into the hospital environment. Materials & Methods: Frequency of the main bacterial pathogens responsible for h-ospital infections were studied among sam-ples from foods, food handlers and food p-rocessing devices. Swab culture and aerobic plate count assay were used for the isolation of suspected bacteria. Colony count of each culture and biochemical or molecular ident-ification of each isolate was determined according to standard methods. Antim-icrobial susceptibility of each bacterial iso-late was determined according to the latest clinical laboratory standard guideline. Findings: Among the 200 samples under study, the highest frequency of contam-ination (40%) was seen among utensils. Furthermore, Staphylococcus aureus show-ed the highest frequency (16%) among the obtained isolates, while Escherichia coli re-presented 8% of the contaminations. Fewer rates of contaminations were belonging to other responsible bacterial pathogens, inclu-ding Pseudomonas spp., Acinetbacter spp. and Enterococcus spp. (0-4.6%). Among the Staphylococcus aureus isolates, the mu-ltidrug resistance phenotypes were observed to be 18.7%. This phenotype was observed among 52.9% of Escherichia coli isolates but not among other isolates. Among the studied samples, the highest frequency of multidrug resistance was seen among uten-sils. Discussion & Conclusion: Outbreaks of food borne disease has been reported in ho-spitals. High frequency of clinically imp-ortant bacteria among utensils compared with samples of foods or food staffs, and the presence of enteric or skin marker bac-teria in these samples revealed the possible role of hospital foods as a risk factor for dissemination of pathogenic bacteria into hospital environment.

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Background and Aims: The discharge wastewater of hospital into surface and groundwater to be provide the major risks and challenges for the human. So, this study is an attempt to be examined the treatment and disposal of hospital wastewater status in Kermanshah Province in 2011-12. Materials and Methods: This study is a descriptive - analytic study was conducted that included all hospitals in Kermanshah province (19 private and public hospitals). Tools and methods of data collection through the Czech list (including 18 questions about general and specific information on the status of hospital treatment and sewage disposal) that were matched with the person. Finally the resulting data were recorded in the form of tables and graphs. Results: The results showed that total of 19 hospitals, 7 hospitals (36.8% of all hospitals) have a wastewater treatment system in use (active), 5 hospitals (24.4%) with a wastewater treatment system inactive and 7 Hospital (36.8 %) do not have a wastewater treatment plant. Conclusion: According to numerous risks that humans and the environment are faced with result in hospital wastewater discharged into municipal sewers, so the lack of wastewater treatment in 12 hospitals (63.15%) is concerned. So getting policies for the construction of wastewater treatment systems in all hospital and operation by companies and professionals in the field, chlorinated raw sewage (wastewater treated if possible) to reduce pollution entering the collection and treatment network House of sewage, Adequately monitor the health authorities, water companies and other related organizations are alternatives that can be very effective to meet the standards required in a hospital and Environmental Management System (ISO14000) in set of management processes to improve the quality adjustment of hospital waste.

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Introduction: hospital as a firm has got a both income and cost. on other hand, health cost will take a great share of family expenditure. So, the hospitals are obliged to apply and use cost-benefit analysis to increase efficiency and productivity accordingly, these institution managers, have to be aware of hospital cost function. Material and methods: this research try to estimate the regression function of hospital cost based on econometrics method with the help of 14 main index which will affect hospital cost in 8 governmental hospitals of Ilam province during 2003-2013. It worth to mention that Translog function specification has been applied in the estimation. Findings: The results indicates that relative cost of Ilam hospital relates to labor -capital price and quantity of production positively during 200/-2013. Besides, since the coefficient are meaningful at a: .05 , so it shows that variables like the emergency rooms, equipments ,buildings ,bedridden time, releasing and mortality rates has reciprocal effect on hospital cost. 10 percent increase in quality of services leads to 34 percent increase in hospital cost. Discussion and Result: Since there is a direct relationship between quality of services, relative cost of labor and investment and hospital cost so, in order to decrease the hospital cost, one of the following two effective factors including labor force or investment should be decreased. labor force includes the number of nurses, And investment includes equipments, building, and so forth. production decrease has a direct relationship with decrease in number of visited, bedridden, and released patients, and decrease in none of them is acceptable. so the labor relative price decrease can be considered as the best solution for decrease in hospital relative cost which is obtainable via change in condition of labor engagement in hospitals, application of the lowest wage rule, and annual wage increase .

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Introduction: Offering the Health-care ser-vices by hospitals at critical conditions is very important. So, it is essential to eval-uate the level of hospitals safety in emer-gency situations and ensures that hospital provides an acceptable performance in criti-cal conditions. Materials & Methods: This cross-sectional study was conducted to investigate the saf-ety condition of Ilam´s hospitals during di-sasters in 4 hospitals of Ilam in 2013. Observation, interview and questionnaire of hospital safety index presented by the World Health Organization (WHO) were applied in order to collect data. This form studies 145 hospital safety indices in three scopes of performance, structural and non-structural safety. Finally, the hospitals are classified in one of the three safety levels A, B, C. Data analysis was performed using SPSS version 18 and descriptive statistics. Findings: In this study, all hospitals were observed in the safety level B. Imam Khomeini hospital had the highest scores in all three above-mentioned scopes. Other-wise, the lowest score in the performance scope concerned to Taleghani hospital, and in structural and non-structural scopes, Ko-wsar and Taleghani hospitals had the lowest scores. Discussion & Conclusion: Totally, despite the differences in the scopes of functional, structural and non-structural, the safety lev-el in all hospitals was moderate (level B). However, some appropriate measures must be conducted in every scope, and the safety factors must be annually and repeatedly assessed to reach the universal standard level (A).

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Introduction: In the current age, great developments of management knowledge has necessitated the evaluation system so that lack of evaluation in various fields of organizations such as assessment of using resources and possibilities, the staff, goals and strategies is considered a sign of organizational defect. Man has continually tried to make the best of things economically such an intendancy can be considered an achievement of higher efficiency. Efficiency is a comprehensive concept promotion of which has always been considered to help life-style, well-fare, people's prosperity and austerity by political and economic authorities.
 Materials & methods: In this research, the data from 9 hospitals of Ilam (western Iran) were analyzed and categorized using Data Evaluation Analysis (DEA) based on CCR Model (input-output-based) as well as various feed-backs in quad-variables (constant, changing, ascending, descending) with two scenarios during 2009-11 applying DEA solver software. In scenario A, the three inputs of doctors, staff, and acting beds besides the three inputs of clinical, para-clinical, and out-door services were used, while in scenario B, the three inputs of doctors, staff, and acting beds were evaluated in relation to the three outputs of admission-day, days bed-occupation percentage, and out-door services.
Findings: The findings showed that the most general technical efficiency rate as well as the rate in the study duration stood for the years 2009, 2010, and 2011 using the output-based scenario B. In most of the investigation years, 40% of the investigated hospitals proved efficient comparatively and technically, while the remained 60% centers implied some degree of inefficiency in respect to techniques and ratios.
 Discussion & Conclusion: The results of our research demonstrate that the selected health centers have not functioned efficiently. It is also concluded that technical efficiency promotion capacity to almost 13% level and comparative efficiency capacity to 10% level were possible without any increase in the costs or the staff.

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Introduction: Burnout defined as, feelings of loss of energy and powerlessness, hopelessness and helplessness. Quality is defined as the satisfaction of customer needs. This definition emphasized on organization's ability to determine the needs and demands of customers and fulfilling these needs. Perceived quality of service by patients can be transferred to nurses who are associated with patients.
Materials & methods: This study is a descriptive-analytical cross-sectional study that performed on 100 patients and 100 nurses by simple sampling method. The instrument we used was a two-part questionnaire including Meslash and Jackson (1981) job burnout of nurses' questionnaire and SERVQUAL measuring the perception of quality of service standard questionnaire of Zdhml and Bytner (1996). The reliability and validity of questionnaire was confirmed and data were analyzed by using SPSS 21 software and Pearson correlation, simple linear regression, analysis of variance, Friedman's rank tests were used.
Findings: Patient’s perception from quality of service and its aspects affected on job burnout of nurses. Empathy (&beta;=0/577, P<0/05), tangibility (&beta;=0/486, P<0/50), assurance (&beta;=0/472, P<0/50), reliability (&beta;=0/144, P<0/50), responsiveness (&beta;=0/225, P<0/50) have the most significant negative effect on job burnout of nurses respectively.
 Discussion & Conclusion:: To offer better services and attention to patients can provide their satisfaction and loyalty and prevent job burnout of nurses and employees.

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Introduction: Although nowadays industrial development and development of technology has been background of human welfare, but occupational accidents are the potential adverse consequences that are considered as a serious threat for health. This study is aimed to epidemiologic study of bone and soft tissue injuries resulting from occupational accidents in hospitalized patients of Shahid Beheshti hospital. Materials & methods: In this cross sectional study all patients were entered to study who admitted at orthopedic section of Shahid Beheshti hospital in Babol city during 2010 – 2012 because of bone and soft tissue injuries resulting from occupational accidents. Information were including demographic characteristics, job, work experience, level of education, time and month of accident event, cause of accidents, affected limb, damaged area and type of injury were extracted from patient's files and then data were analyzed. Findings: of 227 patients, 18.1% were admitted in 2010, 35.6% in 2011 and 46.3% in 2012. 98.2% were male and most of the victims (65.2%) were in the age range of 36-17years. The highest proportion of accidents occurred among construction workers (47.1%). upper limbs had a (69%) most damage and, Most of damage was bone damage (32.6%) and there was a significant relationship between the type of job, cause of accident and injured limb (P<0.0001 and P=0.01 respectively), but there was no significant relationship between type of job and injury (P=0.8). Discussion & Conclusion: The increasing incidence of occupational accidents, the high prevalence in construction jobs and construction prosperity in coastal areas of the country highlighted the need to adopt preventive measures and to reduce the incidence of these adverse events and its consequences.

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Introduction: One of the most important criteria for allocation of hospital sources in health care system is to analyzing the hospital expense. Efficiency of surgical operations has an important role in determining of hospital expense. This study aimed to finished expense calculation of cancelled elective surgical operations based on expense analysis method in Kerman Shafa Hospital in 2012.
 Materials & methods: This a descriptive - analytical study was performed by consensus method on 240 files during a period of one year in 2012 and it was investigated by using a self-designed checklist that its validity was confirmed by the health economics experts. The expense were calculated and analyzed based on three factors including payment of medical personnel, expenses of energy resources and the expense of delay in repayment of insurance companies Data were analyzed by SPSS18 and descriptive and inferential statistics (Fisher's exact test) were used at the significant level P&le;0.05.
 Findings: Of 240 cancelled surgical operations, the highest rate of cancellation was related to clinical status of the patient (%18) in the Eye department and the total imposed expenses were 320 million IRR which The highest expense was related to the personnel’s’ and physicians’ payments with. 69084800 IRR.
 Discussion & Conclusion: The findings indicated that the main cause of cancellation of surgical operations in this hospital was clinical status of the patients who do not have the appropriate condition of surgery and the time period of their hospitalization cause high expenditure for the hospital. Thus, exact evaluation of the patients through consultant and the attending physician can avoid the cancellation of surgical operation and consequently waste of financial sources.

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Introduction: During patients’ hemodialysis Circle, the amount of heavy metals in feed water to dialysis instrument and the patient’s blood are changed. The present study aims at evaluating the trend of lead, cadmium, chromium and zinc concentration in feed water to reverse osmosis, dialysis instrument and blood of hemodialysis patients in 7 hospitals of Kermanshah.
 Materials & methods: A total of 42 samples of feed water, 42 samples of reverse osmosis systems permeate and 42 samples of hemodialysis instrument permeate were collected from 7 hospitals in Kermanshah. The collected samples were analyzed and the concentration of lead, chromium, cadmium and zinc were determined by using ICP (DV-Optima2100 model) according to a standard method. Furthermore, statistical analysis was carried out by using one-sample t-test to compare mean quality of feed water of dialysis instrument with AAMI and EPH standards. In addition, ANOVA test was used for comparing the results of three sample groups.
Findings: The obtained results indicated that the mean concentration of lead, cadmium, chromium and zinc in feed water of reverse osmosis system (drinking water), were 18.53± 8.25, 0.706± 0.42, 86.06 ± 5.56, 112.67± 63.56pbb, respectively. Also, quantity of these constituents in the feed and permeate of electrolysis device was 18.81±5.32, 0.719±0.53, 84.25±2.46, 43.39±19.4pbb and 12.5±6.32, 1.39±0.87, 66.15±13.54, 60.38±22.39pbb, respectively. Due to obtained results, the removal efficiency of zinc and chromium by reverse osmosis system in dialysis instrument were 61.5 and 2.1%, respectively, while it was not effective in removing lead and cadmium metals. Discussion & Conclusion: Increasing the level of lead and cadmium in permeate water of the reverse osmosis system rather than the feed water indicated that the reverse osmosis membrane function is out of service as a result, it is required to be washed or replaced. Decreasing both lead and chromium metals in permeate solution of the dialysis instrument revealed the addition of the amount of those two hazardous metals to the blood of hemodialysis patients, which could be related to reverse osmosis membrane deficiency and high concentration of metals in its water permeate.

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Introduction: Midwives as one of the main groups providing health care and because of their stressful job they are in the exposure of burnout and the consequences of work-family conflict. This would impact on their quality of life. This study was performed to evaluate the relation of quality of life and work-family conflict among midwives in Ahvaz, Iran. This cross-sectional study was performed in 2014-2015 at health centers in Ahvaz.

Materials & methods: The data was collected through a demographic, work-family conflict and quality of life questionnaires. 261 midwives that was the total numbers of midwifes in Ahvaz, filled out three questionnaires. Results showed that 229 midwives completed questionnaires.

Findings: There was a negative significant correlation between quality of life and work-family conflict (p<0/01).

Discussion & Conclusions: According to the findings of this research, it seems that educational courses for health workers, particularly midwives are necessary.

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Introduction: Nowadays, attention to opportunities andthreatsinthe field ofhealthcare and culminating in thehospitals facedwith uncertaintyandrisks wasessentialandmanage the risks involvedin thesecentersis very important. The aimof thisstudy is HSErisk assessmentmodelbasedsystemsinhospitalsmartyrBeheshtiUniversityof Medical Sciences, approaches thatcan becontrolled.

 Materials & methods: In thisstudy,weidentifythe principalrisksandsetstandards formeasuring andprovidingcomprehensive questionnaire. Theanalytical Network predictionbased onfuzzy logic(FANP)was used for priority of risk.

Findings:Theriskprioritynumber isused inhospitals,Biological factorsaffectinghumanRPNequal to32.85 was the highest risk and Physical factorsaffectinghumanisequal to11.68 was the least HSE risk of  hospital.Also the result showed that priority of the risk factors affecting the company's reputation was high.

Discussion & Conclusions: The results showed thatHospital managementshould beincontrol ofchemical and biologicalagentstoadopta specificmanagement plans. Also, according tothe results, it is clear thatit is necessary toconsider themanagementof workplaceergonomicsprogramhas beenandcontrol measureswithinthescopedefined.

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Introduction: Servant leadership is one of factors that influence organizational citizenship behavior. On the other hand, spirituality at work develops organizational citizenship behavior which can improve the performance of nurses and the quality of caring services provided by them. This study aimed to determine the direct effect of servant leadership on organizational citizenship behavior as well as the indirect effect of servant leadership on organizational citizenship behavior through mediation effect of spirituality.

Materials & methods: This is a descriptive correlative study based on path analyzing among 152 nurses and 57 head nurses of training hospitals in Rasht. Samples were randomly selected by cluster sampling. Data were collected using servant leadership, organizational citizenship behavior and spirituality at work standard questionnaires and were analyzed using descriptive and inferential statistics and structural equation modeling.

Findings: The results indicated that the status of servant leadership style for head nurses and the status of spirituality at work and organizational citizenship behavior for nurses are relatively desirable. The direct effects of servant leadership on organizational citizenship behavior (t₌1.35, β₌0.08), servant leadership on spirituality at work (t₌2.05, β₌0.18) and spirituality at work on organizational citizenship behavior (t₌10.02, β₌0.75) are all significant. The indirect effect of servant leadership on organizational citizenship behavior through the mediation effect of spirituality at work (t₌6.21, β₌0.6) is statistically significant.

Discussion & conclusions: According to the findings, by servant leadership, nursing managers can enhance the spirituality at work and organizational citizenship behavior among nursing staff improving the quality of care provided for patients.