Hospitals Without Walls: The Future of the Nursing Profession in Iran


avatar Zahra Farsi ORCID 1 , *

Research Department, Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran

how to cite: Farsi Z. Hospitals Without Walls: The Future of the Nursing Profession in Iran. Jundishapur J Chronic Dis Care. 2019;8(1):e86490.

Dear Editor,

According to the World Health Organization (WHO), urbanization and life expectancy have increased in recent decades in Iran (1). Evidence suggests that aging populations, tobacco use, unhealthy diet, and inadequate physical activity will increase the likelihood of people getting into non-communicable diseases (NCDs), which will be responsible for 70% of the diseases in 2030 (2). In Iran, the most important causes of death include cardiovascular diseases (CVDs), cancers, road accidents, and intentional and unintentional injuries (2, 3). It is anticipated that in the future decades, NCDs and HIV/AIDS will play a major role in the disease burden in Iran (4). In addition to demographic and epidemiological changes, factors such as increasing environmental pollution, increasing private institutes’ participation in health services, increasing the use of technology in the health system, and developing complementary medicine (5) have led to a change in the pattern of diseases and consequently a change in the role of health care providers, including nurses. Evidence shows that conventional models of health service, which mainly focus on providing emergency, acute, and elective services, are imperative but not enough. These models cannot provide integrative and collaborative care and share the information needed for today’s patients, who are elderly with multiple morbidities, dependent, and often confused (6). Although conditions are changing rapidly, the health system has not adapted to these changes. Therefore, it is expected the concept of “hospitals without walls” to be given more attention in the coming years in Iran. In these hospitals, physical and psychological barriers will be dissolved and clinical experts will exceed the hospital environment in which they are confined. Care will be provided at a place and time that will make the patients feel more comfortable. The holistic, integrative, and collaborative care will be provided by multidisciplinary teams. Providing care in the community to the elderly and patients who are involved in multiple chronic diseases will lead to improved quality of life and more satisfaction for patients and their families.

In conclusion, considering the upcoming changes in the future decades and the vital role of nurses as the heart of the health system in improving lifestyle, preventing diseases, promoting the health and coping skills of patients with NCDs (7, 8), including CVDs, cancers, diabetes, and trauma, as the main challenges of the 2030 health system, the author suggests policymakers take more serious decisions regarding the training and recruitment of professional nursing staff, especially the community health and the geriatric nursing staff.

In addition, educating nurses to work in high technology work environments and strengthening their technical and communication skills in order to support patients and their families should be one of the top priorities of educational systems.


  • 1.

    World Health Organization. Islamic Republic of Iran on a fast-track to beating noncommunicable diseases 2017. 2017. Available from:

  • 2.

    Mirhashemi AH, Kalantar Motamedi MH, Mirhashemi S, Taghipour H, Danial Z. Prevalent causes of mortality in the Iranian population. Hosp Pract Res. 2017;2(3):93. doi: 10.15171/hpr.2017.23.

  • 3.

    Saadat S, Yousefifard M, Asady H, Moghadas Jafari A, Fayaz M, Hosseini M. The most important causes of death in Iranian population; a retrospective cohort study. Emerg (Tehran). 2015;3(1):16-21. [PubMed: 26512364]. [PubMed Central: PMC4614603].

  • 4.

    Khajehkazemi R, Sadeghirad B, Karamouzian M, Fallah MS, Mehrolhassani MH, Dehnavieh R, et al. The projection of burden of disease in Islamic Republic of Iran to 2025. PLoS One. 2013;8(10). e76881. doi: 10.1371/journal.pone.0076881. [PubMed: 24146941]. [PubMed Central: PMC3798284].

  • 5.

    Rajabi F, Esmailzadeh H, Rostamigooran N, Majdzadeh R, Doshmangir L. Future of health care delivery in Iran, opportunities and threats. Iran J Public Health. 2013;42(Supple1):23-30. [PubMed: 23865012]. [PubMed Central: PMC3712596].

  • 6.

    Hawkes N. Hospitals without walls. BMJ. 2013;347:f5479. doi: 10.1136/bmj.f5479. [PubMed: 24030563].

  • 7.

    Farsi Z. The Meaning of disease and spiritual responses to stressors in adults with acute leukemia undergoing hematopoietic stem cell transplantation. J Nurs Res. 2015;23(4):290-7. doi: 10.1097/JNR.0000000000000088. [PubMed: 26562460].

  • 8.

    Azarmi S, Farsi Z, Sajadi SA. [Development of adaptation questionnaire using Roy’s adaptation model and its psychometrics on veterans with lower limb amputation]. Hayat. 2014;19(4):26-37. Persian.

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