Medical Ethics
Year:2020 | Volume:13 | Issue:45|Papers Count:30

Background and Aim: One of the most important aspects of human health is spiritual health, which has a great impact on other dimensions. Due to the need to provide a comprehensive definition of spiritual health and determine its components in accordance with the culture and religion of Iranian society, the present study was conducted with the aim of developing a conceptual model of spiritual health based on Islamic texts. Materials and Methods: The research method was qualitative and information gathering, based on the study and qualitative content analysis of related Islamic texts. The study area was specialized Islamic texts and sampling method was purposeful. The tool of data collection was advanced search in scientific and specialized databases, and the method of data analysis was qualitative content analysis with inductive categorization system. Findings: The components of spiritual health were classified into three main categories: Theology, Cognition of guide and Eschatology. The theology components included the 6 concepts: monotheistic attitude, certainty, sincerity, detachment, trust in God, and remembrance of God. Components of cognition of guide included the two main categories: matching manner with the Holy Qur'an (theoretical model), and matching manner with the prophets and the fourteen infallibles (practical model). The first category includes the two concepts of familiarity with the Qur'an and practice of the Qur'an and the second category includes 21 concepts: submission and satisfaction, patience, fulfillment of obligations, abandonment of prohibitions, thanksgiving, contentment, material pleasure, spiritual pleasure, truthfulness, trustworthiness, good-temperedness, generosity, manliness, assistance, forgiveness, justice, courage, Jealousy, forbearance, modesty and halal Livelihood. The last component of spiritual health is eschatology, which includes the three concepts: resurrection-believing, remembrance of death and asceticism. Ethical Considerations: In selecting, reporting findings and citing texts, fidelity has been observed. Conclusion: In the present study, with a comprehensive view of a perfect human being with the monotheistic identity mentioned in Islamic texts, the components of spiritual health are extracted and its conceptual model is designed, which is in line with previous studies in this field.

Background and Aim: In order to control the epidemics, it is necessary to make decisions that can affect many people's normal lives. One of them is to create quarantine for people who are at risk of contracting an infectious disease. The purpose of this study was to investigate ethical considerations related to quarantine or isolation of patients with communicable diseases. Materials and Methods: The present study is a review study using Iranian [(IranMedex), MagIran] and international (Pub med) databases. These have been searched with key words: epidemic, quarantine, Isolation, Iran, Infectious Disease and Medical Ethics. Then the abstracts of the retrieved articles were reviewed and after the removal of duplicate and unrelated articles, the content of related articles was analyzed. Findings: Decisions based on proven scientific foundations, proportionality of benefits and losses from quarantine and reduction of its negative impact, avoidance of any discrimination (whether ethnicity, race, gender, etc. ) and fairness of decisions are necessary. Attempts to compensate for the potential (psychological, physical and material) damages caused by the quarantine and the least restraint as well as coercive force are required to execute the quarantine. Transparency in decision-making, accountability, stability in program implementation, and flexibility are the requirements. Ethical Considerations: In keeping with trustworthiness in analysis, reporting and citing, efforts were made to disseminate the results without any bias. Conclusion: Paying attention to the ethical issues raised can increase the trust of those who should be quarantined, while enhancing their cooperation to ensure that this process is achieved.

Background and Aim: The sexual robots are modern masturbation tools with maximum physical similarity with human samples that have saturated the market of sex products. The aim of producing these products is to satisfy individuals' sexual desires (ranging from ordinary citizens and persons with disabilities) and to eliminate emotional gaps. Materials and Methods: In this review study, relevant and published articles were purposely searched and retrieved, and then ethical arguments for and against sex with sexbots were discussed and criticized from a principlist approach. Findings: From the perspective of pros and cons, the robots firstly are in respect of human autonomy; secondly have positive functions such as protecting women and family entities, proper marriage substitutes for people who lack the ability to form family, preventing sexual crimes and treating some patients; thirdly they never result in harm; and finally using sex robots help in sex justice in society. On the other hand, according to opposition, the popularity of such robots is against human nature and more than probable benefits have disadvantages like increase in loneliness of individuals and destroying the family. Furthermore they will never satisfy the full satisfaction of the individual. Legally, some jurists consider the sex relationship with robots as criminal under the title of “ Outraging Public Chastity” (Art 638) but it seems doubtful. Ethical Considerations: Authenticity of the texts, honesty and confidentiality has been observed in this study. Conclusion: Although, sexual robots have some positive functions, but because of the more negative effects they pursue, alongside the legal moralism and religious considerations, they are considered an immoral option. In the Iranian criminal law, it is not easy to recognize of special title to punish sex with sexual robots.

Background and Aim: The code of ethics is constantly being reviewed, due to some changes in the professional fields of psychologists and the needs of their target groups. Conducting comparative studies creates sensibilities in experts to meet the challenges of the code of ethics. Therefore, the aim of this study is to compare the code of ethics of psychologists in Iran with the Netherlands and Switzerland's. Materials and Methods: The present study is comparative study. Using Science Direct, Pubmed and Google Scholar databases between 2000 and 2019, the keywords of code of ethics, psychology, Iran, Netherlands and Switzerland and their Persian equivalents were searched separately and in combination. The code of ethics of the Netherlands and Switzerland were purposefully selected based on the research gaps in this field; it was also structurally and contently examined, as a basis for comparison, by the Iranian code of ethics. Findings: Structurally, all three codes of ethics have common ground in the introduction and basic principles, but Switzerland and Netherlands ' codes of ethics differ in the code of conduct. In terms of content, Switzerland and Netherlands' codes of ethics are based on clear, definite and operational codes. In addition, they have adapted to the new conditions more than the Iranian code of ethics, especially in the codes related to advertising and resolving ethical issues and they have been able to create organizational and administrative structures. Ethical Considerations: Honesty and fidelity were considered in the reporting of the texts, citing sources and avoiding any bias. Conclusion: By making new changes in the Iranian code of ethics, especially in the field of clarifying the concepts and basic principles of ethics, as well as providing accurate ethical codes, taking into account the practical aspects and the method of their implementation, some challenges can be addressed.

Background and Aim: Given the important role of nurses in promoting health in society, their responsibility in performing their critical task is of particular importance and guarantees health indicators and improving the quality of nursing services. Accordingly, the present study aimed to investigate the role of moral intelligence and social capital in responsibility with the mediating role of professional ethic of nurses of Valiasr Hospital in Lamerd, Fars province. Materials and Methods: This cross-sectional study was performed by descriptive correlation method. The statistical population of the study included all nurses of Valiasr Lamerd Hospital, 300 people. The sample size was 169 according to the statistical population and using stratified random sampling method and Morgan table. Standard questionnaires of moral intelligence (Lnick & Kiel), social capital (Nahapiet & Ghoshal), responsibility (Carroll) and professional ethic (Gregory) were used to collect data. Data were analyzed by Pearson correlation coefficient and structural equation modeling using SPSS and LISREL software. Findings: The results showed that there is a positive and significant relationship between the variables of moral intelligence and social capital with nurses' professional ethic. Also, the correlation coefficient between the variables of professional ethic and responsibility (r=0. 39) is positive and significant. At the same time, with the mediation of professional ethic, the variables of moral intelligence and social capital can precede nurses' responsibility. Ethical Considerations: The objectives of the research and the confidentiality of information were explained to the participants and their informed consent was obtained. Conclusion: This study showed that moral intelligence, social capital and professional ethic have an effective role in nurses 'responsibility and in order to promote nurses' responsibility along with responsibility training, these factors should also be considered.

Background and Aim: Patients' trust in health care providers is the core element of the health system that promotes patients' health and well-being. The purpose of this study is to explore ways to strengthen and increase community trust in health providers from the Islamic perspective. Materials and Methods: Religious teachings, that have shown guidelines for humans’ health and happiness, have also presented some ways to this important issue. In this research, the instructions have been extracted from the Islamic references, containing the Holy Quran and the Innocent Leaders’ guidelines and have been analyzed. The Quranic Verses and Hadiths were listed under twenty-six titles. The factors having positive roles were categorized as the ‘ Confidence’ factors and the ones having negative roles as the ‘ hinders’ ones. Findings: From the viewpoint of religious references, considering the professional morals, sacredness of purposes, responsibility, using hopeful words, being careful in medical examination and listening to the patients are the most important confiding factors. Being secular and not physically and spiritually understanding of the patient are the most important hindering factors for confidence. Ethical Considerations: In selecting, reporting the findings and citing the texts, honestly and trusteeship has been observed. Conclusion: In addition to academic teachings on health confidence, there should be workshops, seminars and in-service training on making patients’ confidence in presenters of health services, with reference to Islamic teachings, in order to inform them and to enhance the level of social health.

Background and Aim: Given the important role of counselors and psychologists in promoting psychological health in society, the compliance of professional ethics in these occupations is of particular importance. The aim of this study was to investigate the factors affecting professional ethics in counselors and psychologists. Materials and Methods: The research method was correlational using structural equation modeling method. The sample consisted of 400 counselors and psychologists who were selected online through social media. The instruments used were professional ethic (Cadozier, 2002), General Self-efficacy scale (Schwarzer & Jerusalem, 1995), Flourishing scale (Diener, 2010) and Social desirability scale (Marlowe & Crowne, 1998). Data analysis was performed by statistical methods of Pearson correlation coefficient and structural equation modeling using SPSS 24 and AMOS 24 software. Findings: The results of structural equation modeling showed that the model of relationships between self-efficacy, flourishing and professional ethics has a good fit and flourishing and self-efficacy can explain 62% of professional ethics (P<0. 001). According to the results, higher levels of selfefficacy and flourishing predict a higher level of professional ethics, as well as social desirability in this regard played a moderating role in model. The role of gender, marriage, education, field of study and years of work in modifying this relationship was not confirmed. Ethical Considerations: The aims of the study and the confidentiality of information were explained to the participants and informed and voluntary consent was obtained in writing. Conclusion: This study showed that Flourishing and self-efficacy have an effective role in the professional ethics of counselors and psychologists and in order to promote the professional ethics of counselors and psychologists along with professional ethics education, these factors should be considered.

Background and Aim: Nurses 'fatigue at work can affect patient care outcomes and lead to increased errors and imposes significant costs on the health care system, so identifying factors related to nurses' fatigue at work is essential. This study has been done with the aim of determine the relationship of satisfaction with income, fear of violence and personality trait of conscientiousness with fatigue in work in nurses of Abadan hospitals. Materials and Methods: In a descriptive-correlational study, 150 nurses, Abadan hospitals, were selected in the second half of the year 2018 with using two-stage cluster sampling method and completed fatigue scale of nurses Rasouli et al. Heneman & Schwab pay satisfaction questionnaire, fear of crime Ahmadi et al. and Conscientiousness subscale of the Personality Inventory NEO-Short Form (NEO-FFI). Data were analyzed using SPSS20 software and statistical tests Pearson correlation coefficient and multiple Regression analysis. Ethical Considerations: Verbal informed consent was obtained from participants and to they were assured about information confidentiality. Findings: Nurses were in the age range of 31-40 years, with mean and standard deviation of age 35. 07± 6. 05, 68. 7% of nurses were female and 31. 3% male, 37. 3% of them were single and 62. 7% married. 89. 3% of nurses had bachelor's degree and 10. 7% had master's degree. Nurses' service history ranged from 1. 5-21 years, with a mean and standard deviation of 10. 97± 4. 68 years. Mean and standard deviation of satisfaction with income were 40. 27± 12. 49, fear of violence 53/06± 16/34, personality trait of conscientiousness 40. 27± 12. 49 and fatigue in work 53. 79± 17. 67. There was a significant negative relationship between satisfaction with income (rs=-0. 49, p<0. 01) and personality trait of conscientiousness (rs=-0. 32, p<0. 01) with fatigue in work; however, fear of violence was a significant positive relationship with fatigue at work (rs=0. 23, p<0. 01). 36% of the total variance of fatigue in work of nurses was explained by satisfaction with income, fear of violence and personality trait of conscientiousness. Conclusion: The findings indicate the need for planning to increase nurses' income levels, protecting them against violence in stressful environment of hospitals and placement of nurses based on their conscience in order to reduce fatigue.

Background and Aim: Learning ethical characteristics can increase students' effectiveness within each field of study as care providers; therefore, it is necessary to train professional nurses who can act effectively in making decisions and can face ethical challenges. This study considers the effects of professional ethics workshop on nursing students' understanding of caring behaviors. Materials and Methods: This study is a semi-experimental one that includes a test and a control group. The study population consists of all nursing students who are spending their third year of study in the paramedical college of Ferdows and Nursing college of Qaen. They were randomly divided into the test and control group. Thus, the Students of paramedical college of Ferdows (35 individuals) were chosen as the test group and the students' of nursing college of Qaen (35 individuals) were chosen as the control group. To evaluate the Perspective of caring behaviors, the final modified version of CDI-35 (Caring dimension inventory 35) was applied. The educational interference was performed in three days. Data collection was conducted before and after interference. For data analysis, SPSS 18, descriptive statistics, independent T-test and paired T-test were used. Findings: Our findings showed that there is a meaningful difference between mean score obtained from total scores of the students' understanding of caring behaviors (p<0. 02) and other sub-groups in the questionnaire including technical-professional caring (p<0. 002) and supportive care (p<0. 02) before and after educational interference. Ethical Considerations: The aims of the study and the necessity of protecting confidential information were explained clearly to the participants and written consent was obtained from all participants in this study. Conclusion: Professional ethics educational workshop increased the students ‘ understanding of caring behaviors; therefore, this interference is considered as an educational method to improve the students ‘ understanding of caring behaviors and by applying them, we can help clients to receive better-caring actions.

Background and Aim: Community-based research has a heavier ethical mission than other research because it has to figure out how to better address health issues in the population under study, while protecting the rights of the population under study. The purpose of this study is to examine the ethics of community-based research and its observance at different levels of society, staff and participants. Materials and Methods: This article searched the databases of Web of science, PubMed, Scopus, google scholar, Magiran, SID with keywords in ethics, community based studies and population based studies. Findings: Five ethical principles that must be considered in communitybased research include: 1. Protecting the health and well-being of populations; 2. Respecting populations and their right to decide on themselves; (3. Protecting The vulnerable population and the need for specific research inquiries; 4. The protection of confidential information, the integrity, and respect for populations; 5. The fair distribution of the benefits of research into populations and the importance of infrastructure creation. These ethical principles must be taken into account at three levels of larger communities in which research is conducted (host societies), field staff and participants in the research. Ethical Considerations: Honesty and trustworthiness were observed in reporting articles and the findings of these articles were stated without bias. Conclusion: Research ethics, such as delivering results to the community, enable the community to actively participate in the development of community-based research.

Background and Aim: Clinical professors as practical models have a significant role in teaching professional behavior to medical students. This study aimed to determine the level of awareness and observance of professional ethics in physicians of hospitals affiliated to Ardabil University of Medical Sciences. Materials and Methods: In a descriptive cross-sectional study, 50 clinical professors working in hospitals affiliated to the Ardabil University of Medical Sciences were selected through self-assessment sampling. David Music's questionnaire was presented to professors after confirmation of validity and reliability. The collected data were analyzed using descriptive and analytical statistics using statistical software. Findings: The average level of knowledge and ability of physicians in different departments about professional ethics indicators was excellent in 91. 7%, acceptable in 8% and 0. 3% in the unacceptable level and the rate of application of professional ethics indicators by physicians in the Clinical environments were considered in 90. 84%, excellent, in 8. 7% were acceptable and in 0. 46% unacceptable. Ethical Considerations: After obtaining permission from the University's Ethics Committee, by expressing the research objectives for the participants, oral informed consent was obtained and information collected without mentioning the name. Conclusion: The results of this study showed that in assessing by selfassessment method, the knowledge and application of professional ethics indexes among the professors of the different departments were optimal. However, effective educational and cultural interventions are required in some areas such as leadership skills, organizational and managerial skills, and the ability to initiate and innovate in delivering treatment to different patients.

Background and Aim: Based on the current evidences people's professional maturity, having occupational & psychological maturity and capability of high diagnosis & judgment keep them protected from commitment to organizational mistakes & deviation and also it can increase the level & reliance among them which has an important role on organizational development. So this research is done in order of study the relationship between academic professional maturity & organizational virtue. Materials and Methods: This is a descriptive correlation study in 2017 and consist of 101 people working in Tabriz Nursing and Midwifery Faculty, and the sample size is estimated 80 people (male and female) according to Morgan table formula, which were selected based on stratified random method. Three types of standard questionnaires including organizational virtue questionnaire, professional development questionnaire and multidimensional perfectionism were used and their reliability were obtained 0. 88, 0. 85, 0. 89 respectively according to Cronbach's alpha coefficient. The resulting data analyzed using Pearson correlation coefficient & multiple liner regression & analyzed using SPSS 23. Findings: According to study result, professional maturity has got a significant & positive relationship with organizational virtue (P<0. 05, R=0. 71), but there was no significant relationship between organizational virtue & perfectionism (P>0. 05, R=0. 41). Professional maturity can predict the changes in organizational virtue in Tabriz Nursing & Midwifery Faculty staff & instructors significantly (%69). (P<0. 05, R2=0. 48). Ethical Considerations: Before completing the questionnaires, we explained about the aim of this research as well as confidentiality of results for participants and they participate in the research with informed consent. Conclusion: According to result of the study, professional maturity has got maximum relation in formation of organizational virtuous. For professional excellence in teaching, research and other related fields for academic members and also in assigning suitable occupational responsibilities for staffs, we can provide an appropriate context for cooperation by empowering scientific associations in universities.

Background and Aim: Medication errors commonly occur in clinical nursing. The present study aimed to determine the causes of medication errors, their lack of report, and their frequency in intensive care units (ICUs). Materials and Methods: This descriptive and correlational cross-sectional study, 200 nurses working in intensive care units, Iran University of Medical Sciences and Tehran University were selected by stratified random sampling. Data were collected using demographic form and Wakefield medication error reporting tool. Descriptive statistics (mean and standard deviation) were then analyzed. Findings: For systemic reasons (61. 93) and pharmacy reasons (46. 18), the highest and lowest mean scores were obtained among the causes of drug error, respectively. It is also observed that the administrative reasons with the mean of 72. 52 and the difference of mean with the mean of 52. 65 had the highest and the lowest mean score among the reasons for not reporting medication error. Intravenous error averaged 32. 07 mean higher than nonvenous error averaged 20. 67. There was also a significant relationship between sex and patient Safety Culture. Also, there was also a significant relationship between sex, age and job experiences with medication Error Report. Ethical Considerations: This article is the result of an approved research project at Iran University of Medical Science. During the research process, the university's ethical policies were complied with in accordance with the principles of the Helsinki Declaration, including obtaining informed consent from nurses. Conclusion: According to the results, reducing the incidence of medication error by nurses requires the provision of proper conditions to minimize systemic errors in hospitals. Furthermore, nursing managers must facilitate error reporting for nurses, while meticulously monitoring the administration of drugs by nurses, especially in the case of intravenous medications.

Background and Aim: In recent years, the physician's duty of notification to the patient about the risks of treatment has been considered as the main and most controversial part of the doctrine of informed consent in various legal systems; The purpose of this study is to analyze the basis of physician's duty to inform the patient about the risks of treatment in legal systems and their evaluation, in order to find a suitable basis in Iranian law. Materials and Methods: This study is a library review with the descriptiveanalytical method and a comparative approach; The existing texts on the physician's duty to inform the patient about the risks of treatment in the American and French legal systems have been studied and with analysis of the issues raised, attempted to extract and explain the basis of this duty. Findings: The American legal system considers the duty to inform the physician about the risks of treatment, as a requirement of the patient's autonomy and believes it to have a legal nature; But in the French legal system, it is considered a necessity for human dignity and is considered to be inherently moral nature; In addition to these basics, the ideas of human body immunity and good faith have also been introduced in some legal systems. According to the jurisprudential and moral principles of Iranian law, accepting the doctrine of inherent human dignity as the theoretical basis of the physician's duty of notification to the patient is more compatible with Iranian law. Ethical Considerations: The reports and citations to the articles and texts are based on honesty and trustworthiness, and with mentioning the sources used and without any bias or distortion of the findings. Conclusion: Acceptance of the moral basis, that is the human dignity, for the duty of the physician to inform the patient about the risks of treatment and litigate a physician liability claim based on moral fault, can provide the basis for full compensation for material and moral damages.

Background and Aim: Discrimination in healthcare is one of the important challenges of health system managers in different countries so; discrimination is the main outcome of a lack of justice in health. Therefore, the whole exploring the discrimination in healthcare and determining effective policies is essential. This study was conducted to explore the experiences of health care providers of discrimination in healthcare. Materials and Methods: This qualitative content analysis study was conducted between 2019 and 2020. Data were collected through semistructured interviews with 16 participants include healthcare in one general and one private hospital in the city of Tehran. The participants were selected by purposive sampling, which continued until saturation of data. Data obtained were analyzed using Graneheim and Lundman's method. Findings: After analyzing the data, three main categories and seven subcategories emerged: 1. Organizational coercion (organizational procedures, Lack of manpower); 2. Moral negligence (Lack of attention to human values, Lack of knowledge of the principles of medical ethics); 3. Positive discrimination (Provide some facilities for the patient, Perform some additional services for the patient and Work history. ) Ethical Considerations: The present study was approved by the Ethics Committee of Tehran Welfare and Rehabilitation Sciences University with the code of ethics: IR. USWR. REC. 1398. 023. Conclusion: Based on the findings of the study, senior managers of the health system can review the organizational process of health care delivery and focus on increasing the level of awareness of health care providers such as physicians and nurses about the principles of medical ethics. Also, it is recommended that managers consider meritocracy policies as one of their decision criteria.

Background and Aim: Moral sensitivity is the first component in observing ethics. However, occasionally some nurses do not possess necessary sensitivity due to certain obstacles and appear to be somewhat confused and indifferent toward moral issues. Materials and Methods: This descriptive study was conducted in 2015 with the aim to determine level of moral sensitivity and its dimensions among nurses working in critical care units. 153 nurses working in critical care units selected by census method. Data were collected using Moral Sensitivity Questionnaire. Findings: Results obtained showed an average level of moral sensitivity among studied nurses (68. 6± 7. 8) and in the dimensions of moral sensitivity, nurses scored the highest in "benevolence" and the lowest in "professional knowledge". Ethical Considerations: After obtaining the approval of the research committee, the objectives of the study and not harming the nurses were first explained. It was then ensured that the completion of the questionnaire was confidential and that nurses would have access to the study results. Conclusion: Greater improvement of moral sensitivity in nurses through holding courses on ethics during academic years and inservice appears essential in providing full and ethical patient care by nurses, especially those working in intensive care units.

Background and Aim: Informing cancer patients about their illness will help them better understand the disease and follow treatment more closely. Given the necessity of cancer patients' awareness of their diagnosis during treatment, the current challenging issue is to the manner by which the diagnosis must be disclosed to cancer patients. Therefore, the aim of this study was to review the studies conducted on the ethical considerations of disclosure among cancer patients in Iran. Materials and Methods: Systematic search in internal databases of Magiran, Elmnet, Irandoc, and Noormags have been done with keywords such as telling the diagnosis, disclose of diagnosis, ethical sensitivity, ethical considerations, how to break bad news, cancer patients and patients with cancer in Persian. There was no time limit on the selection of articles. Out of 24 articles reviewed, 14 articles were omitted based on the inclusion and exclusion criteria. And the final analysis was performed on 10 articles. Findings: The results of this study show that most physicians tend to disclose the diagnosis. They want to express recognized diagnosis immediately and explicitly in a session in detail being conducted by them. Doctors' willingness to disclose depends on variables such as the age of the patients and their specialization. Most patients who are aware of their diagnosis are more likely to participate in selection of treatment. Patients prefer a gradual and appropriate disclosure. Patients need the support of family, health care workers, support organizations, and the right information when disclosing a diagnosis. Ethical Considerations: Integrity and honesty in reporting, documenting and citing of resources were observed. Conclusion: How to disclose the diagnose and consider the psychological and spiritual components of patients and their families on the one hand and the psychological characteristics of physicians on the other hand are important challenges in this process in Iran that need further investigation.

Background and Aim: Identifying and documenting nurses' attitudes to end-of-life care helps to plan and integrate needed interventions to correct and evaluate them based on weaknesses. The purpose of the present study was to determine the attitude of intensive care units (ICU) nurses toward end-of-life care. Materials and Methods: A descriptive, cross-sectional study was conducted at two referral university hospitals in Goran, Iran in 2019. Through consensus sampling 101 nurses of ICUs were enrolled in the study. Data were collected via the Frommelt Attitudes Toward Care of the Dying Scale (FATCOD). Data were analyzed by independent t-test, correlation coefficient, Mann-Whitney, Kruskal-Wallis tests at significance P-value<0. 05. Findings: The mean score of nurses' attitudes toward end-of-life care was 105. 25± 8. 77. 95% of nurses gained high score regard attitude toward patient care at the end of life. There was a significant relationship between nurses' attitude toward end-of-life care with type of employment (P-value=0. 009) and job position (P-value=0. 003). Ethical Considerations: All the principles of ethics in research such as; obtaining informed consent and confidentiality of the individual identity of the participants were observed. Conclusion: The attitude of intensive care unit nurses towards end-oflife patient care was positive. Sensitizing nurses through training in this type of care and obliging the government to formally hire nurses can affect nurses' caring attitudes.

Background and Aim: Moral intelligence as the first component of moral compliance is the basis of moral action. Medical students trained in clinical settings, in addition to technical competencies, must have desirable moral values. The aim of this study was to compare the moral intelligence status of students of basic sciences and medical internships in Tehran University of Medical Sciences in 2018. Materials and Methods: This descriptive-comparative cross-sectional study was performed on 400 medical students in both basic sciences and internships who were randomly selected and met the inclusion criteria. A 40-item Moral Intelligence and Keil Lennick Questionnaire was used to collect data, which included four dimensions and ten indicators. SPSS 25 software and Chi-square t-test were used to analyze the data. Findings: The average total score of moral intelligence in the internship group was 72. 13± 7. 78 and the mean total score of moral intelligence in the basic sciences group was 72. 11± 8. 28. The average total score of moral intelligence of most interns (62. 7%) and basic science students (60. 7%) was obtained in a good category. About 37. 3% of interns and 39. 3% of basic sciences had poor moral intelligence. The mean total score of moral intelligence in internship students was higher than basic sciences, but this difference was not significant (P=0. 026). Ethical Considerations: This article is the result of a professional doctoral dissertation at Tehran University of Medical Sciences. During the research process, the university's ethical policies were observed in accordance with the principles of the Helsinki Declaration, including obtaining informed consent to participate in the research. Conclusion: Indicators of moral intelligence in interns were not higher than students of basic sciences and these findings indicate the failure of general and specific educational programs in the field of developing moral skills in medical students. Therefore, it is recommended to revise the medical education curriculum by considering ethical concepts.

Background and Aim: Spiritual care can alleviate physical pain and improve mental wellbeing, but has not been addressed in the hospital. This study was conducted to design an executive instruction for establishment of spiritual health services in Iranian hospitals. Materials and Methods: A descriptive-analytic study was conducted in the form of designing a system in three main stages of review study, qualitative study and designing a placement style sheet. Data were collected using internal and external databases and six focused group discussions. Stakeholder analysis was carried out and the principles of design were formulated and were agreed. Based on the five main components of a system, style sheet of establishing spiritual services was designed in a hospital. Findings: Principles of Executive instruction includes designing a comprehensive spiritual health services and integrating it into the current system, continuing care in mental and social dimensions, participating senior hospital and physician and nursing managers, evidence-based executive guidelines and emphasizing Spiritual Health Services as an organizational value. The expected goals of this instruction are to increase patient satisfaction, facilitate the recovery of acute illnesses and increase resilience to malignant diseases, reduce patient referrals, improve spiritual and religious status and enhance spiritual skills and promote healthy behaviors. The main process of spiritual health services consists of three main components of the evaluation of spiritual health by a physician, the implementation of spiritual health counseling by an elected counselor, support services including hospital facilities at the time of patient hospitalization and patient education at discharge and post-discharge support. Ethical Considerations: The objectives and content of the study were explained to all participants and after obtaining informed consent, the interviews were recorded. Participants were assured that information will be confidential. Conclusion: Implementation of the designed executive introduction requires the establishment of political support structures, structural and operational dimensions, clinical skills and promotion of people behavior and culture. To establish the introduction, managers must capture the financial, human, equipment and information resources needed and pay attention to the feasibility results of the study.

Background and Aim: Adult children of elderly and sick parents face many challenges and may experience the compassion fatigue, which can affect the care process. The aim of this study was to investigate the dimensions and symptoms of compassion fatigue in children who take care of their elderly and sick parents. Materials and Methods: In this study, data bases including SID, Magiran, IranMedex, Google Scholar, Elsevier and PubMed were searched for studies published between 2000 and 2019 with the following keywords: Parent, Family Caregivers, Compassion Fatigue, Adult Children and Elderly. By this means, a number of 426 articles were acquired which were reviewed in two stages (first, the title and the abstract and then the whole article) based on the inclusion and exclusion criteria. In the end, 17 articles entered the present study. Findings: The type of articles used in this study were as follows: descriptive-analytical and correlational (7 articles), review (3 articles), qualitative (5 articles) and case study (2). The focus of the studies was on the different aspects of compassion fatigue. According to the reviewed studies, compassion fatigue is often accompanied by the symptoms of anxiety, helplessness, disappointment, insomnia, social isolation, reluctance as well as physical and mental fatigue. Ethical Considerations: Publication of the results is carried out honestly without bias and by citing the original reliable resources and references. Conclusion: Since fatigue compassion creates various physical, psychological and social dimensions in adult children of elderly and sick parents, Support centers, counselors, and nurses need to consider this in regard to the families of elderly patients in their support program.

Background and Aim: Moral distress is one of the most common issues in nursing that can have different effects on health and performance of nurses and patients and health organizations. Resilience is defined as the social and personal capacity for recovery, adjustment, and persistence against adversity that can help nurses reduce moral distress. The purpose of this study was to determine the relationship between ethical distress and resilience in nurses working in hospitals affiliated to Shahid Sadoughi University of Medical Sciences in Yazd in 2019. Materials and Methods: This cross-sectional study was performed on 250 nurses working in hospitals affiliated to Shahid Sadoughi University of Medical Sciences in Yazd, Iran. Samples were selected by stratified random sampling. Data collection tools included three questionnaires of demographic characteristics, modified ethical distress scale, and Connor and Davidson resilience scale. Data analysis was performed using descriptive and inferential statistics (independent t-test, one-way ANOVA, Tukey, Pearson tests) in SPSS 20 software. Findings: The results showed that there was no significant relationship between the mean score of moral distress and resiliency of nurses (r=-0. 027, p=0. 67). Among the resilience dimensions, there was a significant inverse relationship between "control" and "positive acceptance of change, and secure relationships" with moral distress" (P<0. 05). The mean score of moral distress was 31. 36± 9. 99, which shows a moderate level of moral distress. The mean score of resiliency of nurses was 64. 87 ± 11. 11. The highest and lowest score of resiliency pertained to the dimension of "spiritual influences" (68. 05± 20. 22) and "trust in one’ s instincts, tolerance of negative affect" (60. 44± 13. 38), respectively. There was a significant relationship between moral distress with gender, marital status, shift status, age groups, employment status and work experience (P<0. 05). Also, resilience had a significant relationship with gender, marital status, education level and employment status (P<0. 05). Ethical Considerations: This study is approved by the Ethics Committee on Medical Research. Ethical considerations such as completing the informed consent form voluntary participation, explaining research goals, and assurance of confidentiality were observed. Conclusion: Individuals with higher ability to "control" and "accept positive change and secure personal relationships" experience less moral distress. Therefore, it is possible to reduce moral distress and consequences such as maintaining the workforce and improving the quality of patient care by applying educational strategies promoting these dimensions and supporting nursing managers.

Background and Aim: Educating nurses and nursing students about spiritual principles and values helps them to have a deep understanding of moral problems. However, the issue of spirituality is not included in the educational content in bachelor's degree nursing program. The purpose of this study was to investigate the effect of spiritual care training on the empathy among nursing students in the two nursing colleges affiliated to the Birjand University of Medical Sciences. Materials and Methods: The present study was a quasi-experimental research conducted in 2020 in which 29 seventh semester nursing students of Tabas Nursing College as intervention group and 29 seventh semester nursing students of Ferdows Nursing College as control group. The instruments used included a demographic characteristics form and the Jefferson Empathy Questionnaire. The spiritual care training in the intervention group was presented as a five-session workshop (four 90-minute sessions and one 120-minute session) as well as a two-month follow-up. In order to follow the observance of educated materials in the workshop, a researcher-made checklist was used. The control group did not receive any intervention. Data were analyzed using SPSS software version 16 using descriptive and inferential statistics (independent t-test, paired t-test, analysis of covariance and chisquare) at a significance level of P<0. 05. Findings: The mean scores of empathy before the intervention in the intervention and control groups was not significantly different (p=0. 98). However, the mean scores of empathy immediately and two months after the intervention in the intervention group was significantly higher than the control group (p<0. 001). Ethical Considerations: After obtaining the ethical code, the researcher referred to the study settings and after introducing the research purpose and nature and explaining the way of conducting study to them, a written informed consent from was obtained from the students to participate in the research. Conclusion: The findings of the present study indicated that spiritual care training can improve the empathy among nursing students. Therefore, it is advised that nurse managers and developers of nursing curriculum consider the spiritual care training for nursing students.

Background and Aim: Nurses' perceptions and attitudes about futility can sometimes lead to the cessation of valuable treatments or the refusal to provide care to patients. On the other hand, having moral sensitivity can change the perspective of nurses in the face of ethical challenges in caring for patients with Covid-19 and may be effective improve nurses’ perception of futile care and the quality of care. The aim of this study was to determine the relationship between moral sensitivity and nurses' perception of futile care in patients with Covid-19 in hospitals affiliated to Hamadan University of Medical Sciences in 2020. Materials and Methods: The present study is a descriptive-correlational study that was performed on 150 nurses working in selected hospitals in Hamadan province in 2020. Participants were selected by convenience sampling. Tools of data collection are used in a research study included a three-part questionnaire of demographic information, Lutzen's moral sensitivity and perception of futile care designed based on Corley's moral distress scale and review of related texts, which was distributed as a physical presence in the hospital and an electronic version. Data analysis was performed using SPSS software version 26 and descriptive statistics (frequency, mean and standard deviation) and analytical statistics (Independent T-test, ANOVA, Pearson correlation coefficient and differential correlation). Findings: Although there no significant relationship was seen between moral sensitivity and intensity of perception of futile care (r=0. 277, p=0. 06) and frequency (r=0. 213, p=0. 15) but is a significant positive relationship between some subclasses of moral sensitivity and perception of futile care. The mean score of nurses' moral sensitivity was low (36. 12± 3. 46) and most of the participants had a moderate perception of the intensity (47. 12± 8. 22) and frequency of futile care (32. 43± 5. 76). Also between moral sensitivity and work experience (r=0. 324, p=0. 03) and age (r=0. 279, p=0. 04) and work nurses’ experience with intensive care futile (r=0. 311, p=0. 04) and its frequency (r=0. 235, p=0. 02) showed a significant relationship. Ethical Considerations: This research has been approved by the ethics committee of Hamadan University of Medical Sciences (IR. UMSHA. REC. 1399. 572). After obtaining informed consent from the participants, the researcher assured them that all their information would be confidential. Conclusion: Several factors are involved in the level of moral sensitivity and perception of nurses' futile care in the care of Covid-19 patients. No significant correlation between moral sensitivity and the perception of futile care in this study was in a situation where nurses faced the peak of the Covid-19 pandemic and were under high organizational and psychological pressures. Therefore, for better conclusions, it is suggested that this study be conducted with further sample size and in the Covid-19 and non-Covid-19 wards.

Background and Aim: Considering the important role of moral intelligence in changing people's attitudes towards different behaviors, it seems necessary to pay attention to the importance of this variable in different jobs especially in the medical profession due to constant and direct contact with human clients. Therefore, the purpose of the present study was to investigate The Role of Moral Intelligence of Emergency Physicians in Predicting Satisfaction of Patients Referred to Ardabil Hospitals. Materials and Methods: The present study was a descriptive-analytical and cross-sectional study. The study population consisted of all physicians and patients referring to the emergency department of Ardabil hospitals. In this study, 56 physicians working in 4 teaching hospitals of Ardabil city and 392 corresponding patients were selected by Available sampling method. For data collection Lennick and Kiel’ s (2005) Moral Intelligence Questionnaire and Salami S & Samouei (2012) Patient Satisfaction Questionnaire were used. Data were analyzed by Pearson correlation coefficient and multivariate regression using SPSS 22 statistical software. Findings: The obtained data from this study showed that there is a significant positive correlation between physicians 'moral intelligence and patients' satisfaction (r=0. 528, p=0. 001). Also, the results of regression Analysis showed that physicians 'moral intelligence can predict the 26/6 percentage of patients' satisfaction (p<0/001). Ethical Considerations: In the process of conducting this research, all ethical considerations related to human studies such as obtaining informed consent and maintaining the confidentiality of the participants in the research were observed. Conclusion: According to the results of the present study, it can be said that moral intelligence is an important factor in patients' satisfaction of received medical services, therefore, it is suggested that skills training such as communication enrichment, empathy, responsibility and compassion therapy be used in physicians' training courses.

Background and Aim: Despite the many efforts made by hospitals, the pace of medical error reduction is still slow, many errors will undoubtedly occur and thousands of patients and physicians suffer from medical errors. Members of healthcare organizations generally do not receive training to disclose medical errors and apologize to the damaged person; they may refuse to disclose errors, apologies, or may have other reactions. It is worth noting that this study aims to investigate the phenomenon of physician apology following medical errors. Materials and Methods: The research method is qualitative (interview based) with the conventional content analysis approach. Data were collected through semi-structured interviews with a purposeful selection of 25 physicians and senior assistants working in Shahid Mohammadi, Children, and Persian Gulf hospitals in Bandar Abbas. Data analysis was performed using MAXQDA 10 software. Findings: The study identified three overarching themes )antecedents, physicians' apologies phenomena, consequences(, eight organizing themes (medical community norms, social factors, individual factors, Components of apologies, apology conditions, achieving of social acceptance, internal and external pressures( and 27 basic themes. Ethical Considerations: To comply with ethical considerations, the ethics research with the code ir. hums. rec. 1397. 237 received from the Ethics Committee. Written consent was first given to the volunteers to participate in the study, and after consent was obtained, permission was given for interview and note-taking. They were assured of the confidentiality of their personal information. Conclusion: Fear of legal consequences and loss of credibility makes doctors more cautious in apologizing, but the factors of education, culture, and personality traits facilitate the presentation and acceptance of apology. On the other hand, apologizing improves relationships between the patient and the doctor and prevents problems such as stress and legal follow-up.

Background and Aim: Nurses experience a variety of ethical challenges during their careers. Then to reduce these challenges, they need to improve their knowledge and attitude regarding nursing ethics. Hence this study was done aimed to investigate the effect of nursing ethics codes education on nurses' knowledge and attitudes in the adult ward of Kerman selected hospitals. Materials and Methods: In this quasi-experimental study 88 nurses were selected by convenience sampling method and randomly assigned into two groups of experimental and control (n=44). Then the experimental group was given a pocket guideline about nursing ethics codes. Before and after the intervention, the data was collected by a questionnaire. The data were analyzed using descriptive and inferential statistics. Findings: The knowledge and attitude mean scores of the experimental group before and after training were 19. 52+0. 64, 17. 71+0. 59 and 27. 55+0. 52 and 23. 9+0. 54 respectively. The results showed that there was a statistically significant difference in the experimental group (p<0. 000). Ethical Considerations: The study subject and method were approved by the Kerman University of Medical Sciences Ethics Committee. Written informed consent was signed by nurses and emphasized voluntary participation, information confidentiality, and withdrawal from the study at any time. Conclusion: The results of this study showed that ethics codes teaching improved nurses' knowledge and attitude. Therefore, to improve the health services quality, the training of nursing ethics codes is suggested and should be considered as an important component of nursing education.

Background and Aim: The quality of moral growth is a dimension of the individuals’ evolution that is formed from childhood until adulthood besides the other dimensions. Moral intelligence is the ability to differentiate right from wrong. A morally intelligent person has strong moral beliefs and the ability to act based on these beliefs with respectful behavior. Regarding the work stress in hospitals, the employees have different moral functions in their behavior with others. However, this issue has not been studied enough despite the importance of the relationship between moral intelligence and risk management. So, the present research aims to investigate the effect of moral intelligence on hospital risk management and job satisfaction in hospital personnel in Tabriz. It is assumed that moral intelligence can decrease hospital risks. Materials and Methods: This research is a cross-sectional descriptive correlation study. The population includes all the university personnel in Tabriz in 2018 (about 700 people). Based on Morgan’ s table, 250 people were selected by random sampling. The research data were collected by three questionnaires, including the moral intelligence questionnaire (Badie et al., 2010), job satisfaction questionnaire (Kendall & Hulin, 1969), and risk management questionnaire (Zaboli, 2009). The collected data were analyzed by structural equation modeling in SPSS 21 and LISREL. Findings: The findings suggested that there is a positive relationship between moral intelligence and hospital risk management with the mediating role of job satisfaction and between moral intelligence and job satisfaction with the mediating role of hospital risk management. Since the T value is more than 1. 96, the hypothesis is significant at the confidence level of 0. 95. The P-value also approves this conclusion (P-value ˂ 0. 05). The value of the path coefficient is more than 0. 6. So, it suggests a strong pair-wise relationship between the mentioned variables. Therefore, the hypothesis is significant and there is a positive relationship between the variables. Ethical Considerations: All the participants signed the informed consent letters before starting the research. Conclusion: It is concluded that moral intelligence in hospital personnel can increase their satisfaction and promote efficient risk management in the hospital. As a result, moral intelligence should be paid attention to improve risk management and job satisfaction.

Background and Aim: Pervasive disasters and epidemics pose challenges to human societies, and among these, moral challenges are the most important and most difficult. The spread of the corona virus has created many moral challenges and dilemmas for humans that need to be identified and addressed. The most important ethical challenges and functions in this crisis occur in the field of medicine. The purpose of this study is to investigate the challenges and ethical functions of the medical field in the Corona epidemic. Materials and Methods: The present study is a narrative review of books and articles that have been searched and analyzed using Data bases. Findings: Challenges identified in the field of medical ethics are: 1. Prescribing unproven and unofficial treatments; 2. Disclosure of the disease; 3. Lack of treatment facilities and resources; 4. Patient quarantine and lack of physical contact; 5. Cost Treatment and hospitalization; 6. Quit work by medical staff; 7. Forced quarantine and use of sanitary ware; 8. Preservation and preference of personal interests. Ethical strategies for facing challenges are also divided into three sections: 1. In dealing with the patient: justice in the distribution of services and medical facilities, kindness to the patient; 2. In dealing with society: maintaining social health, unity and empathy; 3. In dealing with self: self-care and maintaining personal health. Ethical Considerations: While observing fidelity in analysis, reporting texts and citations, an effort has been made to publish the results away from any bias. Conclusion: This study has shown that coping with the corona virus is not enough with treatment efforts and adherence to health protocols, and it is not possible without recognizing the ethical challenges facing corona in the medical field and without applying ethical solutions to deal with them; Because several challenges in the field of health and treatment have been identified during this study that hinder the progress of the medical field in the fight against this virus. Recognizing the ethical challenges and using the ways to solve them by the medical staff, leads to an increase in the quality of health care and the ascent of the recovery process, and prevents the entry of psychological pressures on the patient and society.

Background and Aim: Nurses have a very important and prominent role in the health care system, and turnover of nurses in health care system, disrupts the functioning of the organization. There are many factors that can be associated with the turnover of nursing services. The purpose of this study was to investigate the relationship between moral distress and Nurses' Turnover Intention in intensive care unit nurses. Materials and Methods: This study is a descriptive-correlational study, which was performed using census sampling on 117 nurses working in the intensive care units of Qom hospitals in 2016. Data were collected using the Hinshaw Anticipated Turnover Scale, and the Jamton 30-Questionnaire. Data were analyzed by SPSS software 16 and descriptive statistics and statistical tests of multivariate logistic regression. Findings: The results showed that there was a significant relationship between moral distress and the Nurses' Turnover Intention in intensive care units nurses (p=0. 03, OR: 2. 44). The mean score of moral distress in the participants in the study was 137. 53 with a standard deviation of 23. 14. Also, the mean score of Nurses' Turnover Intention was 3. 44 with a standard deviation of 0. 948. Ethical Considerations: This article is the result of an approved research project at Qum University of Medical Science. During the research process, the university's ethical policies were complied with in accordance with the principles of the Helsinki Declaration, including obtaining informed consent from participant. Conclusion: According to the results of this study, it is necessary for nurses to pay more attention to moral distress and Nurses' Turnover Intention. Therefore, measures should be taken to reduce ethical challenges, moral distress, and subsequently Nurses' Turnover Intention in the clinical setting.