Medical Ethics
Year:2019 | Volume:14 | Issue:44|Papers Count:23

Background and Aim: Information security is a vital issue and nowadays, organizations all over the world have felt this fact. In the majority of the research conducted in this field, the role of human factor has been neglected and the past research has employed a technical approach to tackle this issue. The present article has been conducted with the aim of studying the impacts of personnel’ s perceptions about the consequences of sensitive information disclosure and personnel’ s organizational commitment on their intention to violate the information security. Materials and Methods: The sample for this research was composed of 118 physicians, working in education specialized hospitals in Isfahan, who were nonrandomly surveyed by using the scale adapted from D’ Arcy et al. for security policy, including 7 items and Allen and Meyer for organizational commitment, including 24 items. After confirming its validity by face validity, content validity and construct validity, and its reliability by Cronbach’ s alpha and composite reliability, the hypotheses were examined by using partial least square technique, using SmartPLS. Findings: The results of this study illustrated that physicians’ perceptions toward organizational policies-which is an indication of certainty and severity of sanctions against unauthorized information disclosure has a negative impact on their intention to violate information security (P<0. 001). Moreover, the results demonstrated that physicians’ perceptions about the impact of organizational commitment, consisting of affective commitment, normative commitment, and continuance commitment had no significant impact on their intention to violate information security. Ethical Considerations: Participation was voluntarily, participants’ oral consent was obtained and their identity confidentiality was also assured. Conclusion: Organizational policies in the sense of severity and certainty of the sanctions should be enhanced at the hospital and even ministry level and communicated with service providers in the health centers by using different tools.

Background and Aim: Organizational ethics measurement is a constant concern of many managers and researchers. Considering the special nature of hospitals, the growing attention of the society to medical ethics in recent years and the changing environment and technology in the present era, it is important to have the model appropriate to the hospitals in the country. The purpose of this study was to design the model of virtue-based organizational ethics in hospitals affiliated to Tehran University of Medical Sciences and Health Services as a case study. Materials and Methods: The method of qualitative research is the Grounded Theory (emerging approach). The unstructured interview was used for data gathering. The statistical population of the study consisted of managers and ethical experts at Tehran University of Medical Sciences and Health Services. After 3 stages, sampling was carried out with 18 interviews and the relationships between the dimensions of the model were determined and the validity and reliability of the model were examined. Findings: Based on findings from Grounded Theory, 17 Subcategories in the form of 4 main categories including Ethics in Society, Drivers of Ethics in the Organization, Virtue Ethics, Observance of Ethics in the Hospital Results, the components of this model are made up of. Also, the relations between the model components were determined. Ethical Considerations: The research information was obtained from the interview with the consent of the experts and the confidentiality of their information was assured. Conclusion: Besides, according to the model relations, it was determined to achieve the moral hospital must Ethics in Society that effect to Drivers of Ethics in the Organization, improved. Also, Ethics in Society to be an effect on Virtue Ethics. Based on research findings, achieve organizational virtue ethics Depends on the Correction of the ethics of the treatment on the department, Ethics in Society and other Drivers of Ethics in the Organization. This model is suitable for evaluating the state of the ethics of virtue-based at the hospital level.

Background and Aim: The issue of nature is one of the most complex and important topics that have been discussed by various religions, scholars and even psychologists. The purpose of this study is to explain the relationship between the nature and spiritual health, in order to investigate the effect of spiritual health on the nature flourishing. Materials and Methods: In this narrative review, published books and articles were purposely searched in both manual and electronic manners in internal databases and were analyzed. Findings: The innate sense of nature within human beings calls them towards the God and excellence. And only one can enjoy the capacities of nature in the path of evolution, which is spiritually healthy. Considering conscience as the common origin of human nature and spiritual health, by trimming and enlightening the conscience and confronting the deterrent factors and enjoying spiritual health, the ground is provided for flourishing of human nature and transcendence. Ethical Considerations: Honesty and trustworthiness were observed in citing the texts. Conclusion: The findings suggest some recommendations and strategies based on spiritual health with an inter-religious view for flourishing of human nature.

Background and Aim: Co-word analysis is a reliable way of discovering relationships and revealing links between different disciplines and illustrating the intellectual structure of a discipline. This study attempts to study the intellectual structure of knowledge in medical ethics research using the Co-word analysis technique. Materials and Methods: This research is a descriptive-analytical study that analyzes the content of texts with a scientometric approach. The study population consisted of 3296 medical ethics records in the Web of Science database during the period 1998-2018. Findings: Findings showed that in terms of frequency, keywords of bioethics and informed consent were more abundant in medical ethics research. The hierarchical clustering findings led to the formation of 9 clusters in which the clusters of "medical futility", "informed consent" and "medical education with clinical ethics approach" were in the best position. Ethical Considerations: Honesty and trustworthiness in the selection of articles have been reported and citations to the texts have been observed. Conclusion: The present study showed that Co-Word analysis and clustering can help to understand the structure of the subject relationships in one field. Results of strategic graph analysis showed that "informed consent", "medical education with ethical approach" and "medical futility" is the central clusters. In contrast to the four clusters, "physician-patient relationship", "ethics in medical research", "medical profession and conscientiousness" and "easy death" are emerging or disappearing clusters. Research is lacking in some topics such as abortion, simulation, sterilization and etc.

Background and Aim: Conflicts of interest in medical research could have an adverse effect on all stages of an investigation. The main proportion of articles discussing COI focuses mainly on financial conflicts. The purpose of this research is to investigate the non-financial conflict of interest in Bio-Medical science research. Materials and Methods: A review study was conducted using the search of internal and external data bases. For this purpose, the IranMedex, Magiran, Google and Pubmed databases have been searched with key words: conflict of interest, nonfinancial and research. Related articles were collected. Then the abstract of the retrieved articles was examined and after the removal of duplicate and non-related articles, the content of the related articles was analyzed. Findings: Non-financial conflicts are less considered and more attention is paid to financial conflicts. In Iran, most research expenditures are provided directly or indirectly by the government so it seems that non-financial conflicts of interest to be more prevalent. The scholars' desire for fame, a higher degree of scholarship compared with colleagues, Gaining a higher scientific position, the acquisition of research grant, religious or political desires, etc. in adition, Some policies on the ground for the promotion of faculty members, as well as incentives for publication of papers, are contributing to these conflicts. Ethical Considerations: By observing the trustworthiness in analyzing, reporting and citations, efforts were made to disseminate results far from any kind of bias. Conclusion: The greater attention of policy makers to non-financial conflicts such as financial conflicts, the elaboration of codes of ethics in this field, the preparation of processes to identify such conflicts and changes in the rules that contribute to these conflicts could be useful in its reduction or minimize.

Background and Aim: This study aimed to determine the effectiveness of theoretical training versus practical training of medical ethics to the students in the Psychiatric ward. Materials and Methods: The research method was quasi-experimental. The study population consisted of all medical students undergoing an internship in a psychiatric ward in Ardabil Fatemi hospital. Students were evaluated from April 2016 to June 2016. Using a convenience sampling method, 36 individuals were selected and randomly assigned in two groups: 18 students in the theoretical training group (group 1) and 18 students in the operational training group (Group 2). Moral Competence Questionnaire and Professional Ethics Checklist in psychiatry were used for data collection. Data were analyzed by SPSS 21 software. Mean and standard deviation, ttest and Cohen's effect size index were used for statistical analysis. Findings: The results showed that there was no significant difference between the mean scores of the two groups in the Moral Competence Questionnaire and the pre-test of the Professional Ethics Checklist. After the training, the mean scores of group 2 were significantly higher than group 1 in the post-test. The two large differences were in Autonomy and Privacy respectively. Finally, according to Cohen's scale, the effectiveness of practical training was greater than theoretical training. Ethical Considerations: Making students aware of the research, and getting informed consent, keeping confidentiality of individual results, not involving results in the evaluation of students' educational performance. Conclusion: Practical training of professional ethics was more effective than theoretical training and merely emphasizing on theoretical training could not lead to adherence to professional ethics. Therefore, it is essential that during general practitioners' training, in addition to theoretical classes, other practical methods be used.

Background and Aim: Today, due to changes in health care services, including the use of Updated technologies, differences in people's demands and needs, change in patterns of diseases, increasing public awareness, the necessity of applying an ethical approach is increasingly felt. Therefore, this study was designed to assess the level of ethical development of nurses in Mashhad hospitals and compare it among nurses in teaching and private hospitals. Materials and Methods: In this descriptive-analytical study, 198 nurses were selected by the census sampling from 4 private and teaching hospitals in Mashhad. Informed consent was obtained from each participant included in the study. The data collection tool was Kohlberg standard questionnaire. Data were analyzed using SPSS version 16 statistical software. P-value<0. 05 was considered significant. Findings: The average age and mean work experience of nurses were 35. 86± 7. 80 and 7. 73± 7. 03 respectively. The average score of NP was 45. 29± 6. 84 and the mean CP score was 20. 9± 3. 91 in nurses and there was no significant difference in private and teaching hospitals. Also, except in the intensive care unit there was not a significant relationship between demographic factors and these scores. Ethical Considerations: Participants' informed consent and compliance with the principle of confidentiality were considered. Conclusion: According to the results, it was found that the level of ethical development score is higher than the average score but far from the optimal level. Most of the nurses are at the level of the post conventional and conventional, but a significant number are at the pre-conventional level. On the other hand, considering the effect of professional environment and performance of the nurses on students modeling and learning, it is expected that promotion of ethical aspect of professional nurses, especially in teaching hospitals, will be the priority of nurses’ empowerment programs. Also it is a necessity to monitor and evaluation of Nurses’ performance.

Background and Aim: The nurse's placement in the context of conveying facts or concealing it is inevitable, and sometimes the nurse is in a place where he uses the white lies to protect the patient's interests. Understanding the situations of using white lies and finding solutions to provide truthful treatment to patients to make truth-based therapeutic decisions is a top priority in providing ethical care. The aim of this study was to explore the lived experiences of white lie in ethical care process among a group of Nurses. Materials and Methods: This study was conducted based on the qualitative approach, using an interpretive phenomenological method. Using purposeful sampling method, 18 participants were selected and shared their experiences regarding White lie in patient ethical care through individual in-depth and semistructured interviews in 2018. The transcribed interviews were analyzed based on the Colaizzi approach. Findings: The lived experiences of nurses regarding white lie in ethical care process emerged as the ethical care path ups, the ethical care path downs and ethical care Dilemma. This themes including nine sub themes. Ethical Considerations: All subjects were informed on the content of the study and if they agreed to participate, a written informed consent was obtained. Conclusion: Honest communication and maintaining patients' confidence are Important characteristics of moral care. Using the sense of patient support, teamwork and helping to nurture the values of the nursing profession is facilitated to achieve the goal of protecting patients 'privacy and protecting patients' secrets. . . To achieve this goal, it is recommended to improve nurses' communication skills and to hold contemplation sessions and to express group experiences in providing care in order to maintain and develop the values of the nursing profession.

Background and Aim: Midwives' competency to spiritual care is important for improving the health of the mother and infant. This study aimed to determine the effectiveness of educational intervention on the level of spiritual health among midwifery students. Materials and Methods: This quasi-experimental study was carried out with a pretest-posttest design on 56 undergraduate midwifery students studying at Karaj universities in the academic year of 2017-18. Sampling was done by convenience method and comprehensive spiritual health questionnaire for Iranian populations was used to collect data. The group educational sessions were theoretically held within 16 hours. Mean, standard deviation, Friedman and Wilcoxon nonparametric tests were used to data analysis by applying SPSS 19 software. Findings: The mean and rank score of participants’ spiritual health (in all three structures of insight, affection and behavior) increased significantly after educational intervention immediately, and one month after intervention (p<0. 0001). The highest score of spiritual health was obtained immediately after intervention, and there was no significant difference between the scores immediately and one month after intervention (p=0. 655, p=0. 851). There was no significant relation between the age, academic mean and term of the participants with the mean score difference of spiritual health (p>0. 05). Ethical Considerations: Following the explanation of the research goal and confidentiality of information, oral consent of the participants was obtained. Conclusion: The findings indicate on the effectiveness of educational intervention on spiritual health of the studied students. Thus, inclusion of spiritual health and care education in the education curriculum of midwifery students is recommended.

Background and Aim: Confidentiality and privacy are references to fundamental principles and important pillars of therapeutic relationship and professional ethics in the field of psychological and counseling activities. Psychologists and counselors are required to protect their clients' secrets in accordance with their professional and legal duty. The purpose of this study was to explain the dimensions of confidentiality and disclosure of secrets in the field of psychotherapy services and to consult and analyze the existing laws in this area. Materials and Methods: In this research, the ethical code of the organization of psychology and counseling and related laws has been analyzed. Findings: According to the ethical code of the organization of the psychological and legal system, psychologists and counselors are required to maintain the secrets of their clients. Accordingly, if a psychologist or counsel discloses the secrets of his clients, he has a legal responsibility. Of course, it's important to note that confidentiality is relative and that there may be circumstances in which a specialist, under the law, is required to violate the confidentiality and disclosure of his clients' information. Ethical Considerations: Integrity and honesty in reporting, ducumanting citing of resourdes were observed. This research is carried out at personal expense without any financial support. Conclusion: This study suggests that confidentiality and privacy of the clients is an issue that has been neglected in Iran. There are significant deficiencies in the ethics code and laws that need to be reviewed in light of new issues and challenges. At the same time, professional ethics and confidentiality issues should be considered in the curriculum and retraining courses.

Background and Aim: The connection of physicians and patients is one of the most important human contacts in the health system and Trust is the basis of this connection. The health system is associated with all levels of society and because of the sensitivity, the capacity to create excitement and to be related to the health of people has a better chance of gossip and thus has an effect on trust. Making and publishing false news in social media about medical experiences and their impact on the health system is a major new topic for an important new issue study. One of the interests of governments is controlling the production and distribution of false news in social media. The researcher's observations showed that much of the rumor in the social media was linked to the health system; therefore, the study began. Materials and Methods: Interview and focus group were used for writing this research paper. The data obtained from it are used in the Grounded Theory method. Findings: The study showed that the lack of legal accountability for published content has led to rumored publication in social media with the lowest possible cost. The lack of proper information, the economic cycle of rumor and inefficiency, are the main factors behind the creation and dissemination of rumors about the health system which has reduced the confidence of the health system. The change in the media system towards flattening and the elimination of control mechanisms and goalkeeping of news, the health system, like other governance systems, weakened in news management. Ethical Considerations: This research paper uses data from a PhD thesis in Media Management at Islamic Azad University. Conclusion: The researcher propos that parts of the health system that are responsible for the health system brand management will understand the changes in the media system and increase their activity in the networking community.

Background and Aim: The commitment of community-based medical education system are moving towards the ideals of the health system upstream documents, providing ethical and community-based health services and implementing the community ethical values and celestial belief in medical science education. The basic Iranian-Islamic Model of progress developed as the uppermost document after the constitution. In order to state the values of the medical sciences progress model in Iran, the conformity of the values in the health system and the values in the basic model of progress is necessary. Materials and Methods: The upstream documents related to the health-care and medical education systems were selected purposefully and the value statement contents were analyzed critically. The relationship between the values in the health-related documents and the basic progress model and finally the values for the Iranian medical science progress model were determined. Studies Ethical considerations observed. Findings: All documents include specific values rooted in religious beliefs. Of course, there were different approaches to express these values. Comprehensive Health Map and the overall health policy are very rich in the statement of values. Ethical Considerations: All the ethical issues related to critical analysis of policy documents were observed. Conclusion: The proposed 12 key value for the country's medical science progress model, correlated with the value statement of the basic progress model. Believe in god, religious teaching, ethical virtues, human dignity, the right for maximum health, comprehensive health, spirituality, utility of aim and action, justice, accountability, social cohesion, scientific effort to reach to scientific authority are the values for the medical science progress model in I. R. Iran.

Background and Aim: Awareness of legal and moral obligations when providing pharmaceutical services can improve the quality of treatment and improving the patient's relationship with the pharmacist, increasing the level of cooperation, and reducing the patient's complaint from the pharmacist. Materials and Methods: Keywords (pharmacist-patient relationship) and (pharmacist-patient relationship history) and (pharmacist's role in health law) in internal and external databases PubMed, Magiran, IranMedex, SID, Direct Science and Scopus, all legal documents and legal texts And the basics of pharmacy ethics were searched in persian and English, between 2000 and 2019. Findings: A glance at the health service cycle specifies the need for the correct communication between the pharmacist and the patient because the pharmacist is the ultimate provider of health services, and if he does not do the right care, the efforts of other health professionals will be ineffective. In order to define the relationship between the pharmacist and the patient, the history of the field and its formation must begin. Determining the position of the pharmacist in the health system will also greatly help to define this relationship. Ethical Considerations: Honesty and trust in the selection and reporting of findings and citing texts were observed. Conclusion: Maintaining Dignity, Patients, Human Rights Medical ethics are parallel dimensions that are in the relationship between pharmacists and patients and, in turn, have a responsibility on the part of the government and health care providers, including medication, to ensure minimum standards in all Provide healthcare facilities, especially pharmacies.

Background and Aim: According to the importance of patience in mental health, the purpose of this study was to compare theeffectiveness of patience-based treatment plan with Cognitive-Behavior Therapy (CBT) on cognitive flexibility, psycho-social adjustment with disease, health locus of control and adherence to treatmentamong type 2 diabetic patients. Materials and Methods: The research design is a quasi-experimental test with pretest and post-test. The statistical population of this study was all type 2 diabetic patients referring to Shahid Motahari clinic of Shiraz-Iran from whom 60 patients were selected by available sampling method and randomly divided into two experimental and a control group (20 patients in an experimental group receiving CBT, 20 patients in an experimental group receiving patience-based treatment plan and 20 patients in a control group). Findings: The results showed that the mean of the two experimental groups' scores in cognitive flexibility, psycho-social adjustment with disease, internal health locus of control, and enehchdrh at acheaehda were more than those of the control group. This finding was indicative of the effectiveness of patience-based treatment and CBT. Moreover, the mean of the two experimental groups' scores in the powerful others health locus of control and the chance health locus of control were lower than those of the control group. This finding showed that patience-based treatment plan and CBT were effective in reducing external health locus of control. However, the mean of the experimental group receiving patience-based treatment plan in God health locus of control was more than that of the CBT and control groups and it indicated that receiving patience-based treatment plan increased the scores of God health locus of control among diabetic patients. Ethical Considerations: Ethical consideration related to the study was observed. Conclusion: According to the results showing the effectiveness of patience-based treatment plan, applying this treatment plan to promote mental health and adherence to treatment among diabetic patients is suggested.

Background and Aim: forgiveness can serve as an obstacle to the effects of negative emotions caused by couples' conflicts. The research aimed to evaluate the effectiveness of forgiveness training based on Islamic approach (Qur'an and Hadith) toincrease couples intimacy and its dimensions. Materials and Methods: In this semi-experimental study that was performed using both experiment and control groups, 20 couples that due to marital problems had referred to the counseling centers in Shahrekord City were selected using of random sampling method and randomly were replaced into two experimental and control groups. With the help of marital intimacy questionnaire, first, the amount of marital intimacy were measured before intervention on both the experimental and control groups (pre-test) and after 9 session intervention (forgiveness training based on Islamic approach) for the experimental group, the questionnaire was performed both groups (post-test) again. Data were analyzed using of descriptive statistics and Multivatiate covariance method. Findings: The results showed that compared with the control group, forgiveness training based on Islamic approach (Qur'an and Hadith) significantly increased couples intimacy and its six dimensions namely emotional intimacy, communication, religious, physical, psychological and overall dimension in the experimental group (P<0. 01). Ethical Considerations: Before the study, the goal of the study was explained to participants to participate full satisfaction. Conclusion: The results showed that forgiveness training based on Islamic approach (Qur'an and Hadith) could be used in planning therapeutic interventions.

Background and Aim: Researches have described nurses as poor communicators; therefore, it is essential to examine nurses' communication in different situations. Hence this study was done aimed to compare nurses' quality of communication with spouse, colleague and patient and its relationship with psychological strain and perceived work difficulty among nurses working in hospitals of Malayer. Materials and Methods: The present research was cross-sectional (descriptiveanalytical). The statistical population included all married nurses working in hospitals of Malayer in 2016 year that (115 subjects) were selected using simple random sampling method. Nurses' Quality of Communication Questionnaire, Psychological Strain Questionnaire (PSQ) and Work Difficultly Scale were used for gathering data. The one-way analysis of variance (ANOVA), Bonferroni and Pearson correlation and software SPSS 22 were used for analyzing the data. Findings: The results showed that there was a significant different between nurses' quality of communication with spouse with quality of communication with colleague and patient, respectively with average of 91. 08± 12. 42, 83. 45± 12. 39 and 81. 45± 13. 01 (F=18. 36, p=0. 001), but there wasn't significant different between quality of communication with colleague and with patient (p=0. 690). The correlation results showed that there was a negative and significant correlation between psychological strain with nurses' quality of communication with colleague (r=-0. 19, p=0. 049) and patient (r=-0. 30, p=0. 002). Also there was a negative and significant correlation between perceived work difficulty with nurses' quality of communication with patient (r=-0. 21, p=0. 030). Ethical Considerations: At first, a permissions was obtained from the Malayer Health Network and then, after referring to hospitals the voluntary participation in the research and hide personal information was explained to participants to participate satisfaction. Conclusion: According to findings of this study, nurses aren't poor communicators and they behave according to their audience and another factors and can suggested training and intervention on improving psychological strain and perceived work difficulty of nurses as an effective way on creasing their quality of communication.

Background and Aim: With regard to the importance of professional ethics’ role in organizational development and work life improvement, it is necessary to consider professional ethics principles in organization for determining effectiveness and directing human resources. The aim of this research is to investigate the effect of Islamic values on professional ethics with the mediating role of organization’ s code of ethics. Materials and Methods: This research is applied in terms of purpose and descriptive (survey) in terms of method. The statistical population of the study included all nurses working in government hospitals in Zanjan and 182 people were selected as a sample. Questionnaire was used for collecting data which is content validity and reliability (by using Cronbach Alpha) was approved. For measuring professional ethics, the questionnaire of Ghasemzadeh et al (2014) was used and for two other variables the researchers designed their own questionnaire. For testing hypotheses, structural equation modelling and PLS software, were used. Findings: According to the findings, Islamic values has a positive and significant effect on Nurses’ professional ethics and organization’ s code of ethics. There is a significant relationship between and organization’ s code of ethics and Nurses’ professional ethics. In addition, organization’ s code of ethics mediated the relationship between Islamic values and Nurses’ professional ethics. Ethical Considerations: In the period of data collection, respondents were assured that their opinions and responses will remain confidential and used only for analysis. Conclusion: Compliance with ethical principles will lead to nursing services improvement. Findings show that worth and importance of nurses work is more perceived when Islamic values on the time of service providing is considered.

Background and Aim: Attitude towards death is one of the most important factors affecting the ethics of care of health professionals. Because of their job nature, nurses are the first group to spend the most time with sick and overweight patients. The aim of this study was to determine the attitude of nurses in intensive care units to death. Materials and Methods: In this descriptive-cross sectional study in 2018, all nurses working in ICUs in Golestan University of Medical Sciences were studied in a census (156 subjects). The Wong’ s et al questionnaire was used to collect data. Data analysis was performed using SPSS software 16 and descriptive and analytic tests (linear regression). Findings: 77. 6% (121 persons) were female, 92. 3% (144 persons) with a bachelor's degree and mean age 32. 33± 7. 08, and 4. 50± 4. 06 years in the intensive care unit. The mean and standard deviation of total attitude toward death (150. 89± 23. 59) were in the areas of fear of death (33. 64± 7. 47), avoidance of death (21. 22± 6. 57), neutral acceptance (27. 41± 3. 54), active admission (49. 48± 9. 26) and admission with inertia (19. 13± 6. 76). Ethical Considerations: After expressing the goals of the study, the informed consent of the participants and the confidentiality of the information were assured to them. Conclusion: The findings indicate that the nurses had a neutral or active attitude towards death as it seems that nurses in intensive care units often encounter dying patients and their families during their clinical work. In forming such a positive attitude, death has not been ineffective.

Background and Aim: Diabetes, as the most common chronic metabolic disease, causes a crisis in the physical, psychological and spiritual aspects, which increases the use of spiritual resource as a coping mechanism. Spiritual health is one of the variables that enhance the dimension of spirituality the physical, psychological and spiritual aspects. Spiritual health coordinates different aspects of human life and it is necessary to adapt to the disease. This study aimed to investigating the relationship between spirituality needs and contextual Factors with spirituality well being in cancer patients. Materials and Methods: This descriptive study is Descriptive-correlation. The participants were 113 patients with cancer diseases (female 65, male 48) from Sari city selected through convenience sampling. The data were collected using the spirituality Well-Being scale, spirituality needs scale, Contextual Dimension scale. For data analysis, Stepwise regression analysis and SPSS 21 were used. Findings: There was a significant and positive correlation between scores on the components of Spiritual Needs and spirituality well-being, so that subscales of the Spiritual Needs such as "Religious needs" (P<0. 001), "Existentialistic needs” (P<0. 001), "need for Inner peace” (P<0. 001) and "Actively Giving needs” (P<0. 001) had positive correlation with Spirituality well being. And among all components of Spiritual Needs, Religious needs, Existentialistic needs, Actively Giving needs had a more predictive power in family flexibility. And also there were a significant correlation between dimension of “ behavioral "(P<0. 001), "Political"(P<0. 001), “ Governmental "(P<0. 001), "public health" (P<0. 001), “ Medical "(P<0. 001), "Employment" (P<0. 001) with spirituality well-being and among all these factors had the highest degree of variance in spirituality well-being. Ethical Considerations: All participants signed informed consent form before data collection. Conclusion: It is concluded that Spiritual needs and contextual dimension, as two psychological constructs, can play a significant role in creating spirituality well-being. Therefore, developing plans and approaches to address the patients' spiritual-religious needs and environmental factors influencing the disease to promote spiritual well-being of diabetic patients can be beneficial.

Background and Aim: Disruptive behavior includes any inappropriate behavior, conflict, and confrontation, ranging from verbal abuse to physical or even sexual harassment which results in the injury or intimidation of others. Purpose of this study was to evaluate the disruptive behaviors prevalence and atmosphere governing physiciansnurse relationships in the therapeutic community. Materials and Methods: This is a descriptive cross-sectional study in which 248 health care setting staffs of Isfahan teaching hospitals were enrolled in the study by whole sampling method. Data were collected through a researcher-made questionnaire on disruptive behaviors with multiple-choice questions during the year 2017. Data were reported using descriptive statistics in SPSS software. Findings: 163 (65. 7%) participants were female and the rest were male, 82 (33. 1%) were from Al-Zahra Hospital and 105 (42. 3%) were working in the emergency department. 212 (85. 5%) of the respondents witnessed disruptive behaviors by physicians as well as nurses and 200 (80. 6%) witnessed disruptive behaviors by other hospital staff. 17 (6. 9%) and 148 (59. 7%) of answerers were reported there is very positive and relatively positive relationship between nurse and doctor. Ethical Considerations: This article is the result of a research project approved by Code 292272 in the Research Committee of Isfahan University of Medical Sciences. Prior to the study, informed consent was obtained from all respondents. Conclusion: Since disruptive behavior has a high incidence among physicians and nurses and has a negative impact on their relationship, having an efficient management system for everyone and providing communication training is of paramount importance.

Background and Aim: Existing evidence indicated the association between spiritual health and health related quality of life (HRQoL) in individuals with chronic diseases. The current study is among the first conducted to investigate the association between spiritual health and HRQoL in a general population of Tehranian adult, using the structural equation model method. Materials and Methods: The current cross-sectional study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS). Participants were adults ≥ 20 years who participated in the TLGS during 2014-2016 and completed the spiritual health inventory in Muslim adults (SHIMA) and the Iranian version of Short-Form 12-Item Health Survey version 2 (SF-12v2). Structural equation modeling was used to assess associations between socio-demographic factors, spiritual health and HRQoL. Findings: The spiritual health questionnaire was completed by 1595 adults (56. 2% female) with a mean age of 41. 3± 12. 5 years. Of the total study population, 361(22. 6%) were single and 657 (41. 2%) had academic education. Mean total and subscale scores of spiritual health were significantly higher in women compared to men (p<0. 05). In addition, mean HRQoL subscale scores were significantly higher in men compared to women (p<0. 001). Fit indices of tested conceptual model for men and women were acceptable. Cognitive/ emotional dimension has a significant direct association with the mental dimension of HRQoL in both men (β =0. 37, p<0. 05) and women (β =0. 21, p<0. 05). Ethical Considerations: All participants signed informed consent form befor data collection. Conclusion: The current study indicated a structural model of association between spiritual health and HRQoL in Tehranian men and women, which can be used in future interventions with the aim of improving HRQoL in adults. To generalize these findings, further investigations in other urban and rural Iranian populations is recommended.

Background and Aim: Increasing the population of elderly people in the country, along with a variety of physical and psychological problems on the one hand and on the other hand, social developments, such as changing personal and family lifestyles, increase the number of elderly care institutions. Therefore, the purpose of this study was to consider the importance of the impact of the living environment on various aspects of mental health, comparison of spiritual Well-Being, tolerance of ambiguity and happiness in the elderly living in the home and the nursing home. Materials and Methods: The method of this research was a descriptive-causalcomparative study. The statistical population consisted of all elderly people in Shiraz in 2018. In this study, 60 elderly nursing homes and 60 elderly living at home were selected as the sample size. The elderly living in the nursing home were selected through convenience sampling and elderly living in the home were selected by the cluster sampling method. The measurement tools were the McLean tolerance of ambiguity type 2 Questionnaire, the Dehashiri et al. spiritual Well-Being Scale and the Oxford happiness Questionnaire. Data were collected using questionnaires using descriptive index and multivariate analysis of variance analysis in SPSS software 22. Findings: The results of Pillai's Trace of multivariate analysis of variance showed that the effect of group on spiritual Well-Being, tolerance of ambiguity and happiness was significant (Partial Eta Square=0. 875, P<0. 001, F(3, 116)=270. 31). Also, the results of multivariate analysis of variance showed that the mean scores of spiritual Well-Being (F=304. 29), tolerance of ambiguity (F=65. 64) and happiness (F=405. 31) were significantly lower in the elderly living in the nursing home than the elderly living in the home (P<0. 001). Ethical Considerations: Before the study, the goal of the study was explained to participants to participate full satisfaction. Also written informed consent was obtained from participants. Conclusion: The results of this study showed that spiritual Well-Being, tolerance of ambiguity and happiness in the elderly living in the nursing home is lower than the elderly living in the home. Therefore, family participation can be effective in providing welfare and mental Well-Being of the elderly, supporting officials with appropriate insurance coverage for the elderly, create a health care system at home and support for family caregivers to achieve a higher level of mental health in this group can be effective.

Background and Aim: Cancer is a threat to the health of human and not only has physical influences but vigorous psychological impacts on individuals. The aim of the present study was to investigate the Psychological Hardiness with hope of cognitive coping strategies in female patients suffering from breast cancer. Materials and Methods: The method of present research is descriptivecorrelation and the statistic population was 540 female patients, chosen from all cancer patients of the oncology ward of Shahid Bahonar Hospital of Kerman, who were selected by available sampling method. Participants filled out the questionnaires of Psychological Hardiness (Ahvaz), Hope (Miller), Pain coping strategies (Rosenstile and Keef) in this research. The model was analyzed by AMOS-24 software. The main principal of data analysis was predicated on structural equations and confirmatory factor analysis. Findings: The findings of this study revealed that the direct influence of two variables of cognitive coping strategies and Psychological Hardiness was 0. 78, for hope and Psychological Hardiness was 0. 41 and for hope against cognitive coping strategies was 0. 55 and to show the indirect effect, Bias-corrected percentile method test was utilized. And the test became statistically significant (P-Value<0. 05). Ethical Considerations: The informed consent of the participants was obtained and it was assured about the confidentiality of information. Conclusion: Based on the findings of this study, cognitive coping strategies, as mediating variable, can advance the impact of Psychological Hardiness on the hope of patients suffering from cancer.