Medical Ethics
Year:2022 | Volume:16 | Issue:47|Papers Count:31

Background and Aim: Human dignity is considered the basis of citizenship rights, which people enjoy as human beings. Today, in the light of the principle of human dignity, we have witnessed the emergence of intellectual procedures toward people with disabilities that have been formed based on the rules of citizenship rights. This study aimed to investigate three components of citizenship rights for the persons with disabilities, including the right to equal opportunities, the right to a job, and the right to education as the most effective citizenship rights to maintain the dignity of people with disabilities in Iran. Methods: This research is a narrative review, and its data collection is a documentary library method from reviewing 20 articles in Persian between 2010 and 2020 in various scientific journals. Furthermore, laws such as the Constitution, the comprehensive law on the protection of the persons with disabilities approved in 2013, the protection of the persons with disabilities approved in 2016, and the laws approved in the field of urban development have been reviewed. Ethical Considerations: The ethical considerations have been respected at all stages of research, including the study and data collection, documentation, and analysis. Results: According to the human dignity of the persons with disabilities, the process of formation, legislation, and the monitoring method of the disabled citizens’,rights are considered as the support requirements and concerns. Conclusion: In terms of rights and substantive guarantees of citizenship legal system, the status quo in the legal system of Iran is unable to provide a basis for equalization of opportunities on the right of city and the right to employment for persons with disability, and the desired situation is yet far to reach easily.

Background and Aim: In patient care provision, observing ethical principles is prior to care delivery and observing professional ethics is among the essential components of the nursing profession. Considering this important fact, the present study was conducted with the aim of prioritizing and investigating the degree of observing professional ethics values from the perspective of the nurses in the selected hospitals in Yazd in 1400. Methods: The present study is a descriptive cross sectional study, which was conducted in 2021 in the two selected hospitals in Yazd (A, B). The samples consisted of 100 nurses, who were selected through stratifiedrandom method. The data were collected using a researcher-made questionnaire, deriving from the 10-dimension Nursing ethical values approved by the Ministry of Health in 2011. The results were analyzed in SPSS 20 software using descriptive statistics (frequency, percentage, mean, and standard deviation). Ethical Considerations: The present study has been approved by the ethics committee. Ethical considerations have been observed, including completing the written informed consent form, voluntary participation, explaining the research objectives and ensuring data confidentiality. Results: Among the 10 dimensions of nursing ethical values, the nurses prioritized professional adherence (140±, 2. 03), compassion and kindness (120±, 3. 4) and promoting the awareness of professional regulations (115±, 1. 3), respectively. In addition, 79% of the nurses assessed the degree of observing ethical values as good. Conclusion: Considering the priority of ethical values, paying attention to professional adherence, compassion and kindness, and promoting the awareness of professional regulations in continuous nursing education programs can be effective in improving the quality of hospital performance and the degree of patient satisfaction.

Background and Aim: Moral awareness is a necessary and inseparable part of moral behavior. The behavior of employees can affect the ethical climate of the organization. The existence of an ethical climate causes the management of ethical values in the work environment, the cohesion and balance of the organizational culture. The present study was conducted with the aim of determining the effect of ethical climate on the moral awareness of employees of Shahid Beheshti University of Medical Sciences. Methods: This study was carried out by descriptive correlational method. A total of 278 administrative staff of Shahid Beheshti University of Medical Sciences was selected by stratified random method. The data were collected using the ethical climate and moral awareness questionnaires of Pusriadi et al. (2021). Data analysis was done using the structural equation model. Using Spearman correlation test for analysis by software SPSS 19. Ethical Considerations: The objectives of the research were explained to the participants and they were assured about maintaining the confidentiality of the data. Results: The results showed that the moral atmosphere has a positive and significant effect on the moral awareness of the administrative staff in the health field. In addition to the fact that the various components of the moral atmosphere (teamwork, friendship, organization's interests, rules and procedures, moral atmosphere and personal ethics have a positive and meaningful effect on the moral awareness of administrative employees), but the benefit itself has a negative and significant impact on the moral awareness of employees. Conclusion: According to the results of this study, strengthening the moral atmosphere towards team and collaborative approaches and paying attention to laws and regulations can increase moral awareness and then moral performance (r=0. 801, P=0. 001). Therefore, planning to improve the moral environment is essential.

Background and Aim: Depressive disorder is the second major health condition in the world. It has affected over 350 million people so far and the share of women is twice that of men. Group semantic therapy can be used as a new treatment for the depressed women with low ambiguity tolerance, concerns about body image and few metacognitive beliefs. The present study was conducted with the aim of determining the effectiveness of group semantic therapy on tolerating ambiguity and concerns about body image and metacognitive beliefs in the women with depression symptoms. Methods: The present research is a quasi-experimental study with a pretest-posttest control group design. Among the target statistical population, 30 women with depression symptoms in Borujerd were randomly placed into two groups: Intervention (15) and control (15). Ten sessions of group Semantic therapy were held for the intervention group. The research tools consisted of Sweden et al’, s Intolerance of Uncertainty Scale (IUS), Littleton et al’, s Body Image Concern Inventory (BICI) and Wells' metacognitive beliefs questionnaire. The tools were completed by the intervention group in both pretest and posttest stages. The data were analyzed using variance analysis method in SPSS 26 software. Ethical Considerations: The research objectives were explained to the participants and data confidentiality was ensured. Then informed consent was obtained from the participants. Results: The results showed that group semantic therapy has significant effects on tolerating ambiguity (F=14. 6, P<0. 05) and concerns about body image (F=11. 7, P<0. 05) and metacognitive beliefs (F=5. 6, P<0. 05) in the women with depression symptoms (p-value<0. 05). Conclusion: According to the results of this study, performing group semantic therapy can give meaning to individuals’,lives, increase their tolerance and metacognitive beliefs and reduce their concerns about body image. Therefore, planning to promote such training for the depressed is essential.

Background and Aim: Due to its being new and unknown, high prevalence and mortality rate, as well as creating fear and panic among people, the Covid-19 viral disease has left the world with no choice but finding its cure. One of the positive consequences of posttraumatic stress disorder is the occurrence of post-traumatic growth (PTG), during which the individual tries to reconstruct him/herself mentally and psychologically in order to return to the ideal conditions through his/her abilities and facilities. Religious orientation is an individual’, s overall approach to religion and the indicator of following or having a tendency towards religious teachings, which can be internal or external. Religious orientation is a unifying principle and a great force, which plays an important role in mental health. Therefore, the present study was conducted with the aim of investigating the relationship between religious orientation and post-traumatic growth in Covid-19 survivors. Methods: This research is a cross-sectional correlational study conducted on 222 Covid-19 survivors. The samples were selected through continuous sampling method from October to December 2022. The participants filled out an online questionnaire including three tools: A demographic questionnaire, the Religious Orientation Scale (ROS,Allport & Ross, 1967) and the posttraumatic growth inventory (Tedeschi et al, 1996). Descriptive statistics (mean and standard deviation, frequency distribution and numerical indices), inferential statistics (Pearson's correlation test) and SPSS statistical software version 26 were used for data analysis. Ethical Considerations: The research objectives were explained to the participants and data confidentiality was ensured. The informed consent was obtained from the participants. Results: The results of the present study showed that the total score of religious orientation was 86. 04±, 2. 91, the score of external religious orientation was 49. 02±, 1. 60, the score of internal religious orientation was 37. 01±, 2. 16, and the total score of post-traumatic growth was 80. 57±, 5. 61. In addition, the dimension new methods was 19. 49±, 2. 26, the dimension in relation with others was 26. 72±, 3. 13, the dimension personal strength was 15. 56±, 1. 97, the value of life dimension was 11. 05±, 1. 49 and the dimension spiritual change was 7. 73±, 1. 42. Moreover, there was a significant positive relationship between the variable of religious orientation (internal and external) and post-traumatic growth (total (p<0. 001 & r: 0. 342), external (p: 0. 002 & r: 0. 203) & internal (p<0. 001 & r: 0. 309)). Furthermore, there was a positive significant relationship between the dimension new methods of post-traumatic growth and total religious orientation. There were also significant positive relationships between the dimension in relation with others and post-traumatic growth personal strength and internal religious orientation and total religious orientation, as well as between post-traumatic growth value of life dimension and religious orientation (internal and external). However, there is no significant relationship between the dimension spiritual change and religious orientation (internal and external), (total (p: 0. 217 & r: 0. 083), external (p: 0. 225 & r: 0. 082) & internal (p: 0. 447 & r: 0. 051)). Conclusion: The findings of the research showed that there was a significant positive correlation between the two variables of posttraumatic growth and its dimensions and religious orientation (external and internal). The final findings of the present study indicated that religious orientation (internal and external) is an important factor in promoting post-traumatic growth. Therefore, it is necessary to take measures in hospitals in order to meet patients’,religious needs.

Background and Aim: Informed consent is the patient's voluntary and revocable agreement to participate in decision-making. In order to obtain an informed consent, the patient must be completely conscious and provided with sufficient information. This research has been conducted with the aim of determining how informed the consents obtained from the patients hospitalized in Shahid Beheshti Hospital, Babol have been. Methods: This cross-sectional study was conducted on patients hospitalized in the orthopedic and internal departments of Shahid Beheshti Hospital in Babol in 2021. Number of 424 patients were included in the study and Information was collected and recorded using of the checklist of demographic characteristics and patient awareness questionnaire about informed consent (regarding treatment). Data description and analysis was done using SPSS software version 18 and descriptive indices and T-test and ANOVA at a significance level of 0. 05. Ethical Considerations: In this study, ethical standards have been observed, including data confidentiality, obtaining informed consents, implementing the plan after having obtained approval and obtaining a code of ethics. Results: The mean total score of the patients' awareness of the informed consent form was 52. 2±, 4. 26. There was a significant difference in the level of awareness in patients belonging to different age groups (P=0. 037) and educational levels (P=0. 040). However, there was no significant difference in terms of the patient's gender, hospitalization department and type of treatment (P>0. 05). Conclusion: The patients’,level of awareness was calculated to be over 50 and close to the maximum score of awareness of informed consent (i. e. 60). The level of awareness was significantly different for different age groups and educational levels. The highest score of awareness belonged to agreeing to undergo a treatment and ensuring that the recommended treatment will be performed in order to recover,the lowest score of awareness belonged to the possibility of the treatment’, s being ineffective. In order to obtain more accurate results, it is recommended to conduct a multicenter study, a similar study on the patients undergoing a specific intervention or a systematic revie

Background and Aim: Justice sensitivity is a stable personality trait that relates to prosocial behavioral tendencies and altruistic orientation. Secure attachment and deep emotional bond with others will increase justice sensitivity in students and prepare the ground for academic honesty and efficiency of education system. Considering the role of this personality trait in healthy educational behaviors,the purpose of this study is to investigate the antecedents and outcomes of justice sensitivity in a frame of a causal model. Methods: The present study is descriptive and in the form of structural equation modeling in which, the attachment styles were considered as independent variables, justice sensitivity as a mediating variable and academic dishonesty as a dependent variable. Participants were 240 (boys and girls) M. S. Shiraz University students. They completed Justice Sensitivity Scale, Revised Adult Attachment Scale and Academic Dishonesty Scale. Factor analysis method was used to verify validity and the Cronbach Alpha was applied to determine the reliability of the scales؛ Also, bootstrapping method in AMOS 24 was conducted to examine the mediational effects of the intervening variables. Ethical Considerations: Participants completed the scales online after they were informed of the study aims and were ensured on paper that the responses would remain confidential. Results: Results showed that attachment styles were significant predictor of academic dishonesty through which secure attachment style was negative significant predictor of academic dishonesty (β, =-0/44, p=0/0001) and insecure attachment styles (avoidant and anxious) were respectively positive significant predictors of academic dishonesty (β, =0/13, p=0/0001) and (β, =0/36, p=0/0001). Results also revealed that secure attachment style predicted justice sensitivity positively (β, =0/41, p=0/0001) and avoidant style predicted justice sensitivity negatively (β, =-0/35, p=0/0001). Furthermore, results demonstrated that justice sensitivity mediated the relationship between attachment styles and academic dishonesty. In general,findings confirmed that secure attachment style decreases academic dishonesty through increasing the justice sensitivity. Conclusion: According to the hypothesis testing results, it can be concluded that Secure adults tended to hold positive selfimage and positive image of others,meaning that they had both a sense of worthiness and an expectation that other people were generally responsive and trustworthy. This means that secure students will apply effective and ethical strategies to achieve their educational goals and never intend to violate the rights of others to gain academic legitimacy.

Background and Aim: The social responsibility of managers includes various indicators such as legalism, moral responsibility, communication development, organizational leadership, financial and administrative affairs and innovation. The social responsibility of managers is one of the important issues in the field of organizational ethics, with the understanding of this important,the present study aims to Identification of indicators of social responsibilities of managers in Medical Sciences University of Mazandaran was done. Methods: This study is a mixed research (qualitative-quantitative). In the qualitative section, the method of qualitative content analysis with inductive approach was used and in the quantitative section, the descriptivesurvey method was used. The participants in the qualitative section were experts, faculty members and managers of medical sciences universities and the statistical community in the quantitative part included the employees of Mazandaran University of Medical Sciences. Sampling was done in the targeted qualitative section through interviews with 19 experts. In the quantitative section stratified random sampling method was used. 289 employees were selected as a statistical sample for investigation. The data collection tools included semi-structured interviews in the qualitative section and researcher-made questionnaires in the quantitative section. Validity and reliability of research data collection tools were confirmed. Data analysis was done through confirmatory factor analysis in SPSS 22 and Lisrel software. Ethical Considerations: Respecting honesty and trustworthiness, explaining the objectives of the research to the participants and ensuring the confidentiality of information are among the ethical principles of this study. Results: Based on the research results, Indicators of social responsibility model of managers in medical universities It includes eight indicators of legal responsibility, ethical responsibility, communication responsibility, organizational responsibility, administrative responsibility, financial responsibility, innovation responsibility, public responsibility. Conclusion: Indicators of social responsibility of managers as a management strategy can be used by managers in medical universities.

Background and Aim: Cultural humility is a life-long process which has a crucial role in enabling nurses to establish respectful intercultural relationships. Considering the importance of education in the formation of interaction-related skills, and the necessity of educational planning based on the related macro policies, this study was conducted with the aim of investigating how to pay attention to cultural humility in the official documents of nursing education upstream documents in Iran. Methods: The present study, which has been conducted using a qualitative approach and a directed content analysis method, has reviewed the document of transformation and innovation in medical education and nursing undergraduate curriculum. The semantic units were extracted after studying the documents repeatedly, and categorized based on Furanda's conceptual model. Then, based on the conceptual and logical correlation, the possibility of placing these categories in the main categories existing in the matrix, or the formation of new categories was investigated. Ethical Considerations: Trustworthiness in quoting the documents and unbiasedness, have been observed in all the stages of this study, including reviewing texts and documents, data extracting, analyzing, reporting and publishing the data. Results: Out of the 302 extracted codes, 122 codes were excluded due to the general nature. The remaining codes, considering the number of assigned codes, were respectively placed in the supportive interaction, openness, egoless, selfawareness, self-reflection, and criticism categories, which are among the features of cultural humility. Some codes were not placed in the above conceptual categories, but were separately placed in the attention to spirituality category. Only 52 codes were extracted from the practical part of the course curriculum, i. e. the course outlines. Conclusion: The findings indicate that although the existing documents have implicitly addressed the concept of cultural humility in their macro goals, but it has not been given clear and practical attention in the executive parts of the program. Moreover, some of the features of the concept of cultural humility, which are among the crucially important features of nurses, have been neglected. Therefore, it is recommended that the policymakers and the authorities pay more attention to putting achieving this important feature, nurses' cultural humility, into practice in the upstream documents.

Background and Aim: The present research has been carried out with the aim of examining the effect of wisdom management empowerment (organizational ethics and technological structure and infrastructure) and intellectual capital on organizational performance. In other words, this study aims at finding out how determining intellectual capital and wisdom management can be in the domain of organizational performance. Methods: The current research is a descriptive survey research. The statistical population of this research consists of the staff of this organization, whose number has been considered to be 700. Using Cochran's formula, 248 samples were selected. The data was collected through a standard questionnaire and analyzed using the structural equation model method and LISREL 8 software. Ethical Considerations: In this research, ethical principles were observed, i. e. confidentiality, informed consent and the participants’,right to withdraw from participating in the study throughout the research process. Results: The results showed that all the dimensions of wisdom management empowerment (organizational ethics, technological infrastructure and organizational structure) have impacts on organizational performance and that intellectual capital plays a positive role in this regard, too. Conclusion: According to the research findings, in order to improve wisdom management (organizational ethics, organizational structure and technological infrastructure), it is suggested to design organizational strategies and plans with high buoyancy in order for the staff to have the opportunity to create knowledge. It is also recommended that the staff be provided with the necessary training regarding the positive behaviors which lead to the creation of knowledge. Finally, it is a good idea to consider certain rewards for the staff as well.

Background and Aim: Today, pediatricians face many ethical challenges and dilemmas in clinical practice. The present study has been conducted with the aim of explaining these challenges in the domain of pediatric and adolescent care from the perspective of pediatricians. Methods: This study has been conducted through qualitative approach and content analysis method in 2022. The samples were selected using purposive sampling method and included 20 pediatricians working at Children's Medical Center Hospital, affiliated to Tehran University of Medical Sciences. The data were collected through indepth and semi-structured individual interviews and analyzed using the conventional content analysis approach. Ethical Considerations: In this study, consent was obtained from the participants before conducting the interviews and none of their names have been published. Besides, the study has been conducted under the code of ethics (IR. TUMS. CHMC. REC. 1399. 165). Results: Through analyzing the interviews, three categories of challenges were extracted: "The challenges faced by both children and adolescents", "The challenges exclusively faced by adolescents" and "The challenges existing in the pediatric intensive care unit". The challenges faced by both children and adolescents include three sub-categories: "The factors related to the healthcare staff", " The factors related to parents" and "organizational and policy making issues". The challenges exclusively faced by adolescents include two sub-categories: "The society-related problems" and "The problems related to the healthcare environment". The challenges existing in the pediatric intensive care unit include three sub-categories: "The mental and psychological effects of hospitalization in intensive care units on children, adolescents and parents", "The lack of resources and structural facilities" and "The problems related to dying and recently lost children". Conclusion: The results of this study indicate that many of the ethical challenges in pediatric medicine either stem from the healthcare staff or parents’,unfamiliarity with ethical and legal issues, or are the result of structural problems in the healthcare system such as the lack of executive policies and procedures or the shortage of resources and equipment. Therefore, paying attention to teaching these issues and explaining these policies and procedures, in line with the implementation of the law on the protection of children and adolescents and providing the necessary resources, is the main need and challenge that must be addressed.

Background and Aim: Considering the necessity of integrating medical education and the provision of medical services to patients, observing patient rights during medical education is a major challenge. Therefore, the present study was conducted with the aim of investigating the conflict between medical education and patient rights from the perspective of interns. Methods: This descriptive-analytical study was conducted at Jundishapur University, Ahvaz in 2021. The study population consisted of the medical interns who had passed at least six months of their internship period. The researcher developed a 5-point Likert scale questionnaire to conduct a survey among interns and the validity and the reliability of the questionnaire was confirmed. The data were analyzed using descriptive and inferential statistics tests in SPSS 26 software. Ethical Considerations: All ethical standards were observed during the research process, including ensuring data confidentiality and obtaining the participants’,consent. Results: Based on the participants’,answers, medical students’,level of awareness of patient rights charter was significantly lower than average, with the median of 3 (3-2) out of 5 and p-value=0. 022. In addition, the level of patient rights observance on the part of interns was significantly lower than the average, with the mean of 2. 68±, 0. 89 and p-value=0. 00. The lowest score belonged to ensuring the confidentiality of patients’,secrets and their medical records, with the median of 2 (3-1) and p-value=0. 001. The level of disruption in students' education due to the necessity of observing patient rights was significantly higher than average, with the median of 3. 25 (2. 3-75. 50) and p-value=0. 017. The highest score belonged to patients’,preventing medical interns from doing medical examinations, with the median of 3 (3-4) and p-value=0. 03. Conclusion: The results of the present study indicated that in the educational process, patient rights are observed less than average, and patients cause disruption in the educational process through preventing interns from doing medical examinations and not cooperating with them.

Background and Aim: By using digital health marketing, non-profit organizations, as the custodians of communicating between benefactors and those in need, can direct their marketing activities in a direction that will reach more supporters and benefactors and explore the good intentions of benevolent compatriots to help those in need. Build Therefore,the main goal of this research is to present the digital health marketing model in obtaining the support of donors from non-profit institutions. Methods: This study was conducted using a qualitative method of the grounded theory type. For this purpose, experts related to health marketing were used, including professors of marketing ethics, all experts of Akram, Mohsenin and people's partnerships of a non-profit organization and the sampling method was snowball and targeted until saturation was reached. Data analysis was done using the method of Strauss & Corbin (1998). Validation of the research findings was expressed with the four criteria of Guba & Lincoln (1985), which were measured and confirmed through the tests of acceptability, transferability, reliability and verifiability. Ethical Considerations: The participants in this research were aware of the topic and the method of conducting the research and their presence was informed, free and voluntary. Results: Based on this, by conducting interviews with some experts, 67 concepts directly or indirectly related to digital health marketing in obtaining donor support have been identified in 18 main categories, based on the data base paradigm model, in the form of six causal dimensions or the development of digital technologies (compatibility, ease of use, usefulness), central phenomenon or support (informational support, emotional support, social support), strategies or trust building (trust in institutions, trust in digital technologies, trust leading to donation), background factors (knowledge, resources, education), intervention or demographic characteristics (age, gender, education) and outcomes or trust building (opportunity, desire, performance) were structured. Conclusion: Digital health marketing is the missing link in attracting donors and sponsors. By using digital health marketing, non-profit organizations can direct their marketing activities in the direction of reaching more people and supporters. The set of advantages of digital technologies for donating is effective and causes the desire to use digital health marketing tools and tactics in obtaining the support of donors.

Background and Aim: Nursing students experience moral distress while facing complex moral problems, which has a harmful effect on nursing care. One of the factors which improve nursing performance is adherence to professional values. Therefore, this study was conducted with the aim of determining the relationship between moral distress and professional values in the nursing students of Mazandaran University of Medical Sciences. Methods: This descriptive correlational study included 210 nursing students from three nursing faculties of Mazandaran University of Medical Sciences, Mazandaran, Iran. The samples were selected through convenience sampling method. Data collection was done using 3 questionnaires: the demographic questionnaire, Hamric Moral Distress Scale-Revised (MDS-R) and Weis and Shank’, s Nurses Professional Values Scale (NPVS). The data were analyzed through the descriptive and inferential statistical tests. SPSS software 25 was used. Ethical Considerations: In this study, the standards regarding moral principles, such as confidentiality, Personal consent and the participants’,freedom to continue or quit cooperation during the study process have been observed. Results: Based on the main purpose of the study, Spearman's test did not show a significant relationship between moral distress and professional values (P=0. 251, r=0. 08). The mean of moral distress in nursing students was (92. 61±, 57. 30) and their moral distress was low level. The mean of professional values in nursing students was (79. 69±, 12. 09), which was moderate. The students assigned the highest value to the dimension of care and the lowest value to the dimension of pragmatism. There was no significant relationship between moral distress and demographic characteristics and only gender (p=0. 005) and place of residence (p=0. 028) showed a significant relationship with professional values. Conclusion: Although no significant relationship was found between moral distress and professional values in the intern nursing students, the nursing students' attention to the care dimension of professional values reflects the students' attention to the importance of care as the main professional duty of nursing, which can affect their performance.

Background and Aim: Tax evasion is one of the important financial issues that are affected by various factors. It seems that the extent to which taxpayers consider tax evasion as a moral issue has an effect on tax compliance. But this issue has not yet been agreed upon by experts. Therefore, the present study was conducted with the aim of determining the effect of ethical understanding of tax evasion on tax compliance of health service providers in medical sciences universities in Tehran. Methods: This study is descriptive and correlational. The statistical population of the research was the medical staff (medicine, paramedicine, dentistry and pharmacy) working in the universities of medical sciences in Tehran. 383 people were selected as the research sample based on Cochran's formula and simple random sampling method. The data collection tool was Kaliberg et al. 's (2008) and Waltin and Bettman's (2011) questionnaire, whose validity was calculated and confirmed by the face and content method and its reliability by Cronbach's alpha method. The obtained results were analyzed using the structural equation model and Smart PLS software version number 2. Ethical Considerations: In this study, the objectives of the research were explained to the participants and the confidentiality of the data was emphasized. The participants were free to answer the questionnaire. Results: The results showed that morally imagining tax evasion has a negative and significant effect on the tax compliance of health service providers (p<0. 05, r=-0. 524) Meanwhile, the dimensions of idealism, tax knowledge on Tax compliance has a positive effect, religiosity and education level have no effect on tax compliance and relativism has a negative and significant effect on medical staff tax compliance. Conclusion: The findings of this research help the tax policy makers to pay more attention to the ethical aspects of tax compliance and think of measures to prevent tax evasion.

Background and Aim: Whistle blowing is a new and important issue which needs organizations special attention in order to increase organizational health. Ignoring it can create many problems, which shows the importance and the necessity of this study. The purpose of this research is to investigate the relationship between ethical leadership and whistle blowing with the mediating role of work-related stress and the moderating role of interactional justice. Methods: The present study is descriptive-communicative research. The study tools consisted of the Ethical Leadership Questionnaire, the Whistle Blowing Scale, stress questionnaire and the Interactional Justice Scale. The study was conducted in the winter of 2022 and the sample consisted of 153 health system employees in Fars Province. To analyze the findings through 3 main hypotheses, structural equation method and Smart PLS 3 software were used. Ethical Considerations: In this research, the principles of research ethics have been observed through maintaining the publishing rules and the participants’,privacy, as well as committing to use the collected data only for appropriate and ethical purposes. Results: The research findings showed that there is a positive and significant relationship between ethical leadership and whistle blowing at the level of 65% with the significance less than 0. 0001. Furthermore, this relationship will be positively strengthened by the presence of interactive justice. Other findings also indicated that ethical leadership reduces stress in employees (with the significance less than 0. 0001) and this reduction in stress levels can increase the level of whistle blowing (with the significance less than 0. 0001), which confirms the mediating role of stress. Conclusion: Considering the findings as well as the importance and the sensitivity of the health system, besides creating safe and appropriate paths, it is necessary to pay more attention to its psychological and managerial aspects such as ethical leadership and interactive justice in order to reduce violations in medical organizations. Individual factors such as work-related stress are also necessary to be taken into consideration by senior managers and planners.

Background and Aim: Moral disengagement includes the cognitive mechanisms which are formed in the doer’, s mind while performing unethical actions or deciding not to perform ethical actions, which influences the occurrence of unethical actions or not performing ethical behaviors. The Present study aims to narratively review the studies that have examined the role of this variable in medical and nursing settings. Methods: Through Google scholar and PubMed databases, besides using the search section of the websites of the journals related to medical and nursing ethics, the keywords moral disengagement, medical ethics and nursing ethics were searched,the articles which had studied moral disengagement in medicine and nursing until 2022 were reviewed. Ethical Considerations: The results of the studies have been mentioned without bias, while observing trustworthiness in reporting the contents of the articles. Results: Moral disengagement was found to be prevalent among the nurses and the physicians. Moral disengagement was accompanied by decreasing moral reasoning, behaviors and traits, as well as increasing unethical and unproductive behaviors among the physicians and the nurses. In addition, these mechanisms increased in the medical environments with higher levels of stress, more perceived injustice and higher power. On the other hand, they decreased in managerial conditions in the form of moral leadership. These mechanisms were more prevalent among the physicians and the nurses who had stress, unstable moods, negative emotions, as well as the desire for power. Conclusion: Considering the modifiability of moral disengagement through certain educational interventions, it is necessary to add some lessons or courses in order to introduce and reduce the mechanisms of moral disengagement in academic programs and the in-service courses of doctors and nurses In addition, considering the role of variables such as job stress, perceived injustice and having uncontrolled power, it can be possible to reduce the aforementioned variables and consequently, moral disengagement through applying certain management reforms such as applying ethical leadership.

Background and Aim: Ethics in marketing and the use of up-to-date technologies are considered as two strategic factors in today's health tourism industry,therefore, the current research was conducted with the aim of designing a model of digital transformation of ethical marketing in the tourism industry. Methods: The current research method is qualitative and using the foundation data method. The data of this research was obtained through semi-structured interviews with the snowball technique, which reached theoretical saturation for interviews with eight expert university professors in ethical digital marketing and eight expert managers of the health tourism industry. After performing three stages of open, central and selective coding, the paradigm model of the research was developed. Ethical Considerations: In the different stages of design, collection and analysis of data and research findings, the principles and standards of ethics in research such as faithfulness to the text, referring to sources and observing the principles of scientific writing have been followed. Results: This research provides a comprehensive model regarding the digital evolution in ethical marketing in the health tourism industry and according to the goal of the Ministry of Health, Treatment and Medical Education regarding digital services, the health tourism industry as an industry based on international information and communication and the interior will be affected by digital technology very quickly. Conclusion: This research provides a comprehensive model regarding the digital evolution in ethical marketing in the health tourism industry and according to the goal of the Ministry of Health, Treatment and Medical Education regarding digital services, the health tourism industry as an industry based on international information and communication and the interior will be affected by digital technology very quickly.

Background and Aim: Safe and satisfactory delivery with the least pain experience is one of the important principles in providing midwifery services in any society and culture. The key point in the management of labor pain is the ethical commitment of the service providers. Therefore, this study was conducted with the aim of comparing the relationship between the observance of medical ethics on the part of the medical team during the delivery process and labor pain perception in the women having natural births from the perspective of the parturient women visiting the birthing centers in Yasuj and Shiraz. Methods: This research is a correlational descriptive study. The study population consisted of 400 parturient women visiting the maternity hospitals affiliated to Yasuj and Shiraz University of Medical Sciences in 2019. Sampling was done through convenience sampling method. The data collection tools included a demographic information questionnaire, the Perception of Labor Pain Questionnaire (PLPQ) by Yadollahi etal and Medical Ethics Attitude in Vaginal Delivery Questionnaire (MEAVDQ) by Mirzaee et al. The data were analyzed through SPSS 22 software using Pearson's correlation coefficient and regression analysis. The significance level was p<0. 05. Ethical Considerations: Ethical considerations were observed through completing the informed consent form, voluntary participation and explaining the research objectives. Results: According to the parturient women in the city of Yasuj (group 1), respect for autonomy (β, =-0. 530, P=0. 001) as well as the principles of beneficence and non-maleficence (β, =-0. 361, P=0. 002) were the negative predictors of the score of labor pain perception. However, according to the women in Shiraz (group 2), only the principles of beneficence and nonmaleficence (β, =-0. 267, P<0. 037) were the negative predictors of the score of labor pain perception. In addition, observing the principle of respect for autonomy was different from the viewpoints of the parturient women in the two groups (P=0. 006) Conclusion: Considering that the second and the third principles of medical ethics, beneficence and non-maleficence, are of equal importance in both cultures, the delivery team can reduce the severity of labor pain through paying complete attention to both the mother and the fetus, as well as avoiding unnecessary intervention in any culture. Therefore, it is possible to take a step towards promoting maternal and child health and prevent further irreparable psychological harm to mothers.

Background and Aim: Nurses, as members of the therapeutic team in health care centers, are faced with challenging decisions, moral issues and problems. The purpose of this study was based on examining the mediating role of cognitive flexibility in the relationship between Professionl Values and moral sensitivity among nurses during the corona epidemic. Methods: This study was a descriptive-correlational study. By applying quota convenience sampling method, 220 subjects were selected among the nurses working in Khatam Al-Anbia (PBUH) hospitals in Abarkooh and Imam Khomeini (RA) towns, Abadeh town in order to participate in the study. To collect data, The Weis and Shank (2009) Professionl Values Scales, Lutzen et al. (2006) and Dennis and Vanderwall (2010) Cognitive Flexibility Questionnaires were used. The Data were analyzed through Pearson's correlation test and structural equation modeling. Ethical Considerations: In this study, criteria concerned with moral principles as confidentiality, personal satisfaction and freedom of participants in cooperation or non-cooperation during the study process have been observed. Results: The findings of the study demonstrated that there is a positive and significant relationship between the variables of occupational values and moral sensitivity, Professionl Values and cognitive flexibility (P<0. 001). Moreover, it confirmed the mediating role of cognitive flexibility in the relationship between Professionl Values and moral sensitivity among nurses during the corona epidemic (P<0. 01). Conclusion: Considering the findings of the present study, in order to increase Professionl Values, it is recommended that appropriate strategies in line with addressing to the principles and criteria related to this variable, including social, emotional and economic support, especially in the nursing field, should be exerted to be strengthened their moral sensitivity by affecting their cognitive flexibility.

Background and Aim: Substance abuse disorders are a major concern in today's world, which have both emotional and physical impacts on substance abusers. A significant part of these complications is caused by marking these patients with stigma and labeling them. The analysis of the concept of stigma regarding substance abuse disorders was carried out with the aim of reaching semantic integration, reducing ambiguities and increasing stability in the application of this concept. Methods: This study was conducted with the aim of clarifying and analyzing the concept of the stigma of substance abuse disorders and determining its dimensions and characteristics, using the concept analysis approach of Walker and Avant in 2022. Ethical Considerations: In the current research, the ethical aspects of the review study, including the originality of the texts, honesty and trustworthiness, have been observed. Results: After analyzing the studies, the characteristics of the multi-dimensional psycho-social process were obtained: Pervasiveness in different areas of life, rapid spread in the society, being based on the socio-cultural context, dependence on the type and the quantity of substance consumption and being chronic. Conclusion: In this conceptual study, a comprehensive definition of the stigma of substance abuse disorders, along with antecedents, characteristics and consequences, was achieved through the process of conceptual analysis. The investigation of the findings eventually led to model, borderline and contrary cases. The presented definition, which is also supported by the literature, claims that the stigma of substance abuse disorders is a chronic, multidimensional psycho-social process, which is pervasive in different areas of the affected individual's life, along with rapid spread in the society. Moreover, it is based on the socio-cultural context and depends on the type and the quantity of substance consumption. The unfair and criminalizing practices of healthcare and non-healthcare organizations, the social beliefs regarding the undesirable identity of the affected individual, people's ignorance, the relatives’,lack of personal experience in dealing with the substance abuser, the socioeconomic power gap between the stigmatizer and the affected individual and demographic characteristics trigger stigmatization. Stigmatization leads to comprehensive vulnerability of the stigmatized individual’, s credibility and health in different aspects: personal, functional, family, social, cultural, economic and political. This definition as well as its antecedents, consequences and empirical references can be a basis for a more comprehensive perception and future applied studies.

Background and Aim: The corona pandemic, which was observed in China in December 2019, soon spread to other parts of the world and became a critical issue for the right to public health at the international level. The right to health is important and vital for societies today and one of the criteria and values in the principles of medical ethics is the observance of justice in equal access to health services,Prisoners, like other members of society, have access to it as a more vulnerable group of society whose law restricts some of their freedoms. The purpose of this study is to review the strategies of the Iranian legal system and international instruments on the right to health of prisoners and the principles of medical ethics in prisons and legal strategy to observe the principles of medical ethics in prisons in order for health policy makers to benefit from it during the corona pandemic. Methods: This research is of review type and its information has been collected by library-documentary method. Ethical Considerations: Ethical considerations have been observed in all stages of research, including the study and collection of data, their documentation, analysis and publication. Results: The research findings indicate that in the supra-legislative, legislative and sub-legislative norms of the Iranian legal system and binding and guiding international documents on the principles of medical ethics in prisons and the right to health of prisoners, general and specific regulations have been set to observe ethical rules in medicine. Prisoners can also enjoy the right to health as a human right. Therefore, health system policymakers can use them to expand the role of ethics in prisons and to support the health of prisoners. Conclusion: Based on the results, it can be said that observing the principles of medical ethics and paying attention to the health of prisoners during the corona pandemic in order to prevent Covid-19 virus and treat infected prisoners should be considered by health policy makers. Therefore, using the norms of the Iranian legal system and international documents, it is necessary to adopt regulations in order to standardize the ethical principles of doctors, nurses and health center staff in prisons to maintain the health of prisoners during the corona pandemic.

Background and Aim: Extensive and rapid changes owing to the arrival of new needs, along with technological innovations and the development of surgical and anesthesia techniques, has exposed surgical teams to various operating room ethical issues. Undoubtedly, offering a theoretical topic for a number of hours will not be sufficiently effective. The present study was conducted with the aim of comparing the professional ethics curriculums in the Operating Room Technology undergraduate program in Iran and in the similar disciplines in the selected universities around the world in order to identify the approaches to the revision of the existing program. Methods: The current research is a comparative study which was conducted based on Bereday’, s four-step comparative analysis method. After data collection, the data were analyzed using a researcher-made verification checklist based on Harden's integration strategy and the curriculum components. Then they were placed in a table according to the similarities and the differences. Next the key and important items were explained based on the research topic in order to identify the approaches to the revision of the curriculum of the operating room professional ethics in the country. Ethical Considerations: The present research has been approved by the Ethics Committee of Alborz University of Medical Sciences. Results: According to the results of the present study, in many universities, the professional ethics course is offered in the form of integration during the training course. This course is offered considering the educational goals in the theoretical and psycho-motor dimensions, in addition to the cognitive dimension, and using active teaching methods such as story writing, scenario-based, simulation, and group discussion, as well as the assessment methods such as conducting projects, recording experience writing, case study, reflection writing in the portfolio, and direct observation in addition to the written test is offered. Conclusion: In comparison to other universities in the world, the curriculum of professional ethics in the operating room in Iran has serious defects in various aspects, including educational strategy, educational goals, teaching methods and assessment methods, which require revision and basic reforms.

Background and Aim: In developing countries, two-thirds of people do not have access to psychotherapy insurance services. Nowadays, self-help mental health software, without supervision by a therapist, has increased dramatically among the young. The present study has been conducted with the aim of reviewing the ethical issues concerning the use of self-help mobile-based healthcare software in mental healthcare. Methods: In this narrative review, first, the articles indexed from 2000 to 2022 were searched in valid national and international databases: SID, PubMed, Science Direct, Web of Science and Google Scholar search engine. The keywords included e-health, mental health, intervention, software, internet, messenger, mobile phone, ethics, efficacy and self-help. Twenty-five articles were retrieved and reviewed. Then the ethical considerations were extracted and analyzed based on the four principles of biomedical ethics. Ethical Considerations: All ethical issues have been observed in this study, including unbiased citation, literature originality and trustworthiness. Results: According to the current study, the ethical advantages of self-help mental health software include availability, anonymity, equality opportunity, immediate support, ease, attractiveness for the user and costeffectiveness. They also have certain ethical disadvantages including the potential of being harmful, the need for internet literacy and access, ignoring the user's psychological characteristics, the user’, s lack of ability to recognize when he/she may require higher levels of psychotherapy, the possibility of not taking enough therapy sessions, the users’,lack of skill in choosing the proper software and the inadequate management of treatment motivation. Conclusion: Due to the potential of mental harm, this software must be used with the help and under the supervision of therapists. Personalization in the design of these software in accordance with the user's needs, cultural compatibility, moving towards game therapy, as well as determining its effectiveness by therapists are among the leading perspectives in this regard.

Background and Aim: Privacy is one of the essential human needs and respecting the patient' territory is one of the important duties of nurses. Most patients are not aware of their rights and nurses’,awareness and performance regarding the patient's privacy is at a moderate level in different hospitals. On the other hand, providing training programs for nurses leads to the promotion of respect for patients' privacy and their satisfaction. Therefore, the present study was conducted with the aim of comparing the effects of in-person and virtual narrative ethics training on nurses’,respect for the patient’, s privacy. Methods: This quasi-experimental three-group study was conducted on 93 nurses working at three internal wards of Imam Reza Hospital in Mashhad. The samples were selected using the random sampling method, through a lottery. Nurses of each ward were invited to participate in the study based on the inclusion criteria and using convenience sampling method. The instruments used in the study included a patient privacy questionnaire and a demographic information form. In the first intervention group, the nurses were divided into five groups and three one-hour in-person sessions were held for each group. In these sessions, standard narratives of the dimensions of privacy were presented. In the second intervention group, the nurses received training on privacy through a virtual messaging network. No training was provided to the control group. The patient privacy questionnaire was completed by all three groups both before the intervention and one month after it. The data were analyzed with SPSS 25 using descriptive statistical tests, Wilcoxon and paired t-test. Ethical Considerations: The present study was approved by the Ethics Committee of Mashhad University of Medical Sciences (IR. MUMS. REC. 1398. 079). Results: Before the intervention, there was no significant difference in the mean and the standard deviation of respect for privacy among the three groups (P=0. 952). After the intervention, the mean and the standard deviation of respect for privacy had increased in both in-person and virtual training groups compared to the control group (P<0. 001). The study findings showed that there was no significant statistical difference between in-person and virtual training (P=0. 256). Conclusion: The findings of the present study showed that in-person and virtual narrative ethics training have similar effects on the respect for the patient's privacy. Therefore, in situations where it is not possible to hold in-person sessions, the necessary training on patient privacy can be provided virtually.

Background and Aim: Observing the ethics of the nursing profession has an effective role in providing quality care. The present study was conducted to determine Knowledge and practice of nurses regarding the standards of professional nursing ethics. Methods: This descriptive cross-sectional study was performed in 2020 by 392 nurses from teaching hospitals affiliated with the Sabzevar University of Medical Sciences in Iran. Nurses were selected by the simple random sampling method and to collect data, two questionnaires were used to assess the knowledge and practice of nurses to comply with nursing ethical standards. Data were analyzed by SPSS software 16 and descriptive statistics (mean and standard deviation, frequency) and inferential tests (correlation coefficient, regression). The Significance level was considered less than 0. 05. Ethical Considerations: To participate in the study, informed written consent was obtained from the participants. Necessary information was given about the nurses being free to participate and leave the study. Results: The average knowledge of nurses about compliance with ethical standards (17. 2±, 4. 81) and their average performance was by ethical standards (130. 88±, 9. 11). Pearson correlation coefficient indicated a positive and significant relationship between nurses' knowledge and practice of adhering to ethical standards (P<0. 05, r=0. 65). The nurses' knowledge (R2=0. 26) significantly predicts their performance in terms of ethical standards. The non-standardized beta value showed that the share of knowledge in predicting nurses' performance is (2. 54). There was no significant relationship between the average knowledge and practice of nurses and demographic characteristics (P>0. 05). Conclusion: The efforts of systems to improve the awareness of their nurses can play an influential role in improving their performance in line with ethical standards in the clinical environment. Continuous training programs can play an important role in sensitizing nurses in the face of ethical issues and therefore improve their performance according to ethical standards.

Background and Aim: Moral sensitivity, as the cornerstone of nursing ethics, paves the way for nurses to provide effective and ethical care to patients. One of the examples of ethical care is paying attention to patients’,rights and supporting them. The present study was conducted with the aim of investigating the correlation between moral sensitivity and patient advocacy in the nurses working at the hospitals affiliated to Mazandaran University of Medical Sciences in the city of Sari. Methods: This cross-sectional study was conducted on 140 nurses working at internal, surgical and intensive care departments of the hospitals affiliated to Mazandaran University of Medical Sciences in Sari from January to May 2022. Sampling was done through simple random sampling method. The data collection tools included Lutzen et al. 's moral sensitivity questionnaire and Hanks' Protective Nursing Advocacy Scale. The data were analyzed through descriptive tests and Pearson's correlation coefficient using SPSS 16 software. Ethical Considerations: In this study, the ethical principles including maintaining confidentiality, obtaining a personal consent and the participants’,freedom of choice to cooperate or not during the study process were observed. Results: The mean score of moral sensitivity was 69. 04±, 7. 39 and that of patient advocacy was 154. 71±, 13. 83, both of which were at moderate level. There was a positive and significant correlation between moral sensitivity and patient advocacy (r=0. 573 and P<0. 01). The results of the regression test showed that moral sensitivity explains 57. 3% of the variance of the variable of patient advocacy. Conclusion: Both moral sensitivity and patient advocacy were at moderate level in the nurses, and there was a positive and significant relationship between them. In order to promote positive outcomes in the patient achieve optimal care and act as a patient advocate, it is necessary to pay attention to moral sensitivity in nurses. Moreover, paying attention to the approaches to increasing it seems to be crucial and indispensable.

Background and Aim: Nurses’,ethical values in today's complex world have made ethics a vital and important issue. These values arise from nurses’,philosophical approaches and are influenced by the prevailing philosophical thinking in each historical era. Considering that several decades have passed since the postmodernism era, a comprehensive study of the effects of this school of thought on the ethical values in the nursing profession seems to be necessary. Therefore, the present study was conducted with the aim of investigating nursing ethical values from the postmodern perspective. Methods: This is a scoping review study, which was conducted based on the five stages suggested by Arksey and O'Malley in 2005. The articles published from 2000 to 2021 were searched in Magiran, SID, PubMed and Web of Science databases, as well as Google Scholar search engine using MeSH terms. The keywords included nursing, ethics, ethical value, nursing ethics, postmodern and postmodernism. Out of the 170 articles obtained, 9 were included in the study, based on the inclusion and exclusion criteria, after a two-phase review: first, the title and the abstract and then the whole article. Ethical Considerations: Honesty and trustworthiness was observed in the analysis, reporting the texts and citing. Results: The articles used were in English, qualitative, narrative analytical and case studies. The focus of the current studies was on issues such as relational narrative and its nature, ethical values and how to make decisions based on these values. Therefore, the findings of the present study are divided into two categories: "the basic role of relational narrative in postmodernism ethics and its effects" and "decision making and nursing ethical values in postmodernism compared to the previous perspectives, emphasizing positivism". Conclusion: From the perspective of postmodernism, ethical values emphasize considering each care recipient in his/her own cultural, social, political and economic contexts, maintaining the care recipient’, s autonomy, developing a holistic view in nurses, avoiding discrimination in care provision and nurses’,providing humanitarian and empathetic care.

Background and Aim: In the intensive care unit, moral distress stands for one of the major problems of nurses that may be caused by various reasons. In the long term, job burnout is one of the serious consequences of moral distress. The current study was carried out aiming at determining the association between moral distress and job burnout of nurses working in the intensive care units of hospitals affiliated to Zanjan University of Medical Sciences in 2021. Methods: This was a cross-sectional descriptive correlational study. A total of 350 nurses working in all intensive care units of hospitals affiliated to Zanjan University of Medical Sciences in 2021were selected by total population sampling method. Data collection tools included Hamric’, s Moral Distress Scale-Revised (MDS-R) and Maslach Burnout Inventory (MBI) Manual. The data was analyzed by means of descriptive inferential statistics and through SPSS 20 software. Ethical Considerations: The present study was approved by the ethics committee. Ethical considerations were observed, such as completing the informed consent form, voluntary participation and explaining the research objectives, as well as ensuring the confidentiality of the information. Results: The nurses in question had an overall mean of moral distress equal to (116. 47±, 49. 79), indicating a low level of moral distress. Moreover, the burnout in nurses working in intensive care units had a medium level of emotional burnout (31. 76±, 5. 41), a high level of depersonalization (13. 45±, 4. 77) and a low level of personal success (26. 24±, 5. 61). The results revealed a significant and direct association between moral distress and the depersonalization dimension of job burnout (r=0. 18, P<0. 001), besides its significant and inverse association with the individual success dimension of job burnout (r=-0. 17, P<0. 001). Conclusion: Given the association between moral distress and job burnout in intensive care units’,nurses, the officials of the medical centers are required to formulate strategies like periodic review of this phenomenon besides arranging training sessions to take steps in the field of how to deal with ethical distresses in the wards to decline their impacts on the care of patients as well as preventing burnout among nurses.

Background and Aim: Although fear of illness recurrence and negative illness perceptions can significantly undermine the quality of life of cancer survivors and increase their physical and psychological fatigue as well as anxiety and depression, few studies have introduced effective treatments for adjusting the perceptual-psychological factors involved in breast cancer. While, spirituality is an important factor for adapting to stressful conditions caused by chronic diseases, ensuring physical and psychological health as well as hope of patients and consequently improving the health condition of patients. The present study was an attempt to investigate the effect of spiritual therapy on the fear of illness recurrence and negative illness perception among women with breast cancer. Methods: The present research falls within the category of semi-experimental studies with a pre-test, post-test control group design and two-month follow-up. Population of the study consisted female breast cancer patients subjected to chemotherapy who referred to the specialized and subspecialized breast pathology center of Jihad In Iran during winter of 2021. 30 patients were selected through convenient sampling and randomly assigned to two groups: intervention and control groups (n=15). The fear of cancer recurrence and the perception of the illness were measured using the Simard & Savard’, s FCR Inventory and Broadbent’, s IPQ before, after and two months after the intervention, respectively. The intervention group received spiritual-religious psychotherapy for 12 sessions (each 120 minutes) individually, but the control group did not receive any intervention. Data analysis was done using repeated measure ANOVA and Bonferroni's post hoc test (α, =0. 05) within the framework of SPSS 24 software. Ethical Considerations: After obtaining the code of ethics, the researcher went to the research sites and obtained the written informed consent of patients by introducing the objectives and nature of the research as well as the implementation and intervention techniques. Results: The results suggest that spiritual therapy has a significant effect on mitigation of the fear of cancer recurrence and improvements in the illness perception of women with breast cancer (p<0. 001). The mean difference between pre-test, post-test and follow-up was significant in both mentioned variables (p<0. 001), however, the mean difference of post-test and follow-up stages in terms of fear of cancer recurrence and illness perception was not significant (p>0. 05). Conclusion: According to the findings, spiritual therapy has a lasting effect on mitigation of the fear of cancer recurrence and improvements in illness perception of women with breast cancer. Thus, health professionals can effectively apply this treatment method to female breast cancer patients with fear of illness recurrence or a negative illness perception to help them improve their physical and psychological health.

Background and Aim: Moral distress is one of the important issues in the field of medical ethics, which can have different effects on nurses, patients and the health systems. Considering that one of the consequences of moral distress may be professional stress, the present study was conducted with the aim of determining the relationship between moral distress and professional stress in the nurses caring for the patients with Covid-19 at Tehran University of Medical Sciences. Methods: This descriptive-correlational study was conducted, with a sample size of 265, on the nurses working in the Covid-19 departments at the hospitals of Tehran University of Medical Sciences in 2021. Sampling was done using stratified and simple random methods. Data collection was done using a demographic questionnaire, Corley Moral Distress scale and Wolfgang professional Stress scale. The data were analyzed by SPSS 16 software using descriptive (percentage, frequency, mean, standard deviation) and inferential (Pearson correlation coefficient) statistical tests. Ethical Considerations: In this study, ethical principles were observed, including confidentiality, personal consent and the participants’,freedom of choice regarding whether they wish to cooperate or not during the study process. Results: The results indicated the low to moderate level of moral distress, with the mean standard deviation of 99. 52±, 26. 32, as well as high level of occupational stress, with the mean and standard deviation of was 80. 32±, 10. 40. Moreover, the results showed that there is a relationship between moral distress and professional stress in the nurses working in the Covid-19 departments (r=0. 416, <0. 001). Conclusion: According to the obtained results, it is suggested that nursing managers consider strategies to cope with moral distress by nurses in order to experience less professional stress.