Iranian Journal of Medical Ethics and History of Medicine

Development of charter of rights in medical diagnostic laboratories

Nooshafarin Safadel

Medical laboratory services and its clients are somehow different from services of the other sectors in the health system. Patient’s Rights Charter, published by the Ministry of Health and Medical Education, was comprehensive, but addressing specific aspects of the related areas in medical laboratories could promote the commitment and dedication in laboratory professional services hence, development of the Patient’s Rights Charter in medical diagnostic laboratories was put on the agenda. After a comprehensive review of existing references and resources, a committee was formed consisting of representatives of laboratory associations and experts in this field, and the draft was prepared. Thereafter several meetings and workshops were held and the members of legal organizations, medical ethics experts as well as laboratory stakeholders, technical staff and laboratory directors attended these gatherings where the draft was surveyed and comments were received. The draft underwent some changes and was edited. Finally in August 2012, the charter was approved by the Health Policy Council of the ministry and in October 2012 was officially announced by the health minister.To be consistent with the context of the Patient’s Rights Charter, essentials of this bill have been based on 5 pillars: access to appropriate laboratory services, access to information in a sufficient and effective manner, the right to choose and decide freely, respect for customer privacy and the principles of confidentiality and integrity, and availability of an efficient system for investigating complaints and suggestions.Developing and delivering the bill of rights for health services recipients is one of the foremost matters, but implementation of the provisions of the charter and monitoring of its effectiveness are the most important goals ahead. Therefore, an effective strategy to implement the rights of patients in medical laboratories should be designed and established.

Moral distress and its relationship with professional stress in nurses

Mostafa Roshanzadeh

Moral distress is an important issue in the field of medical ethics that can have serious effects on nurses, patients and health organizations. One of the most common effects of this phenomenon is professional stress in nurses. Stressful situations in nurses’ job environment lead to burnout and dissatisfaction, and adversely affect the quality of care.This was a cross-sectional study aimed to determine the relationship between moral distress and professional stress in 220 nurses of educational hospitals in the city of Birjand. Data were collected using a 51-item questionnaire based on Corley’s Moral Distress Scale and Wolfgang’s Health Professions Stress Inventory. Reliability and validity of the questionnaire were assessed by the researchers, and its reliability was calculated using Cronbach’s alpha (93%).The results indicated a positive relationship between moral distress and professional stress (P<0/05, r = 0/8). Intensity and frequency of moral distress and professional stress were reported average.Moral distress and professional stress were reported at a frequency and severity of moderate size. Findings of this study can provide guidelines for educating nurses on this phenomenon and the conditions leading to it. They may also be used to develop management strategies and establish organizations to prevent and minimize the consequences of these phenomena in nurses.

Development & psychometric properties of the social dignity questionnaire in heart failure patients

Faride Yaghmaei

Heart failure not only affacts the patients but also their families and social networks. This study was conducted to evaluate the development & psychometric properties of the Social Dignity Questionnaire (SDQ) in heart failure patients. This study is an exploratory research of questionnaire design type. Twenty two patients with class II to IV heart failure (New York Heart Association Functional Classification) were chosen through purposive sampling from selected hospitals of Tehran, and semi-structured interviews were conducted with them. Qualitative content analysis was performed to analyze the interviews. The primary items were developed based on the findings obtained from the interviews, literature and designed questionnaires about social dignity. Content validity and construct validity were determined in 130 patients with heart failure. The data were analyzed using SPSS version 19. Through face validity and content validity analysis, 16 out of 101 primary items were removed. As a result of exploratory factor analysis, 2 items with factor loading less than 0.5 were deleted, and 6 were removed due to inclusion in other factors. The following five factors were extracted: family communication and support, social communication and support, health care communication and support, burden to others (physical, emotional and social), and burden to others (economic). Reliability of the Social Dignity Questionnaire (SDQ) was calculated to be 0.97 by using Cronbach’s alpha coefficient, and 0.99 by using split-half method.Considering the acceptable validity and reliability of the questionnaire in the present study, its application can be useful in planning support for patients and improving their treatment and care. The questionnaire may also be helpful in conducting further research related to dignity in different patients

Development and psychometric properties of Inherent Dignity Questionnaire in heart failure patients

Faride Yaghmaei

Respect for the inherent dignity of human beings means respecting their basic rights in different environments, and this has an important role in studies and discussions about health care. This study was conducted on the development and psychometric properties of the Inherent Dignity Questionnaire (IDQ) in heart failure patients. The present study is a methodological research for designing a questionnaire. First, 22 patients with class II to IV heart failure were chosen by purposive sampling from patients of Hazrate Rasoule Akram, Imam Hossein and Shariati hospitals of Tehran, and semi-structured interviews were conducted on ethical issues until data saturation was achieved. A qualitative content analysis was carried out to analyze the interviews. Then, based on the findings obtained from the interviews, literature, and the designed questionnaires about inherent dignity, 39 items associated with inherent dignity in heart failure patients were developed. The face validity of the questionnaire was determined. To measure the content validity of the questionnaire, opinions of 12 experts were used considering Content Validity Index (CVI), Content Validity Ratio (CVR) and Lawshe table. To assess construct validity of the IDQ, exploratory factor analysis and to determine the reliability of the questionnaire, internal consistency with Chronbach’s alpha coefficient and split-half method were used on 130 patients with heart failure. The data were analyzed using SPSS version 19.Through face validity and content validity analysis, 4 out of the 39 primary items were removed, leaving 35 items. Through exploratory factor analysis, 11 items with factor loading less than 0.5 were removed and the IDQ was created with 24 items and three factors (9 items on the first factor, 8 items on the second factor and 7 items on third factor). These factors were: "inherent dignity in family", "inherent dignity in the community" and "inherent dignity in health care environments". Reliability of the Social Dignity Questionnaire (SDQ) was calculated to be 0.94 by using Cronbach's alpha coefficient, and 0.96 by using split-half method.Results of this study showed that the IDQ is adequately valid and reliable. Therefore, using this questionnaire can be beneficial to planning support for patients and improving their treatment and care and doing further research related to dignity in different patients.

Nursing’s code of ethics: a survey of respecting the code among nursing students

Hadi Jafari manesh

Assessing nursing students’ level of respect for ethical codes of nursing is essential as these students are the future health care providers. There is a need to check observance of ethics codes among students, because that will determine ethics education and training needs. This study aimed to assess nursing students’ compliance with professional ethical codes and some of the relevant factors.This is a descriptive-analytic and cross-sectional study performed by census on 118 nursing students who were training in hospitals of Shahid Beheshti University of Medical Sciences. The data gathering tool consisted of a questionnaire including demographic information, and another questionnaire which was developed by the researcher based on studies in Iran and throughout the world.The ethical codes that were respected most included "principles of conflict management" and then "respect for the medical staff". "Respect for patients' rights" and "patient education" received less consideration. Grade point average, gender, marital status, interest in nursing and likelihood to work in nursing had significant association with respect for ethics codes.The results of this study can be used in developing courses on nursing ethics and educating nurses on the subject, and could be of special interest to health planners and policy makers.

Moral Dilemmas and Realistic Vision in the Field of Health with regard to Confidentiality

Zeinab Jannat Makan

Secrecy or confidentiality has always been considered a crucial issue in the medical profession. Secrecy is a common and essential principle among patients and physicians, and is highly emphasized in professional ethical codes and guidelines.This case report is based on an actual case in Medical Ethics Grand Rounds in Tehran Children's Medical Center, with a glance at the boundaries and challenges of keeping and revealing the secrets of the patients.Case Scenario: In this report, a neonate with withdrawal symptoms was admitted to the hospital. After routine examinations by the medical team, they found the neonate’s mother was addicted and had concealed her addiction from her husband and her family. To facilitate treatment of the infant, they discussed the matter with the mother in order to get accurate information. The mother’s denial on one hand, and the need for accurate and comprehensive information necessary to begin treatment on the other caused a challenge to keeping or disclosing the mother’s secret. Here the medical team assumes responsibility to obtain the information from the mother, convince her and win her cooperation, and finally share the secret with the spouse to help their ill neonate.Although respect for patients’ confidentiality is an imperative issue for physicians and healthcare workers, it is not an unequivocal requirement. Due to logical and religious reasons and based on each specific case, it is necessary to make decisions that are more reasonable and less harmful to the patients and their families. Naturally the staff is required to keep the secrets of their patients permanently.

Medical confidentiality

Sedigheh Ebrahimi

Confidentiality is an inevitable pillar of the history of the physician-patient relationship. Misunderstanding of this principle not only causes harm to sanctity of the medical profession, but also can damage the quality of the therapeutic relationship, and more broadly public health. The keystone of this negative effect is the potential harm to the patients’ trust and confidence. Generally, the Western school tends to agree that respecting patient confidentiality is essentially desirable. Islam also respects and emphasizes confidentiality, and has general and some specific recommendations about the importance of secrecy and concealment of people’s secrets. Overall, despite strong agreement about the importance of the principle, some ethical theories do not insist on maintaining confidentiality under any circumstance. This paper is an attempt to describe the importance of confidentiality in the medical profession considering the approach of both absolutists and relativists in practice.Absolutists believe that the intrinsic desirability of implementing the principle of confidentiality in all cases is the same and without any exception, but the issue is about not giving just priority to other conflicting moral values.Additionally, the absolutists believe that breaching this principle in practice cannot be permissible due to some serious long-term and mostly hidden complications such as patients’ failure or delay to seek medical assistance or advice and/or withholding important information and so forth. Overall, according to empirical evidence and rational considerations, adherence to absolute confidentiality seems more desirable to absolutists. Unlike absolutists, in relativists’ concept of confidentiality, insisting on maintaining the secret will not be allowed in certain cases, and those cases are considered exceptions of the rule of confidentiality.The most important reasons for falling into the wrong orientation of relative confidentiality seem to be precipitance to attain the desired result, poor communication skills, ignorance of the consequences, and being headstrong.

The effect of motivational factors in providing holistic care: a qualitative study

Madineh Jasemi

Holistic care is a comprehensive approach for achieving optimal level of care for patients. Identifying the motivational factors can increase quality of nursing care and improve the healing process. Investigation of nurses’ experiences will provide real and meaningful results in this field. In this study we aimed to explore nurses' experiences regarding holistic care.This qualitative study was conducted on 18 nurses from Uremia, Tabriz, Ardebil and Tehran teaching hospitals of Iran. The data were obtained by interviews with nurses. These interviews were transcribed and analyzed by the conventional content analysis method and using MAXQDA software.Personal characters and experience of hospitalization were identified as motivational and promotional factors in providing holistic care.Considering the role of personal characters and experience of hospitalization in holistic care, paying more attention to nurses’ characteristics and upgrading their communication skills and knowledge are necessary for development of holistic care and are highly recommended.