Iranian Journal of Medical Ethics and History of Medicine

Omid Asmeni

Difficulties in using Western guidelines for breaking bad news in the emergency department: the necessity of indigenizing guidelines for non-Western countries

Amirhossein Jahanshir

Breaking bad news is one of the most difficult tasks an emergency physician has to perform and unfortunately it is not well studied. Almost all of the original studies for compilation of the guidelines of breaking bad news have been conducted in a non-emergent situation and were physician-oriented. In this study and by reviewing related articles in medical databases, the authors try to show the necessity of adapting these guidelines into the situation of the emergency departments and indigenizing them for non-Western countries. This can be the first step to design a guideline for the emergency department.The different nature of bad news and the chaotic situation in the emergency departments are the two most important points that may prevent using these guidelines in the emergency departments. On the other hand, breaking bad news guidelines are designed based on Western cultures and their application in a non-Western country may decrease their effectiveness.To the best of our knowledge, there is no national guideline for breaking bad news in Iran. There is a long way to go before we can suggest a national guideline for emergency departments, so we recommend using one of the Western guidelines and indigenizing it according to the Iranian culture and emergency situations.

Ethical analysis of physicians' participation in the legal punishment of convicts

Sajjad Azmand

Presence of physicians in different fields of the society has always been associated with ethical and legal considerations. Physician participation in legal punishment is one of the areas that are associated with different perspectives. In medical history, physicians and medical professionals have participated in legal punishment in different ways, but they have been directly involved with this process after the development of the lethal injection method. Proponents and opponents have discussed the ethical aspects of physician participation in legal punishment, and medical organizations have announced their viewpoints about this subject. In the Islamic Republic of Iran according to the Islamic punishment laws and their implementation regulations, physician participation in legal punishment is necessary, but the physician does not play a direct role in the execution of punishment. In this article we will study the main arguments of opponents and proponents as the background of the subject and will then evaluate the exact role of physicians in the execution of punishment in Iran and analyze the ethical aspects of this role.

Nurses’ lived experiences of preservation of patients’ dignity

Mohammad Ali Cheraghi

Considering and preserving patients’ human dignity is one of the most essential moral obligations in the medical and nursing professions. Indeed, respecting patients’ human dignity is the essence of nursing care which is frequently emphasized by national and international nursing standards.This study was conducted based on the qualitative approach, using an interpretive phenomenological method, which aimed to explore the meaning of patients’ dignity preservation based on nurses’ lived experiences. Using purposeful sampling method, a sample of 12 participants was chosen and the data were collected through 16 individual, in-depth and semi-structured interviews. The transcribed interviews were analyzed based on the hermeneutic approach using the analysis method proposed by Diekelmann, Allen and Tanner (1989). The mentioned interviews continued until no new meanings emerged and until the researchers were satisfied with the depth of their understanding. Through fusion of the horizons of the participants’ lived experiences and the researchers’ pre-understandings, the extracted meanings of patients’ dignity preservation emerged as: “respecting the equal human essence”, “providing professional patient-centered care” and “respecting the rights of patients’ companions”.The findings revealed that it is essential to respect the patients’ and also their companions’ rights and recognize the humanness and individuality of each patient for preserving and promoting patients’ dignity and providing more dignified care at the bedside.

Barriers to moral sensitivity: viewpoints of the nurses of educational hospitals of Sabzevar

Narjes Hashmatifar

Due to the development of societies and nursing sciences, complexity of the ethical situations that nurses encounter is increasing. Moral sensitivity is the first component of ethical behavior, but most of the nurses encounter many barriers in acquiring it. This study was an attempt to determine barriers to ethical sensitivity in nurses’ viewpoints in educational hospitals of Sabzevar in 2012.This descriptive cross-sectional study was conducted on a random sample of nurses working in hospitals affiliated to Sabzevar University of Medical Sciences, Iran (n = 125). Data were gathered through a questionnaire developed by the researchers containing 30 items in four categories of ethical sensitivity barriers including “managerial”, “environmental”, ”patient related” and “nurse related”. Validity and reliability of the questionnaire were assessed = α) 0.85), and data were analyzed by SPSS version 16.The most important barriers were “insufficient number of staff” (83.2%) in the management area, “inappropriate and intensive working shifts” (78.4%) in the nurse related category, “lack of awareness of nurses’ duties among patients” (84.8%), in the patient related category and “overcrowded wards” (76.8%) in the environmental area. The results of this study emphasize the importance of moral sensitivity barriers in all four areas of management barriers, environmental barriers, and barriers to nurses and patients, and could be of special interest to managers and health planners.

The relationship between management ethics and organizational commitment among employees of the Tehran University of Medical Sciences

Hossein Dargah

Observation of ethical principles by health care organizations managers can direct and control human resources. Moreover, organizational commitment is a type of emotional and fanatical dependence on the values and goals of an organization that can help preparing an appropriate background for employee development. Therefore, this research is aimed to determine the relationship between management ethics and organizational commitment among employees of the Tehran University of Medical Sciences. This is a cross-sectional, descriptive and analytical research conducted among the headquarters employees of the Tehran University of Medical Sciences. One hundred and fifty employees were selected as a research sample using the Cochran formula. The research tools were two types of standard questionnaires including organizational commitment and principles of ethics questionnaires that were completed by the employees. The response rate was 86%. The collection and analysis of data were performed by SPSS software. The results of this research showed that most managers of TUMS headquarters observed the principles of ethics and also most of the employees had a high level of organizational commitment. However, organizational commitment of TUMS employees does not appear to be influenced by managers’ observance of ethical principles, and it seems that other factors like organizational culture or organizational health could be correlated with employees’ organizational commitment. The authors recommend preparation of ethical charters and avoidance of instrumental usage of ethical principles by the managers in order to direct the employees to follow ethical guidelines and create a unified culture within the organization.

Disclosing medical errors and its relationship to disclosure of actual and hypothetical errors: nursing staff's attitude

Shourangiz Biranvand

Despite the efforts of health care practitioners, medical errors are inevitable. Disclosure of errors is patients’ demand and right. The aim of this study was to determine the nursing staff’s attitudes about disclosure of medical errors to patients and its relationship with disclosure of actual and hypothetical errors. In this descriptive cross-sectional study, 180 of the nursing staff employed in the educational hospitals of the city of Khorramabad were selected by non-probability quota and available sampling. Data collection tools were a valid and reliable questionnaire including some questions about the nursing staff’s attitude toward disclosing medical errors to patients, recording and reporting actual errors, and scenarios to investigate the tendency of nurses for reporting hypothetical errors. The data was analyzed SPSS software. The findings indicate that the mean score of the nursing staff’s attitude about disclosing medical errors to patients was 80.50 14.4. The mean score of the nursing staff’s attitudes toward recording minor actual errors (P < 0.02) and their tendency to disclose hypothetical errors causing minor injuries (P < 0.001), moderate injuries (P < 0.001) and major injuries (P < 0.003) were meaningfully more than those who did not tend to disclose errors. There was no significant difference between attitudes of nurses with a history of disclosing actual errors that lead to major harms to patients (P = 0.64) and those who did not report such medical errors to patients. Attitude of the nursing staff toward disclosing medical errors to patients was at a moderate level, which practically increases the probability of concealing errors.

Managerial and moral obstacles in reporting nursing errors: nurses’ view point

Hajar Sadeghi

Although errors in health services are harmful and the consequences might be irreversible in some situations, none of the health care providers are free of errors. Since health provision is the main goal of the nursing care, it is important to report professional errors in order to reach this goal. However, there are many obstacles in reporting nursing errors that should be identified and solved. The present study tried to evaluate the nurses’ point of view about managerial and moral obstacles in expressing nursing errors.Two hundred and one nurses of the educational hospitals of Sabzevar University of Medical Sciences were enrolled in this descriptive analytic study. The students were selected by convenience sampling method and the study data was collected using a questionnaire that consisted of a demographic part and a researcher made part with 13 and 27 questions related to managerial and moral obstacles respectively. Content validity index and reliability were measured by internal consistency (α = 80) and test-retest (r = 0.84). Data analysis was done by SPSS 18 software.The results of this study showed that the main reported managerial obstacle in reporting nursing errors was endangerment of academic position (43.3%), and the main moral obstacle was losing physicians' support (55.2%). Thus this problem might be solved by designing appropriate plans from both managerial and moral points of view.