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Showing 38 results for Type of Study: Poster
Defenders without a Defense: Factors Associated with Ethical Conflict in the Context of Nursing Care
Ebrahim Falahati, Mousa Alavi, Mohsen Shahriari,
Volume 17, Issue 0 (12-2024)
Abstract
While ethical conflict is an internal and individual experience, it is significantly influenced by environmental factors and variables. It describes a situation characterized by a discrepancy or conflict between the ethical values of caregivers, between caregivers and patients, or within the individual caregiver regarding the morally right course of action, often leading to ambiguity regarding duties and obligations. This research aimed to elucidate the factors associated with ethical conflict within the nursing context. This qualitative study employed conventional content analysis. Participants included 27 nurses working in various clinical departments, including emergency, intensive care, internal medicine, and surgery. Data were collected through in-depth semi-structured individual interviews conducted after obtaining written informed consent. Data analysis was performed using MAXQDA version 20 software, adhering to Granheim and Lundman's approach. To enhance the rigor of the study, the criteria of credibility, confirmability, dependability, and transferability proposed by Lincoln and Guba were applied. Decision-making challenges within the context of care emerged as a central theme. Several factors were identified as contributing to ethical conflict in nursing care, including disrupted relationships, inefficient management systems, physician prioritization, conflicts of interest, legal constraints, a negative ethical climate, and insufficient resources. Nurses, as primary patient advocates, are consistently exposed to various ethical conflicts within their practice. This study highlights the critical importance of addressing decision-making challenges within the context of care for policymakers within the healthcare system. Reducing these conflicts is crucial for improving the quality of nursing care.

The Dignity of the Elderly: The Missing Link in the Search for Primary Health Care Services: A Qualitative Study
Mohaddeseh Mohsenpour, Amir Zoka, Fahimeh Amani, Elham Charoghchian Khorasani, Seyyed Javad Hosseini,
Volume 17, Issue 0 (12-2024)
Abstract
Societies that fail to adequately address the growing needs of the elderly and the consequences of aging will face significant challenges. A critical challenge in many countries involves ensuring the provision of accessible and affordable healthcare services for the elderly. The active engagement of older adults in seeking healthcare services and adhering to preventive care measures is crucial for reducing healthcare costs. This study aimed to elucidate the lived experiences of elderly individuals regarding the factors influencing their utilization of primary healthcare services in Mashhad, Iran. This qualitative study employed content analysis. Participants were recruited through snowball sampling from a list of elderly individuals registered with health centers in Mashhad, including those who regularly utilized services and those who had not visited in the past two years. Eighteen elderly individuals participated in the study. Data were collected through in-depth interviews using open-ended questions and subsequent probing. Interview transcripts were analyzed using Bernard's formal content analysis approach. A significant barrier to accessing healthcare services identified by elderly participants was a lack of dignity during their visits to health centers. This theme encompassed two subcategories: perceived dignity violation and observed dignity violation. The imposition of feelings of worthlessness on the elderly was recognized as a prevalent cultural issue within society. Factors contributing to a diminished sense of dignity included: inadequate physical space to accommodate the limitations of the elderly, informal and unprofessional behavior of healthcare providers, excessive waiting times, unsanitary and overcrowded health centers, a lack of appointment scheduling, disruptions in internet and software systems that prolonged the healthcare process, shared waiting spaces with infants and young people, and insufficient seating. Participants emphasized the detrimental impact of a lack of dignity in healthcare settings, expressing feelings of worthlessness. These findings corroborate those of previous studies highlighting the paramount importance of dignity in healthcare environments. The perception among elderly individuals that healthcare services prioritize administrative processes over patient-centered care may discourage them from seeking preventive services. This study underscores the critical need for a cultural shift within healthcare systems to prioritize the dignity and respect of elderly patients and foster a supportive environment that encourages preventive care.

Moral Empowerment in Intensive Care Unit Nurses: A Scoping Review
Maryam Kashani, Mansoureh Ashqli Farahani, Fatemeh Golestan,
Volume 17, Issue 0 (12-2024)
Abstract
The intensive care unit (ICU) environment presents numerous ethical challenges, contributing to significant levels of moral distress among ICU nurses. This distress negatively impacts their well-being and job satisfaction. Recognizing this critical issue, researchers have investigated the potential of moral empowerment programs to alleviate moral distress. This scoping review aimed to systematically synthesize existing literature on these programs and evaluate their efficacy in mitigating moral distress among ICU nurses. A comprehensive search of PubMed, Scopus, and CINAHL databases was conducted, utilizing keywords such as "moral empowerment," "moral distress," and "intensive care unit nurses." Fifteen articles meeting predefined inclusion criteria, including publication between 2010 and 2022 and a specific focus on moral empowerment programs for ICU nurses, were selected for analysis. The scoping review revealed that moral empowerment programs demonstrated positive outcomes in reducing moral distress among ICU nurses. These programs, encompassing workshops, case-based discussions, reflective exercises, and role-playing simulations, were designed to enhance moral reasoning, ethical decision-making, and moral resilience. Consistent findings indicated a significant decrease in moral distress among nurses who participated in these programs. Participants reported increased confidence in navigating ethical dilemmas, making sound clinical decisions, and effectively advocating for patients' rights. Moreover, moral empowerment programs fostered a sense of moral agency, empowering nurses to address ethical challenges proactively. Moral distress poses a significant challenge for ICU nurses, impacting their well-being and potentially compromising the quality of patient care. Moral empowerment programs offer a promising approach to mitigating this distress and enhancing ethical decision-making capabilities. The successful implementation of these programs requires a supportive work environment that fosters open dialogue and ethical reflection. Nurse leaders and educators play a crucial role in collaborating with ethics committees to develop and implement tailored interventions, including integrating moral empowerment modules into new nurse orientations and ongoing professional development programs. Continuous support through follow-up sessions, mentoring, and debriefing is essential to sustain the long-term benefits of these programs. Ethical consultation services and interprofessional collaboration further contribute to the ethical well-being of ICU nurses. While this review provides valuable insights, further research is warranted to investigate the long-term effects and broader implications of moral empowerment programs in the ICU setting.

Spirituality Components in the Nurses' Health Monitoring Website
Nasrin Rasoulzadeh, Abbas Abbaszadeh,
Volume 17, Issue 0 (12-2024)
Abstract
A crucial aspect of nurses' professional performance is adherence to ethical principles, which can significantly impact their spiritual health. Strengthening spiritual well-being contributes to improved physical and mental health for individuals and society as a whole. By prioritizing spiritual dimensions such as faith, purpose in life, and moral commitment, individuals can mitigate anxiety and its associated complications. Spiritual aspects of life foster greater tolerance for shortcomings and challenges, facilitating more appropriate interactions with others within society. To effectively monitor the health status of nurses, accurate and readily accessible online health information is essential. Therefore, this study aimed to determine the key spirituality components that should be incorporated into a nurses' health monitoring website. This research was conducted in two stages. The first stage employed a content analysis approach with 25 participants, followed by a Delphi approach involving 51 participants across four rounds. Purposive sampling was utilized, with participants including nurses and other relevant specialists. In the first stage, data were collected through semi-structured interviews and guiding questions related to nurses' health monitoring. In the second stage, a questionnaire with open-ended questions was administered to participants in four rounds. Items achieving consensus from more than 75% of experts were incorporated into the final statements defining the information structure of the health monitoring system. Qualitative data were analyzed using directed content analysis. In the first qualitative stage, analysis of participant statements within the category of "spiritual peace" revealed a primary focus on the stability of health monitoring pillars. Participants identified belief in God and service to humanity as key contributors to establishing inner peace. However, all participants did not initially recognize the necessity of assessing spiritual health within the health monitoring framework. They tended to equate religious behavior with spiritual health, considering it primarily an internal and personal category, likely influenced by the prevailing religious and cultural context. In the second Delphi stage, expert consensus emerged regarding the importance of assessing nurses' spiritual health. While nurses initially may not have explicitly identified the need to assess spiritual health, neglecting this aspect can potentially hinder their ability to identify and address the spiritual needs of their patients. Therefore, it is recommended that the implementation of the health monitoring system incorporate a component for assessing nurses' spiritual health, tailored to the specific cultural context of Iran, enabling users to evaluate their own spiritual well-being.

Moral Sensitivity Among Pre-Hospital Emergency Personnel: A Cross-Sectional Multicenter Study
Mostafa Ghasempour, Abbas Dadashzadeh, Majid Purabdollah, Fezeh Hoseini Lilab,
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity is a crucial attribute for pre-hospital emergency personnel, significantly impacting their ethical decision-making and patient care in urgent and often complex situations. Defined as the capacity to recognize ethical dilemmas and comprehend their implications, moral sensitivity empowers personnel to navigate challenges such as resource limitations, critical patient conditions, and the imperative for rapid, independent decision-making. This study aimed to evaluate the level of moral sensitivity among Emergency Medical Technicians (EMTs) and identify key influencing factors. A cross-sectional study was conducted in 2023, encompassing 245 EMTs selected through cluster random sampling. Data were collected using the Moral Sensitivity Questionnaire (MSQ) and analyzed employing correlation tests and regression analysis. The findings revealed a mean moral sensitivity score of (39.45 ± 7.13) among participants, indicating a moderate-to-high level of ethical awareness. A significant correlation was observed between moral sensitivity and specific demographic and professional characteristics. Notably, work experience emerged as a key determinant (P < 0.001). Regression analysis further emphasized work experience (β = 0.08, P < 0.001) as a strong predictor, demonstrating that increased exposure to clinical and ethical challenges over time enhances moral sensitivity. Enhancing ethical sensitivity among pre-hospital emergency personnel is paramount to improving their ability to identify and address complex ethical challenges and deliver high-quality patient care. Given the unique demands of emergency situations, including time constraints, resource limitations, and the need for immediate action, it is crucial to equip personnel with the tools necessary to recognize and navigate ethical dilemmas. Implementing comprehensive training programs that emphasize ethical awareness and reasoning can empower EMTs to make more informed and empathetic decisions. Furthermore, cultivating a supportive organizational culture that prioritizes ethical performance and provides ongoing training can further enhance their confidence and competence in managing ethically sensitive situations.

Nurses’ Attitudes About Euthanasia: A Systematic Review
Shabnam Rasoulpoor, Reza Nematollahi Maleki, Neda Tagizadeh,
Volume 17, Issue 0 (12-2024)
Abstract
Euthanasia, defined as the intentional ending of a patient's life to relieve intractable suffering, presents complex ethical, legal, and emotional challenges for healthcare professionals, particularly nurses. Nurses play a pivotal role in end-of-life care, making their attitudes toward euthanasia crucial for understanding its implications in clinical practice. This review aims to synthesize existing literature on nurses' attitudes about euthanasia to identify key influencing factors and areas requiring further exploration. This study was conducted using the PRISMA 2020 guideline with no time limitation (by December 2024). Eligible articles were selected following a search in various databases (Scopus, Web of Science, PubMed, ScienceDirect, Embase, and Google Scholar) using keywords and operators of “AND” & “OR.” The search strategy included “Perceptions” OR “Attitudes” OR “Nurse” AND “Euthanasia.” Data extraction and risk-of-bias assessment were performed independently by two reviewers (SR and NT). Studies were evaluated with the Appraisal Tool for Cross-Sectional Studies (AXIS Tool). A total of 21 studies were included in the review. The review revealed that nurses’ attitudes toward euthanasia vary widely depending on legal frameworks, cultural norms, religious beliefs, and personal values. In countries where euthanasia is legalized, such as Belgium and the Netherlands, nurses often report greater acceptance and willingness to participate in the process, emphasizing their role in ensuring patient autonomy and dignity. Conversely, in regions where euthanasia is illegal, nurses frequently express ethical concerns, moral distress, and reluctance to support the practice. Common themes include the need for clear guidelines, ethical training, and emotional support systems for nurses dealing with euthanasia-related situations. Nurses’ attitudes about euthanasia are influenced by a complex interplay of cultural, legal, and personal factors. While some nurses view euthanasia as an extension of compassionate care, others experience ethical dilemmas and professional conflict. This highlights the need for robust ethical frameworks, specialized training, and supportive resources to help nurses navigate the challenges associated with euthanasia in their practice.

Is Elder Infantilization Ethical? An Analysis of the Concept of Elder Infantilization
Farzaneh Mokhtary, Fatemeh Talebian, Akram Sanagoo, Leila Jouybari ,
Volume 17, Issue 0 (12-2024)
Abstract
Infantilization is a behavioral pattern where an autonomous individual is treated as a child. This behavior manifests in various forms, such as the use of inappropriate or exaggerated vocabulary, thereby disregarding the social status and dignity of the elderly. Ethics, as a branch of philosophy, guides values related to appropriate and inappropriate human behavior. This article aims to enhance our understanding of elder infantilization and consequently facilitate the avoidance of such behaviors through a thorough analysis of the concept. This concept analysis study employed Walker and Avant's eight-step approach. A comprehensive literature search was conducted, encompassing both Persian and English databases, including Magiran, SID, PubMed, Scopus, Web of Science, and Google Scholar, with no time limitations. Keywords used for evidence retrieval included "infantilization," "elderspeak," "elderly," and "older people" in both Persian and English. A total of seven selected articles were reviewed in full text, and attributes, antecedents, and consequences related to the concept of elder infantilization were extracted. Antecedents of elder infantilization include functional impairment and observable disabilities, cognitive impairment, age over 70 years, and non-age-related factors such as lower education, less credible professional backgrounds, and care provided by younger caregivers. Infantilization is more prevalent in patients with delirium and those experiencing prolonged hospital stays. Environmental factors contributing to infantilization include the use of childish decorations in elderly care facilities. Activity-related manifestations encompass the lack of elderly participation in decision-making, inappropriate grooming of elderly women, loss of privacy and independence, reprimands, punishments, confinement, suppression of sexual expression, engagement in childish games, and the use of nicknames without the elderly person's consent.Linguistic manifestations include the use of childish terms and phrases, short sentences, simplified language, slow or exaggerated speech, and addressing elderly individuals by diminutive names without their permission. Consequences of elder infantilization encompass negative impacts on behavior, well-being, personal identity, relationship formation, social interaction, diminished abstract thinking abilities, limited problem-solving skills, decreased self-esteem, and increased resistance to care in individuals with cognitive impairment. Fostering autonomy is an ethical imperative in the care of the elderly across all service-providing settings. The occurrence of infantilizing behaviors towards the elderly stems from a failure to adopt a person-centered approach to care. It is crucial to prevent such behaviors by ensuring the provision of age-appropriate services for the elderly, even when they experience physical or cognitive disabilities.

No to Ageism in Older People: A Review Paper
Fatemeh Estebsari, Maedeh Moradpoor Ivki, Mohadeseh Mokhtariyan Delooei,
Volume 17, Issue 0 (12-2024)
Abstract
While the concept of ageism has existed across centuries, countries, contexts, and cultures, the term itself is relatively new and lacks a universal equivalent in many languages. Ageism encompasses stereotypes (how we think), prejudice, and discrimination directed towards individuals based on their age. Given the recent emergence and growing attention to this concept, this study aims to establish a common and consistent understanding of ageism within scientific literature. This review examined the concept of ageism in older adults. A search of the PubMed, Scopus, Web of Science, and Embase databases was conducted using the keyword "Ageism" and "Older adult," yielding 18,945 English-language abstracts published between 2014 and 2024. Two researchers independently reviewed the articles in two stages. An initial review of titles and abstracts resulted in the selection of 77 relevant papers. A subsequent full-text review narrowed the selection to 34 papers, of which 17 were ultimately included after a quality assessment. The findings encompassed various aspects of ageism, including types of ageism, its effects, determining factors, and strategies recommended by the World Health Organization to mitigate ageism. Age discrimination significantly diminishes the quality of life for older adults, increasing social isolation and loneliness. Ageism has profound and widespread consequences for individuals' health, well-being, and human rights. For older adults, ageism is associated with shorter life expectancy, poorer physical and mental health, slower recovery from disability, and cognitive decline. Based on the findings of this study, it is recommended to implement policies and laws, integrate ageism education into curricula from elementary school to university and in both formal and informal settings, and invest in interventions that foster intergenerational contact to effectively reduce age discrimination.

Exploring Advance Directives and End-of-Life Preferences in Heart Failure Patients: A Systematic Review and Meta-Analysis
Aydin Feyzi, Amirali Soheili, Samira Chaibakhsh, Fidan Shabani, Shiva Khaleghparast,
Volume 17, Issue 0 (12-2024)
Abstract
Advance directives (ADs) are legal instruments that enable individuals to express their healthcare preferences in anticipation of a future loss of decision-making capacity. These directives are particularly important in the context of chronic conditions such as heart failure (HF), a disease marked by progressive functional decline and unpredictable medical crises. ADs help safeguard patient autonomy by ensuring that care aligns with personal values and preferences, especially at the end of life. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to examine the preferences of patients with heart failure regarding life-sustaining treatments and end-of-life decision-making. A comprehensive literature search was performed across PubMed, Scopus, and Web of Science databases, covering publications up to March 2024. Search terms included "advance directive," "advance care planning," "heart failure," and "end-of-life decision-making." Studies were included if they were original, peer-reviewed, full-text articles focusing on HF patients aged 18 and older. Non-peer-reviewed works and inaccessible full texts were excluded. A total of 25 eligible studies were identified and appraised using the NIH quality assessment tool. Extracted data included demographic characteristics, preferences for treatment, surrogate decision-making, and educational interventions. Findings from the reviewed literature reveal consistently low levels of awareness and completion of ADs among HF patients. Completion rates varied significantly across studies, reflecting potential cultural and systemic influences. Preferences for surrogate decision-makers overwhelmingly favored family members over healthcare professionals. A notable finding from Jawahri et al. (2016) indicated that patients who received video-based education were significantly less inclined to choose cardiopulmonary resuscitation (CPR) or mechanical ventilation compared to those receiving only verbal information. Additional qualitative insights, such as those from Formiga et al. (2004), showed that patients prioritized maintaining dignity, independence, and meaningful relationships over merely extending life. These patterns highlight the necessity of aligning care with patients’ broader goals and values. Across the 25 studies included, a total of 4,091 heart failure patients were analyzed, with a mean age of 68.22 years. Meta-analytic findings demonstrated diverse preferences regarding life-sustaining interventions: approximately 53.73% of patients favored such treatments, while 45.37% declined CPR. These statistics underscore a substantial variability in end-of-life preferences, further reinforcing the need for individualized care planning. In conclusion, patients with heart failure display heterogeneous preferences concerning end-of-life care, shaped by cultural context, personal values, and the type of information provided. Despite the established importance of ADs, significant deficits in awareness, understanding, and documentation persist. These findings point to a critical need for tailored educational interventions, improved provider-patient communication, and culturally sensitive approaches to advance care planning. Future research should focus on designing and integrating standardized AD facilitation tools into routine clinical practice to support truly patient-centered care.

Modern Care and Ethical Challenges: Emerging Needs and Considerations
Aliasghar Pishdad , Soolmaz Moosavi,
Volume 17, Issue 0 (12-2024)
Abstract
Scientific advancements and emerging technologies in healthcare - such as Artificial Intelligence (AI), the Internet of Things (IoT), and telemedicine -have created unprecedented opportunities to enhance the quality of care. These innovations enable physicians and patients to achieve faster and more accurate methods in diagnosis, treatment, and monitoring. However, they also introduce new ethical challenges that require careful analysis and appropriate solutions. This study was conducted as a Scoping Review aimed at exploring and elucidating various dimensions of modern care. The methodological framework proposed by Arksey and O'Malley, along with its enhancements by Levac et al., was employed. The main steps included:
1. Research Questions
  • The review focused on the following key questions:
  • What is modern care, and what are its main dimensions?
  • What factors and evidence influence the design and delivery of modern care?
  • What are the major challenges associated with modern care?
  • What are the potential strategies to address these challenges?
2. Search Strategy Development
Reputable scientific databases including PubMed, Scopus, Web of Science, and Google Scholar were searched using relevant keywords such as “modern care,” “contemporary healthcare,” “innovative care,” and “advanced patient care.” Boolean operators were applied to refine the search strategy.
3. Study Selection
Inclusion and exclusion criteria were as follows:
  • Inclusion: Articles related to modern care, published within the last 10 years, in English or Persian, addressing challenges, strategies, or innovative care approaches.
  • Exclusion: Studies focused solely on traditional care or lacking full-text access.
  • Initial selection was based on titles and abstracts, followed by full-text screening
4. Data Extraction and Analysis
Key data were extracted using standardized forms, including study characteristics (year, location), definitions of modern care, focus areas, and main findings. A qualitative approach was used for data analysis, and core themes were identified. Findings were categorized into three major areas:
  • Types of Advanced Technologies and Applications in Care
  • Ethical Challenges in Modern Technology Use
  • Proposed Strategies for Addressing Ethical Challenges
1. Artificial Intelligence (AI)
  • AI algorithms assist in analyzing complex data, pattern recognition, and treatment outcome prediction. Their applications are significant in medical imaging, genetic data analysis, and patient outcome forecasting.
2. Internet of Things (IoT) in Healthcare
  • IoT enables real-time monitoring through connected devices, useful in remote monitoring and chronic disease management.
3. Telemedicine
  • Telemedicine provides patients in remote areas or at home with access to healthcare services, reducing the need for in-person visits and enhancing patient comfort.
Ethical Challenges in Modern Care
  1. Privacy and Data Security
    • Modern technologies, especially AI and IoT, require the collection and analysis of vast amounts of sensitive patient data, posing significant privacy risks and opportunities for unauthorized access.
    • Solution: Employ advanced security systems, data encryption, and adherence to privacy regulations such as GDPR.
  2. Automated Decision-Making by AI
    • AI systems may suggest or even make treatment decisions, sometimes without human oversight. This could result in ethically inappropriate decisions that overlook human and emotional aspects.
    • Solution: Ensure that AI-based decisions are supervised by medical professionals and account for human factors.
  3. Accountability and Responsibility
    • Determining responsibility in case of errors or failures in automated systems is complex. Is the medical team liable, or the technology provider?
    • Solution: Develop clear guidelines and legal frameworks outlining responsibilities and oversight mechanisms.
  4. Equity in Access to Advanced Services
    • Advanced care may not be accessible to all, especially in low-income areas or developing countries, leading to healthcare and social inequalities.
    • Solution: Plan for equitable access and provide support to underserved communities.
  5. Use of Genetic Data and Personalized Medicine
    • Although personalized medicine based on genetic profiling improves outcomes, it also raises concerns about genetic discrimination and privacy breaches.
    • Solution: Establish strict laws and ethical standards for handling genetic data.
  6. Changing Roles of Physicians and Patient Trust
    • Automation may diminish the central role of physicians, potentially undermining patient trust.
    • Solution: Reinforce the human element in care and ensure physicians maintain their role as primary decision-makers.
Proposed Strategies to Address Ethical Challenges
  1. Education and Empowerment of Medical Teams and Patients
    • Familiarity with new technologies and their ethical implications helps care teams make informed decisions. Patients should also be aware of their rights and data privacy issues.
  2. Development of Comprehensive Regulations
    • Clear and enforceable legal frameworks that uphold ethical standards and protect patient privacy are crucial.
  3. International Collaboration and Knowledge Sharing
    • Global standard development and sharing of best practices can enhance ethical use of medical technologies.
  4. Establishment of Ethics Committees and Oversight Bodies
    • Ethics committees in healthcare and research institutions can assess and manage emerging ethical concerns. Close monitoring of technology use is essential.
  5. Assessment of Long-Term Impacts
    • Longitudinal studies are needed to understand the long-term consequences of modern technologies, supporting better decision-making.
Modern healthcare technologies offer vast potential for improving quality of life. However, they also introduce new ethical challenges. Addressing these requires integrating ethical principles with scientific innovation and strategic planning. This article underscores the importance of comprehensive legislation, education, and maintaining the human role in medical processes to reduce these challenges and strengthen patient trust in modern care.

The Role of Ethics in Emergency Care for the Elderly
Soolmaz Moosavi ,
Volume 17, Issue 0 (12-2024)
Abstract
The elderly population is rapidly increasing, and as a result, the demand for emergency services for this age group is also growing. Due to their specific physical and mental conditions, the elderly are exposed to numerous ethical issues and challenges when receiving emergency services. These issues are significant because their physical and mental conditions can prevent them from making decisions independently and achieving informed consent. The aim of this article is to examine the ethical challenges associated with the care of the elderly in the emergency department and to provide suggestions for improving this care. This educational narrative review article examines and analyzes ethical challenges in elderly care in the emergency department using reliable sources and articles between 2005 and 2024. Keywords included "medical ethics," "elderly care," and "emergency," and sources were extracted from reliable scientific databases such as PubMed, Scopus, and Google Scholar. Ethical challenges in elderly care in the emergency department include maintaining the independence of the elderly, obtaining informed consent, ensuring privacy and confidentiality, decision-making at the end of life, observing justice and fairness, maintaining honesty, providing psychological and emotional support, offering compassion and empathy, upholding professional principles of education and awareness, communicating effectively with the family, managing pain, and ensuring patient comfort. Although developed countries have long faced the issue of aging, in recent years, the growth rate of aging in developing countries has accelerated. These countries face major challenges in elderly care due to inadequate infrastructure and rapid demographic changes. Ethical challenges in caring for elderly patients in emergency rooms are among the most important issues that healthcare teams face. These challenges are exacerbated by the physical and mental sensitivity of the elderly, the complexities of treatment, and the need for rapid decision-making. Adherence to ethical principles, along with ongoing education of caregivers, can improve the quality of care for the elderly in emergency situations and prevent physical and mental harm. Therefore, in addition to knowledge and skills, caring for the elderly requires adherence to ethical principles and humane behavior. By following these principles, a sense of trust and peace can be fostered in the elderly. Some suggested solutions include educating and raising awareness among healthcare teams, strengthening communication with family and legal representatives, using ethical standards, encouraging the elderly to prepare a medical will, and utilizing psychological and physical assessments.
Scientometric Analysis of Studies in the Field of Ethics and Artificial Intelligence
Nafiseh Rezaei, Rasha Atlasi,
Volume 17, Issue 0 (12-2024)
Abstract
Artificial intelligence (AI) ethics encompasses principles and standards guiding the design and application of AI, ensuring privacy, security, and fairness. This study aims to conduct a scientometric analysis of research in this field, identifying key features and emerging trends. A search was conducted in the PubMed database using the Medical Subject Headings (MeSH) terms "artificial intelligence" and "ethics." All indexed documents from inception to September 1, 2024, were retrieved and analyzed. Scientometric analysis and data visualization were performed using R, with results presented through tables, graphs, and scientific maps. A total of 534 papers were published in this domain from 1986 to 2024, with the highest number (n=70) in 2024. The American Journal of Bioethics had the most publications (n=30), and Melissa D. McCradden (University of Toronto) was the most prolific author with five articles. The University of Oxford (n=24) and Stanford University School of Medicine (n=21) were the leading institutions in this field. The most active countries were the USA (n=236), Germany (n=91), and France (n=52). In 2024, the top trending topics included "research personnel," "informed consent/ethics," and "artificial intelligence/ethics/trends," while in 2023, "privacy," "biomedical research," and "medical education" were predominant. The field of AI ethics has seen exponential growth in scientific output, paralleling the rapid advancements in AI applications across disciplines and daily life. Addressing ethical concerns and fostering international research collaboration will be essential for maximizing benefits while mitigating challenges in this evolving domain.
Ethical Challenges in ICU
Atefe Salimi Akinabadi, Maryam Jahangiri, Mitra Zandi,
Volume 17, Issue 0 (12-2024)
Abstract
The intensive care unit (ICU) is a complex environment where diverse healthcare professionals collaborate to care for critically ill patients. Evidence suggests that ethical issues or conflicts are prevalent and can negatively impact ICU care. This research aimed to investigate the ethical challenges encountered by critical care nurses in clinical practice. Using the PRISMA guideline, relevant studies were identified through searches of the PubMed, Scopus, and Web of Science databases from 2015-2024 using the following MeSH terms: "ethics," "ethical challenges," "nursing," and "intensive care unit." Only English-language manuscripts were included. Ethical challenges in the ICU were categorized as follows:
1. Internal Constraints: Lack of self-confidence, fear, maladaptive coping mechanisms, religious conflicts, and spiritual conflicts.
2. External Constraints: Lack of collegiality, hierarchical structures, poor communication, inadequate staffing, restrictive policies, shortages of full-time critical care physicians and nurses, and working with incompetent staff.
3. Clinical Situations: Futile treatment, inappropriate care, inadequate pain relief, hastening death, providing false hope, end-of-life care decisions, decisions about life-sustaining treatments, and the use of physical restraints.
Recognizing ethical challenges in the ICU is crucial. It enables the implementation of measures to minimize ethical conflict, design effective strategies for preventing ethical dilemmas, and improve the nursing work environment.

Educational Strategies to Enhance Moral Sensitivity in Nursing Students: A Systematic Review
Pooriya Samadzadehshahri, Reza Mohammadpourhodki, Zahra Delir,
Volume 17, Issue 0 (12-2024)
Abstract
Nursing students, as future healthcare professionals, must develop not only clinical competencies but also ethical competencies to deliver appropriate and professional care. Moral sensitivity is a critical aspect of professional competence, enabling nurses to recognize and respond sensitively to ethical situations as patient advocates. Consequently, fostering moral sensitivity should be prioritized from the beginning of nursing education to ensure quality care. This study aimed to examine the characteristics and effectiveness of educational interventions designed to improve the moral sensitivity of nursing students. In this systematic review, articles were retrieved using Persian and English keywords from international databases, including PubMed, Web of Science, and Scopus, as well as Persian databases such as SID and Magiran, from inception until October 2024. Keywords used in the search included "moral sensitivity," "ethical sensitivity," "nursing students," "ethics," and "moral sensitivity in nursing students." A total of 2,321 articles were identified in the initial search. References for each study were also manually reviewed. Based on inclusion criteria, experimental and quasi-experimental studies published in Persian and English focusing on effective interventions to improve the moral sensitivity of undergraduate nursing students were selected for analysis. Ultimately, six articles met the criteria for thorough review, and relevant data were extracted. Two researchers independently extracted the data and assessed the quality of the studies using the Joanna Briggs Institute (JBI) checklist. A total of 190 nursing students from six selected studies participated in the research, with 60% in intervention groups. The six educational interventions identified included:
  1. Two studies on nursing ethics workshops.
  2. A nursing ethics workshop conducted through a seminar.
  3. A motivational ethical education program.
  4. A virtual narrative ethics workshop.
  5. Problem-based learning.
However, the nursing ethics workshop conducted through a seminar was not effective in improving the moral sensitivity of nursing students. Evidence suggests that while the positive effects of educational interventions on the moral sensitivity of nursing students are limited, they are nonetheless encouraging. This review highlights various approaches to ethics education and moral sensitivity development. The findings can be utilized to enhance students' preparedness and ability to navigate ethically challenging work situations. However, further research is necessary to confirm the effectiveness of these interventions in fostering moral sensitivity among nursing students.

The Relationship Between Ethical Courage and Moral Distress in Nursing Students of Mashhad University of Medical Sciences in 2023
Sepide Ghavidel, Sajedeh Ghaani, Seyedehghodsieh Bahreinitousi, Mohaddeseh Mohsenpour,
Volume 17, Issue 0 (12-2024)
Abstract
Moral distress is a common topic in medical ethics, referring to a state where individuals, despite possessing knowledge and the ability to act ethically, are unable to perform the right ethical actions due to external constraints. Ethical courage is a crucial virtue for conscientious performance by healthcare providers, particularly nurses and nursing students. It facilitates the delivery of nursing care and is especially important in today’s healthcare environment, where factors such as increased patient awareness, evolving health needs, social justice issues, and access to healthcare services have contributed to heightened levels of moral distress among nurses and nursing students. This study aims to investigate the relationship between ethical courage and moral distress in nursing students. This descriptive, cross-sectional study was conducted in 2023 in Mashhad, Iran. The study population consisted of third-semester nursing students at Mashhad University of Medical Sciences. A total of 40 third-semester nursing students, both male and female, participated in the study. Data were collected using two questionnaires: the Moral Distress Scale (Corley) and the Ethical Courage Questionnaire (designed by Sekerka and colleagues). The data were analyzed using SPSS version 25, employing descriptive statistics and Pearson correlation tests. The majority of the students were female (51.2%), while 36.6% were male. The average age of the participants was 21.14 years. Among the students, 75.6% were single, and 4.9% were married. The findings revealed a weak, non-significant negative correlation between moral distress and ethical courage (r = -0.055, p > 0.05). The average moral distress score was 75.34 ± 10.81 (range: 12–16), while the average ethical courage score was 85 ± 9.33 (range: 60–103). The study found a weak, non-significant negative correlation between moral distress and ethical courage among nursing students. Based on these findings, it is recommended to implement workshops focused on ethical motivation and educational programs designed to reduce moral distress and enhance ethical courage among nursing students. Additionally, the non-significant correlation may be attributed to the small sample size. Therefore, future studies with larger sample sizes are suggested to validate these findings.

The Heart of Healing: How Narrative Medicine Deepens Nursing – A Systematic Review of Clinical Trials
Negin Farid, Nazanin Nazari, Narges Jafar Malek,
Volume 17, Issue 0 (12-2024)
Abstract
Narrative medicine has emerged as a transformative model in healthcare, emphasizing the role of patient stories in enhancing the quality of care. By recognizing the individuality of each patient's narrative—shaped by personal experiences and cultural contexts—this approach fosters deeper connections between caregivers and patients. Despite its growing recognition, narrative medicine remains underutilized in nursing, where the psychological and emotional dimensions of care are often overlooked. This systematic review examines clinical trials that investigate the integration of narrative practices into nursing education and care delivery, with the aim of assessing their clinical and educational impact. A comprehensive literature search was conducted across international and national databases including PubMed, Scopus, Web of Science, SID, Noor, Magiran, Irandoc, and Google Scholar, using relevant English and Persian keywords. Eligible studies were clinical trials published in English or Persian. After removing duplicates and applying inclusion criteria, eight studies were included for analysis. Selection and data extraction were conducted independently by two researchers, with discrepancies resolved by a third reviewer. The review adhered to PRISMA guidelines and ethical standards were maintained throughout. The studies, published between 2018 and 2024, involved nursing students (mean age 17.96–21.5 years), patients with lung tumors (mean age 49.31 years), and elderly patients (aged 61–89 years) with complex fractures. Findings were synthesized into three main domains. First, narrative-based education significantly enhanced empathy and academic performance among nursing students. Second, the implementation of narrative approaches led to measurable reductions in anxiety and depression among patients, particularly those with lung tumors. Third, improvements were observed in overall quality of life, pain management, and cognitive function, especially in elderly patients. These findings suggest that narrative education plays a critical role in improving both clinical and psychological outcomes. Narrative-based interventions enhance the empathetic capacity of nurses and contribute to higher standards of patient care. Incorporating narrative approaches into nursing curricula and clinical practice is recommended as a strategy to foster more holistic and human-centered care.

Moral Courage in Intensive Care Nurses: Exploring the Predictors of a Professional Virtue
Ali Akbari, Alireza Arman, Alireza Nikbakht Nasrabadi,
Volume 17, Issue 0 (12-2024)
Abstract
Moral courage is essential for intensive care unit (ICU) nurses to navigate complex ethical dilemmas and advocate for patient rights. Despite its importance, the factors that influence the expression of moral courage remain poorly understood. This review aims to identify key predictors of moral courage in ICU nurses, offering valuable insights to enhance ethical decision-making and improve patient care in critical care settings. This review followed the Cochrane systematic review principles and adhered to PRISMA guidelines. A comprehensive literature search was conducted using both English and Persian keywords related to "moral courage," "ICU nurses," and "predictors." International databases such as PubMed, Scopus, and Web of Science were searched, along with grey literature from Google Scholar. No time frame restrictions were applied. Inclusion criteria included observational studies that focused on predictors of moral courage in ICU nurses, while studies such as clinical trials, reviews, opinion pieces, and those lacking primary data were excluded. Two authors independently screened and extracted data, resolving discrepancies through consensus with a third author. The Newcastle-Ottawa Scale (NOS) was used to assess study quality, and relevant data were systematically organized into an extraction table. A total of 136 articles were initially identified, with 24 observational studies included after screening. The final selection consisted of 4 cross-sectional studies and 8 cohort studies. Key predictors of moral courage in ICU nurses were identified, including age, gender, professional experience, ethical training, and workplace support. Older and female nurses were more likely to demonstrate moral courage, while nurses with more years of experience and formal ethical training exhibited a stronger ability to confront ethical challenges. Additionally, a supportive work environment and personal ethical beliefs were found to significantly influence the likelihood of nurses advocating for patients and addressing unethical practices. These findings emphasize the importance of both individual and organizational factors in fostering moral courage. This review identifies age, gender, professional experience, ethical training, and workplace support as significant predictors of moral courage in ICU nurses. These findings highlight the critical role of individual characteristics and organizational support in promoting ethical behavior and moral courage in critical care settings.

Ethical Considerations in Providing Healthcare Services to the Elderly in Iran: A scoping review
Jalal Saeidpour, Alireza Hajizadeh,
Volume 17, Issue 0 (12-2024)
Abstract
As one of the countries with the fastest growing aging population, it is predicted that more than 20% of the Iran’s total population will be elderly in 2040. It is important to address ethical considerations in providing healthcare services to aged population. This study aimed to review the evidence related to ethical considerations in providing healthcare services to the elderly in Iran.  This study was a scoping review conducted using the six-step protocol of Arksey and O’Malley. The English-language, Persian-language databases and Google Scholar, were searched without time limitation. After selecting studies and extraction the data, the narrative analysis was used to analyze the data. Providing comprehensive healthcare including, preventive, diagnostic, treatment, and rehabilitation services to the elderly needs to be based on humane-Islamic principles and values ​​accepted by society. The most important ethical considerations required are: Maintaining the dignity and eminence of the elderly in all situations, considering ethics in communication with the elderly, ensuring autonomy and independence of the elderly in relevant decision-making, paying attention to the principles of justice and benefit in healthcare interventions, empathy and cheerfulness among healthcare providers, ensuring confidentiality and privacy and protecting information, paying attention to privacy, obtaining informed consent in healthcare centers, paying attention to religious and Islamic rules in caring for the elderly, the responsibility of government and non-government institutions in preventing stigma and discrimination against the elderly, carrying out timely and ethically-based care actions, healthcare providers' adherence to teamwork and scientific and professional behaviors, supporting the elderly as a vulnerable population group in prioritizing health services, preventing conflicts of interest in elderly care, and using safe, affordable, reliable, and evidence-based healthcare services for the elderly. It is necessary to pay attention to the ethical considerations identified in this study in providing healthcare services to the elderly. So, it is recommended that policymakers, managers, and healthcare providers take actions at the levels of the ministry of health, medical universities, and healthcare centers providing services to the elderly to promote humane-Islamic principles and values.

Ethical Challenges in Nursing and Midwifery Schools from the Perspective of Faculty Members: A Qualitative Study
Mahrokh Keshvari, Negar Farajzadeh, Mohsen Shahriari, Mohammad Azadmanesh, Aliasghar Jamalinasab,
Volume 17, Issue 0 (12-2024)
Abstract
Nursing and midwifery professors play a crucial role in transmitting societal norms, providing cultural experiences, shaping students' behavior, beliefs, and attitudes, and cultivating moral virtues. As significant influencers on students' moral development during their academic journey, careful attention to this aspect is essential. This study aimed to elucidate the ethical challenges encountered by faculty members within the Faculty of Nursing and Midwifery. This qualitative study employed content analysis. Purposive sampling was utilized to select 23 faculty members from the Faculty of Nursing and Midwifery at Isfahan University of Medical Sciences, with data collection spanning eight months. Data were collected through semi-structured interviews and analyzed using conventional qualitative content analysis. Continuous and comparative data analysis revealed three primary categories of ethical challenges perceived by faculty members: discrimination and injustice, low professional commitment, and unprofessional behavior.
· Discrimination and injustice: This category encompassed three subcategories: disparities in rule implementation across faculties and groups, unfair financial compensation, and inequitable distribution of academic units and points.
· Low professional commitment: This category included two subcategories: educational underselling and non-adherence to established rules by faculty members.
· Unprofessional behavior: This category comprised two subcategories: unhealthy competition among faculty members and inappropriate student evaluations.
The experiences of faculty members in this study highlighted the presence of numerous challenges, with ethical issues significantly impacting their performance and motivation. The identified ethical challenges primarily revolved around discrimination and injustice, low professional commitment, and unprofessional behavior. Given the pivotal role of faculty members in teaching ethical principles and actively addressing ethical challenges, it is imperative for administrators and officials to acknowledge these concerns and implement strategies to mitigate these issues.
Evaluation of the Effect of Guided Reflection on the Communication Skills of Undergraduate Nursing and Midwifery Students
Homa Sadeghi Avval Shahr, Kosar Alizadeh, Leila Amini, Shima Haghani,
Volume 17, Issue 0 (12-2024)
Abstract
Effective communication with patients is not only a crucial element of professionalism in healthcare but also plays a significant role in achieving care and treatment goals. In light of the importance of active learning strategies and reflective practices in education, this study aimed to evaluate the effect of guided reflection on the communication skills of undergraduate nursing and midwifery students. This semi-experimental study with a pre-test and post-test design was conducted at the Faculty of Nursing and Midwifery, Iran University of Medical Sciences. A total of 50 second- to fourth-year undergraduate students in nursing and midwifery voluntarily participated in the study following a public invitation. Data collection tools included a demographic questionnaire and a patient communication skills questionnaire developed by Javaher et al. The intervention consisted of four 90-minute interactive training sessions conducted weekly via Google Meet. The first two sessions focused on teaching components of professionalism with an emphasis on patient communication and reflective practice. The final two sessions included scenario presentations, film viewings, opportunities for reflection, and shared discussions. Data were analyzed using descriptive and inferential statistical tests in SPSS version 24. The findings indicated a positive change in the overall communication skills score immediately after the training and one month later, although the change was not statistically significant. In specific areas of communication skills, the "conscious initiation" domain showed a statistically significant improvement from pre-intervention to immediately after (P=0.005) and one month after the training (P=0.011). Additionally, in the domain of "unconditional acceptance of the client," pairwise comparisons revealed a significant improvement in scores one month after the intervention compared to the pre-intervention phase (P=0.02). Although guided reflection showed some promise in enhancing specific aspects of communication skills among nursing and midwifery students, the overall impact was not statistically significant. Further research with larger samples and longer follow-up periods is recommended to more conclusively determine its effectiveness.

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