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Showing 15 results for Type of Study: Ethics Congress
Journal Supplement for the National Ethics Congress: Important Considerations
Farzaneh Zahedi,
Volume 17, Issue 0 (12-2024)
Abstract
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Co-Editors and Reviewers of the Supplement

Volume 17, Issue 0 (12-2024)
Abstract
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Ethical Considerations in Healthcare Policy-Making and National Planning: A Qualitative Study
Peyman Parvizrad,
Volume 17, Issue 0 (12-2024)
Abstract
Healthcare policy-making and national planning are complex processes that require the integration of ethical principles to ensure fairness, effectiveness, and public trust. This qualitative study explores the key ethical considerations that should guide the development and implementation of healthcare policies and plans. A qualitative research design was utilized, incorporating semi-structured interviews with key stakeholders in the healthcare sector, including policymakers, healthcare providers, and patient representatives. A total of 15 interviews were conducted until data saturation was achieved. The interviews were transcribed verbatim and analyzed using thematic analysis. Thematic analysis identified seven key ethical considerations in healthcare policy-making and planning: (1) Equity and Justice – ensuring equitable access to healthcare regardless of socioeconomic status, race, or other demographic factors; (2) Autonomy and Informed Consent – respecting individual autonomy and ensuring informed decision-making in healthcare interventions; (3) Beneficence – prioritizing actions that maximize benefits and minimize harm; (4) Non-Maleficence – preventing harm to patients and communities; (5) Confidentiality and Privacy – safeguarding patient information and ensuring data protection; (6) Resource Allocation – making fair and justifiable decisions regarding the distribution of limited healthcare resources; and (7) Transparency and Accountability – promoting openness in policy decisions and ensuring accountability for outcomes. Ethical considerations play a critical role in shaping healthcare policies and national planning efforts. By integrating ethical principles into decision-making, policymakers and healthcare providers can foster policies that enhance public well-being, equity, and trust in the healthcare system. A structured ethical framework can help ensure that healthcare policies align with societal values and promote justice in health service delivery.

Relationship Between Moral Reasoning and the Quality of Care of Nurses Affiliated with Yasuj University of Medical Sciences in 2024
Milad Amiri, Simin Kokabiasl, Abolfazl Dehbanizadeh, Malihe Rezaee,
Volume 17, Issue 0 (12-2024)
Abstract
The nursing profession has a moral nature. Explaining and clarifying the role of moral reasoning in the quality of nursing care in nurses helps improve the quality of services in the treatment system and, as a result, increases the satisfaction of patients. This study aimed to determine the relationship between moral reasoning and the quality of nursing care in nurses affiliated with Yasuj University of Medical Science in 2024.  The present study is cross-sectional and correlational, which was conducted on 187 nurses working in the clinical departments of Shahid Jalil, Shahid Beheshti and Imam Sajjad  hospitals in Yasuj City in 2024. Participants were selected using systematic random sampling. Questionnaires of nursing ethical dilemmas and the quality of nursing care were used to collect information. T-test, one-way analysis of variance (Bonferroni post hoc test), and linear regression were used. Data analysis was done using SPSS 26 software. In this study, the mean and standard deviation of moral reasoning and quality of nursing care are 38.86 ± 5.39 and 199.34 ± 18.83, respectively. These results indicate the average level of moral reasoning and the desired level of nursing care quality. Also, the results of the study showed that there is a significant and positive relationship between moral reasoning and the quality of nurses' care (p = 0.01 and r = 0.188). On the other hand, with the increase in familiarity with ethical challenges and problems, the quality of nursing is decreased (p=0.007 and r=0.188) The findings of this study showed that nurses' moral reasoning is positively and significantly related to the quality of nursing care. This shows that nurses' ability to analyze and solve ethical issues can lead to providing better and more responsible care. However, reducing the quality of care by increasing nurses' awareness of ethical dilemmas highlights an important challenge. This may be due to the complexities involved in ethical decision-making, conflicts in the workplace, or the pressures of dealing with ethically difficult situations. Based on this, it is suggested to design and implement educational and support programs to strengthen the moral and psychological skills of nurses to prevent the negative effects of awareness of moral dilemmas on the quality of care and at the same time strengthen their moral reasoning.
 

Home-Based Care Ethical Issues and Solutions: A Review Study
Shima Yadegar Tirandaz, Azam Shirinabadi Farahani,
Volume 17, Issue 0 (12-2024)
Abstract
In recent decades, care delivery has shifted from hospital settings to community and home-based care due to factors such as an aging population, cost control, patient preferences, and advancements in technology. While home care offers advantages like patient independence and care aligned with individual values, it also presents unique ethical challenges. These challenges arise from the home environment, which may not be designed for medical care, as well as potential conflicts between the values of patients and care providers. This study aims to explore the ethical issues in home-based care and propose solutions. This review was conducted by analyzing original articles from PubMed, Scopus, WOS, and Google Scholar, using the keywords "Home-Based Care" and "Ethical Issues" until November 2024. A total of 10 studies relevant to the study’s focus were included. The studies identified several ethical challenges in home-based care, including: respecting patient autonomy, establishing trust, managing patient resistance to care, balancing autonomy with benevolence, the risk of harm, justice concerns, limited resources, managing patient expectations, decision-making capacity, disagreements on treatment, access to healthcare providers, caregiver roles, maintaining professional relationships, providing truthful information, conflicts between families and patients, self-medication, medication access, sudden changes in condition, care coordination issues, inadequate treatment due to resource limitations, insufficient psychosocial support, life-saving decisions, communication problems, ineffective care, and cultural conflicts. To address these challenges, the following solutions were proposed: respecting patient values, beliefs, and preferences; supporting patient rights in family conflicts; promoting independence; building trust through respectful communication, empathy, and encouragement; ensuring patient dignity; maintaining healthcare workers' moral obligations; avoiding coercion; adhering to legal and ethical principles; facilitating patient participation; reducing caregiver burden; providing adequate resources; and educating and guiding patients and families. Ethical challenges are inherent in home-based care. If not properly identified and managed, these issues can negatively impact the quality of care. Home care organizations and providers must implement ethical strategies to uphold patients' independence and dignity within their home environment.
 

Barriers to Reporting Medication Errors Among Nurses in Iran: A Narrative Review
Faezeh Rostamian, Fatemeh Khosravi,
Volume 17, Issue 0 (12-2024)
Abstract
Reporting medication errors is essential for improving patient safety and enhancing the quality of nursing care. By identifying and reducing medical and treatment errors, reporting helps foster better care practices. However, various barriers prevent nurses from reporting errors, allowing mistakes to persist in clinical environments. This study aims to identify the barriers to medication error reporting among nurses in Iran through a narrative review. This narrative review involved searching articles from several databases, including ScienceDirect, PubMed, SID, Scopus, CINAHL, Magiran, and Google Scholar, using keywords such as "nurses," "barriers to reporting," "causes of non-reporting," "medication errors," "drug mistakes," "Iran," and their English equivalents. Research articles in both Persian and English, published between 2011 and 2024, which focused on barriers to medication error reporting among nurses in Iran and offered full-text access, were selected for review. Initially, 67 articles were identified. After reviewing the titles, abstracts, and in some cases, full texts, 23 articles were selected and analyzed based on their alignment with the research aim. The review revealed that barriers to reporting medication errors among nurses in Iran are influenced by individual, organizational, and cultural factors. Individual barriers include fear of legal and professional consequences, concerns about negative impacts on performance evaluations, and fear of being labeled incompetent. Organizational barriers consist of workload pressures, lack of time, inefficient reporting systems, and a lack of support from managers and colleagues. Additionally, a weak safety culture in hospitals and insufficient training on the importance of error reporting further hinder the reporting process. The findings of this study indicate that barriers to reporting medication errors among nurses in Iran are primarily due to individual, organizational, and cultural factors. To address these barriers, it is crucial for hospital administrators and healthcare system officials to provide appropriate training and foster a supportive environment that encourages error reporting. Regular training sessions, coupled with positive, non-judgmental feedback on error reporting, can enhance nurses' trust in the reporting system. Strengthening reporting systems and cultivating a safety culture with active involvement from both nurses and administrators will not only improve the quality of nursing care but also reduce medication errors.
 

The Importance of Patient Autonomy in Home Care: A Systematic Review
Mohammadreza Jalilfar, Hedayat Jafari, Fatemeh Roudi, Seyed Tohid Hoseini, Soodabeh Eslami, Seyed Mohammad Mirshafiei,
Volume 17, Issue 0 (12-2024)
Abstract
With the increasing need for home nursing care, patient autonomy emerges as a crucial ethical principle in delivering care services. Therefore, this study aimed to investigate the importance of autonomy and individual independence in home-based patient care. In this systematic review, articles from PubMed, Scopus, ScienceDirect, Magiran databases, and Google Scholar search engine, published within the last 10 years, were used to search for articles related to autonomy and independence in home nursing care. The keywords used in the search were: "patient autonomy", "home nursing care", "nursing ethics" and "autonomy in nursing home care".  After reviewing and filtering the articles based on the study's objectives, 20 articles related to autonomy in home nursing care were included in this systematic review. The findings of these studies indicated that various factors can influence patient autonomy at home-care, including: · Individual factors: age, gender, physical and mental health status of the patient; · Family factors: family support, family relationships, family culture; · Social factors: social support, access to social resources; · Organizational factors: care policies, organizational structure, organizational culture.  Considering these findings and their comparisons, it can be concluded that to promote patient autonomy at home, all the mentioned factors should be considered. Some of the suggested solutions to promote patient autonomy are: · Educating the patient and family about patient autonomy; · Strengthening family support for the patient; · Providing social support services to the patient; · Developing care policies that support patient autonomy; · Improving organizational structure and culture.  Patient autonomy is one of the essential ethical principles in home nursing care. Considering the factors affecting patient's autonomy, comprehensive solutions should be considered to promote it. Patient and family education, strengthening family support, providing social support services  and improving organizational structure and culture are among the effective solutions in this field.

Strategies for the Promotion and Development of Socio-Cultural Indicators Affecting Professional Commitment in Nursing Students
Mandana Arash, Nadergholi Ghourchian, Parivash Jafari, Akhtar Jamali ,
Volume 17, Issue 0 (12-2024)
Abstract
Professional commitment is a key indicator of success in the nursing profession. Nursing schools play a critical role in fostering this commitment by instilling the values and responsibilities associated with the profession. Developing a culture of commitment and integrating it as a societal value is essential for cultivating professional behavior in students. This study aimed to identify strategies for enhancing and developing socio-cultural factors that influence professional commitment among nursing students. This applied research employed a qualitative approach. Twenty professional experts were selected through purposive sampling in 2021. Data were collected using semi-structured interviews, guided by the principle of theoretical saturation, and analyzed using content analysis. Six major components were identified as influential strategies: 1. Participation of communication media in the cultural and scientific advancement of the profession; 2. Attention to cultural differences between universities and healthcare centers; 3. Promotion of a culture of commitment in universities and clinical settings; 4. Attention to the alignment between individual culture and professional culture; 5. Attention to ensuring the profession benefits from social support; 6. Attention to the promotion of a culture of work and effort in society. These components were reflected in 20 specific indicators, including: raising awareness, instilling a sense of need, fostering concern among academic communities, educating nurses, resolving cultural conflicts, creating conducive educational environments, employing committed faculty, embedding commitment in the culture and as a duty, aligning individual and professional cultures, promoting social prestige and recognition of the profession, addressing local cultural aspects and gender roles, and enhancing flexibility and participation in social interactions.
The development of professional commitment in nursing students can be significantly enhanced through the promotion of ethical and professional principles and the establishment of a supportive socio-cultural environment. Embedding professional commitment within cultural frameworks contributes to students’ sense of responsibility and its sustainability in professional practice.
 

Moral Sensitivity Among Nurses in Cardiac Critical Care Units of Selected Hospitals Affiliated with Isfahan University of Medical Sciences in 2024
Safoura Dorri, Seyed Ali Rasooli, Hamideh Hakimi,
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity, defined as the ability to recognize and assess the ethical complexities of clinical situations and make appropriate ethical decisions, is a crucial skill for nurses. Despite its importance, various studies report varying levels of moral sensitivity among nurses, suggesting a gap in this competency. Nurses’ continuous exposure to ethical dilemmas can lead to adverse outcomes, including psychological and moral distress, decreased job satisfaction, and compromised care quality. As moral sensitivity can differ across healthcare settings and may change over time, studies assessing its levels across different periods are essential. This study aims to assess the level of moral sensitivity among nurses in hospitals affiliated with Isfahan University of Medical Sciences in 2024. This cross-sectional descriptive study was conducted with 200 nurses working in cardiac intensive care units (CICUs) of four large hospitals affiliated with Isfahan University of Medical Sciences. Participants were selected using a random sampling method. Data were collected using a demographic information form and the Lutzen Moral Sensitivity Questionnaire. Data analysis was performed using SPSS version 26, employing descriptive statistics such as means and standard deviations. The findings revealed that the average moral sensitivity score among the nurses was moderate (60.17±13.04). When analyzing the different dimensions of moral sensitivity, the highest score was observed in the dimension of "honesty and benevolence" (15.30 ± 4.48), while the lowest score was found in the dimension of "professional knowledge" (3.25 ± 1.88). The mean scores for the remaining dimensions were as follows: "respect for patient autonomy" (7.44 ± 2.13), "awareness of how to communicate with patients" (15.18 ± 3.41), "experiencing ethical problems and dilemmas" (7.74 ± 2.03), and "applying ethical concepts in ethical decision-making" (11.95 ± 3.35). The study revealed that nurses demonstrated a moderate level of moral sensitivity, with the lowest scores in the dimension of professional knowledge. This suggests that nurses may not be sufficiently involving patients in their treatment and care decisions. Given these findings, it is critical for healthcare policymakers and nursing managers to implement continuous assessment and feedback systems to accurately evaluate nurses' moral sensitivity and professional knowledge. By identifying the weaknesses and educational needs of nurses, targeted training programs can be developed, ultimately enhancing nurses' moral sensitivity and improving the quality of care.
 

Ethical Challenges of Nurses in Caring for Patients with Chronic Mental Illness
Alireza Zare, Mohammad Hossein Taklif, Alireza Javid, Zahra Amadeh, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses, as key members of the healthcare team, face complex ethical issues when caring for patients with chronic mental illnesses. These challenges include maintaining confidentiality, obtaining informed consent from patients with limited cognitive abilities, managing conflicts between patient rights and safety requirements, and addressing social stigma. Inadequate attention to these challenges may lead to reduced care quality and psychological stress for nurses. A better understanding of these challenges and the provision of appropriate solutions is essential. This study was conducted through a simple review approach. A comprehensive search was first conducted in PubMed, Scopus, PsycINFO, and Google Scholar databases. Combined keywords such as "ethical challenges," "nursing," "chronic mental illness patients," and "ethical care" were used. Inclusion criteria included studies published in English and Persian from 2010 to 2023, including research, review, and qualitative articles related to the topic. A total of 150 articles were identified, and after evaluating their quality and relevance, 30 articles were selected for final analysis. Data were analyzed using thematic and comparative analysis methods. The findings revealed that nurses face multiple challenges, including maintaining confidentiality when interacting with families, obtaining informed consent from patients with cognitive disorders, and managing ethical conflicts between patient safety and individual freedom. Additionally, a lack of specialized ethical training, the absence of clear protocols, and the pressure from the social stigma of patients were identified as key challenges. The ethical challenges faced by nurses in caring for patients with chronic mental illness require special attention from relevant organizations. Providing continuous education, developing ethical guidelines, and creating psychological and legal support can help mitigate these challenges. Further studies on practical, experience-based solutions to address these issues are recommended.

Nursing Ethics in the Care of Elderly Patients: A Review of Challenges and Solutions
Alireza Zare, Mohammad Hossein Taklif, Alireza Javid, Zahra Amadeh, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
As the global elderly population continues to rise, nursing care for this demographic faces increasing ethical challenges. The elderly are particularly vulnerable, requiring specialized care that addresses their physical, psychological, and social needs. However, these needs often present ethical dilemmas, including issues related to autonomy, informed consent, fairness in resource allocation, and managing conflicts between patients and their families. This systematic review aims to identify the ethical challenges nurses face in caring for elderly patients and to propose solutions that enhance the quality of care. A comprehensive search was conducted across several reputable databases, including PubMed, Scopus, CINAHL, and Google Scholar, using keywords such as "nursing ethics", "elderly", "ethical challenges", and "ethical care". Articles published between 2010 and 2023 in English and Persian were considered for inclusion. After an initial screening, 40 eligible articles were selected for final analysis, and thematic analysis was used to interpret the data. The findings reveal several key ethical challenges for nurses in elderly care, including respecting patient autonomy, navigating decision-making processes in cases of cognitive decline, ensuring confidentiality, and managing family pressures. Additional difficulties include resource shortages, high workload, and limited access to ethics training. Proposed solutions to address these challenges include continuous ethics education, the development of comprehensive ethics protocols, and the formation of interdisciplinary teams to facilitate more informed decision-making. Addressing ethical challenges in elderly care requires robust planning and action from health systems. By establishing clear ethical guidelines, promoting ongoing education, and fostering a supportive work environment, the quality of care for elderly patients can be significantly improved. Further research should evaluate the effectiveness of these strategies in mitigating ethical issues within nursing practice.

Nurse's Ethical Challenges During Global Crises: War and Beyond
Fatemeh Roudi, Hedayat Jafari, Mohammadreza Jalilfar, Seyed Mohammad Mirshafiei, Seyed Tohid Hoseini, Soodabeh Eslami,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses are critical healthcare providers during global crises, particularly in situations of armed conflict and war, where they face unique and often overwhelming ethical challenges. These professionals are tasked with making immediate and difficult decisions under extreme conditions. This study aims to thoroughly examine the ethical challenges encountered by nurses during global crises, with a particular focus on armed conflicts and wars. This systematic review analyzed articles sourced from PubMed, Scopus, ScienceDirect, Magiran, and Google Scholar databases, using the following search terms: "nursing ethics," "war," "global crises," "ethical considerations in nursing during war," and "nursing ethics in armed conflicts." Following a thorough review and filtering process based on the study's objectives, seven articles were selected for inclusion. The findings highlight several ethical challenges faced by nurses during wartime. These challenges include: allocating limited resources under dire circumstances, providing care to both combatants and civilians without bias, maintaining patient confidentiality while cooperating with military authorities, and delivering care in hazardous and unpredictable environments. The ethical issues nurses encounter in global crises, particularly in war, include: 1) the tension between professional duty and political or military affiliations, 2) the ethical dilemma of allocating scarce resources in critical conditions, 3) the decision of which patients should be prioritized for treatment, and 4) the significant risks to life involved in providing care in conflict zones. Nursing care during global crises, especially in wartime, presents profound ethical dilemmas that demand rapid and sound decision-making. Adequate training in nursing ethics tailored to wartime conditions, as well as robust support for nurses in these high-pressure environments, are critical to addressing these challenges effectively.

Challenges of People Living with HIV in Equity Access to Health Care
Heshmatolah Heydari,
Volume 17, Issue 0 (12-2024)
Abstract
Acquired Immune Deficiency Syndrome (AIDS) occurs in the final stage of infection with the Human Immunodeficiency Virus (HIV). According to the World Health Organization (WHO), approximately 39.9 million people were living with HIV worldwide as of 2024, with reported global incidence and mortality rates of 1.3 million and 630,000, respectively. In Iran, the prevalence and incidence rates of HIV are reported at 54,000 and 2,400 cases, with an annual mortality rate of 3,200. Access to healthcare is considered a primary goal of the health system, and the Universal Declaration of Human Rights recognizes the right to access health services as a common standard. However, people living with HIV, as a vulnerable group, may face barriers to accessing healthcare services. This study aims to explore the challenges faced by people living with HIV in accessing equitable healthcare. This qualitative study utilized a conventional content analysis approach, conducted between April and September 2024 in Iran. Participants included people living with HIV and healthcare providers, recruited through purposive sampling. Data were collected via 10 face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. Data analysis revealed 406 initial codes, which were then categorized based on similarities and differences into three main categories: 1) Factors related to clients (with subcategories: fear of transmitting the disease to others, poverty, physical problems, unfamiliarity with self-rights, and non-adherence to treatment regimens). 2) Factors related to the healthcare system (with subcategories: discrimination in access to health services, contemptuous attitudes from healthcare providers, incompetency of healthcare providers, fear of virus transmission, disclosure of patient information, negligence of medical centers in identifying infected people, and failure to conduct premarital tests). 3) Cultural factors (with subcategories: non-acceptance of infected people in the general culture, stigma, and discrimination in marriage and childbearing). The rights to access health services, confidentiality of information, marriage, financial protection, and participation in society should be considered essential for people living with HIV. Addressing these issues is crucial for ensuring that individuals with HIV can live with dignity and equal access to healthcare.

A Review of Ethical Challenges in the Care of Elderly Patients
Fatemeh Ghonoodi, Zahra Amrollah Majdabadi , Sahar Keyvanloo Shahrestanaki,
Volume 17, Issue 0 (12-2024)
Abstract
This study emphasizes that adherence to medical ethics principles by healthcare professionals is essential for improving the quality of care for elderly patients. With the aging population in Iran, the importance of this issue continues to grow. Therefore, integrating all care infrastructure to address healthcare challenges and identifying ethical issues in elderly care, along with efforts to resolve them, aligns with the practical application of medical ethics and meets the current and future care needs of this population. The present study aimed to identify and examine the ethical challenges in the care process of elderly patients. Using a systematic review approach based on Aveyard, databases such as PubMed, CINAHL, Web of Science, Scopus, Ethics Share, and Google Scholar were searched for articles published between 2017 and the present. The search used keywords including “ethical challenge,” “care,” and “elderly patients.” Inclusion criteria were articles published in English or Persian that were relevant to the research objective; studies without available full texts were excluded. Thirty articles that systematically analyzed ethical challenges in elderly care were included. The results indicated that the primary ethical challenges are respect for elderly patients’ autonomy, preserving their dignity and privacy, insufficient education and awareness regarding professional-patient communication, and a lack of elderly-friendly activities in healthcare settings. Additionally, the emotional difficulties caused by complex chronic conditions necessitate expanded access to appropriate psychological support for the elderly. This study highlights that these ethical challenges are influenced by cognitive, educational, practical, and structural factors. Consequently, integrated care approaches that prioritize elderly patients’ independent preferences and ensure strong physician-patient relationships in clinical decision-making are needed. To mitigate these challenges, appropriate educational programs aimed at enhancing both the quantity and quality of medical ethics education for healthcare professionals—including students, staff, and faculty—are essential. Given the significance of this issue, continuous educational programs should be developed for nurses and other healthcare professionals to familiarize them with existing ethical challenges and improve the quality of care provided to elderly patients.

Pediatric Nurses' Adherence to Codes of Ethics: A Narrative Review
Naiire Salmani,
Volume 17, Issue 0 (12-2024)
Abstract
Codes of ethics serve as essential guides for nurses in all medical settings to implement ethical principles, and they are especially important in pediatric wards. Given the vulnerability of sick children, it is crucial for pediatric nurses to provide care grounded in ethical codes and guidelines. This study aimed to review pediatric nurses' adherence to these codes of ethics. This review study was conducted by searching for articles using keywords such as “nurse,” “care,” “codes of ethics,” and “children” (and their Persian equivalents) through databases including Google Scholar, PubMed, Scopus, and SID from 2013 to 2024. A total of 1537 articles were retrieved initially. After reviewing the full-text English or Persian articles, 23 were assessed for quality, and 10 were selected for analysis. Pediatric nurses' adherence to ethical codes encompasses several key principles, including respecting the patient's family, establishing trust-based relationships, maintaining the privacy of sick children, demonstrating patience, taking responsibility for errors in patient care, and ensuring non-discrimination between sick children and families. To effectively adhere to codes of ethics in pediatric care, nurses must provide ethical care that is both patient-centered and family-focused, using ethical principles as a foundation for their practice.

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