Iranian Journal of Medical Ethics and History of Medicine

The observance of professional ethics standards’ is inherent nature of nursing profession. Observance of ethical standards by them will be an effective factor in improving performance of patient care and affecting the quality of health care. This study was conducted to determine the facilitating and Inhibitory factors of professional ethics from the perspective of nurses. This cross-sectional descriptive study with the participation of 367 nurses in Masjed-e-Soliman hospitals was performed in 2019. The data collection tool was a questionnaire of facilitating factors in the three dimensions of management, individual, and patients and inhibitory factors in three dimensions of management, environmental, and individual care; design, validity, and reliability of the questionnaire was reported by Dehghani. Data analysis was analyzed using SPSS version 22 and statistical tests. From the nurses' point of view, facilitating factors to follow ethics were: sufficient personnel in proportion to the number of patients (64.6%) in the managerial dimension, proper interpersonal relationship between colleagues and other treatment teams (60.3%) in the individual dimension;. appropriate treatment of patients with nursing staff (59.1%) in the patient dimension. The most important inhibitory factors were: lack of attention to the ability and skills of personnel during the division of labor (71.2%) in the managerial dimension; crowded and busy wards in environmental dimension  (69.6%); shortage of time in the individual and care dimension (66.4%). In this research, most important facilitating and inhibitory factors for following professional ethics standards in nurses was evaluated. Due to the necessity of observing the standards of professional ethics in nursing performance, the managers of health care organizations can observe the current situation by conducting periodic studies in the field of professional ethics from the perspective of nurses and patients.

Ethical climate is an important part of organizational culture which affects all aspects of individual characteristics and its improvement in health care centers causes better response of nurses to moral stress and ultimately promotes the quality of medical services. The aim of this study was to determine the nurses' perception of the ethical climate governing in clinical environment in the teaching hospitals of Shahrekord University of Medical Sciences in 2018. This study was a descriptive-correlational study performed on 300 nurses by purposive sampling method. Two questionnaires used for data collection included demographic information and Olson ethical climate questionnaire. Data analysis was performed using linear regression and mean (SD) tests and by SPSS version 20. The results of the study showed that the overall score of moral climate in the participants was 3.79 ± 0.67. The highest and lowest ethical climate scores in this study were related to the dimension of nursing managers (3.86± 0.74) and physicians (3.58 ± 0.79), respectively. Also, a significant relationship was observed between variables such as years of experience and age with the dimensions of the ethical climate (p<0.05). According to the score of ethical climate obtained in this study, which is less than some studies conducted in this field in Iran. Considering the importance of the ethical climate and the consequences of defects in this issue, it is necessary for hospital managers to make appropriate plans to set up a favorable ethical climate on clinical environment in their most important priorities.

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.