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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.

Examination of Nursing Students' Moral Sensitivity and Its Relationship with Demographic Characteristics
Maryam Sina, Zahra Keshtkaran, Zinat Mohebbi, Naeimehossadat Asmarian,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses, as the largest healthcare provider group, play a crucial role in patient care and treatment teams. To provide professional and appropriate care, nursing students must possess both clinical and moral competencies. Moral sensitivity, defined as the ability to recognize and understand moral situations, is paramount. It fosters trust and responsiveness to individual patient needs while equipping nurses to navigate ethical challenges within clinical settings. This study aimed to assess the moral sensitivity of nursing students and investigate its relationship with demographic characteristics. This descriptive-cross-sectional study involved 112 third- and fourth-year nursing students. Data were collected using demographic questionnaires and Lutzen's moral sensitivity scale. Data analysis was performed using SPSS version 23, employing descriptive and analytical statistical tests. The highest mean score for moral sensitivity was observed in the area of "honesty in decision-making" (14.71 ± 6.25), while the lowest mean was found in the area of "professional knowledge" (3.70 ± 2.12). The overall mean score for moral sensitivity was 15.87 ± 8.54, indicating a moderate level. Analysis of the relationship between demographic variables, including age, GPA, gender, marital status, living situation, current semester, family financial status, and parental education, revealed a significant positive correlation between moral sensitivity and family economic status only in the area of "experience with moral issues" (P=0.046). The findings of this study underscore the critical need for the development and implementation of structured programs designed to enhance the moral sensitivity of nursing students. Furthermore, this study highlights the importance of considering influential social factors, such as economic conditions, in fostering moral experiences and strengthening ethical sensitivity.

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.
 

Explaining Nursing Students’ Experiences of Professional Ethics in Relation to Psychiatric Clients: an Analysis Based on Narrative Writing-Reflection
Mina Gaeeni, Hamid Asayesh, Ahmad Parizad, Zahra Abedini,
Volume 17, Issue 0 (12-2024)
Abstract
Clinical education constitutes the cornerstone of nursing education. Enhancing students' theoretical and practical knowledge within the psychiatric department is crucial for improving their attitudes, acceptance, and delivery of care. The outcomes of effective clinical learning encompass the development and refinement of professional competencies, including communication and professional ethics, the cultivation of critical thinking for clinical judgment and decision-making, the enhancement of ethical sensitivity, and the fostering of effective team and group performance. Recognizing the significance of these factors, this study aimed to "explain the experiences of nursing students based on narrative writing-reflection during their first encounter with psychiatric clients." This qualitative study was conducted during the psychiatric nursing internship at the Faculty of Nursing, Qom University of Medical Sciences, over two consecutive semesters. Purposive sampling was employed, and data were collected through 10 semi-structured individual interviews and 2 face-to-face and virtual focus groups (n=5 per group). Data collection continued until data saturation was reached. Data analysis was conducted using a qualitative content analysis approach with the assistance of MAXQDA20 software. The clinical experiences of students during their initial psychiatric nursing training course, as reflected in their narrative writing-reflections, revealed a primary theme: "encouraging ethical and spiritual communication in nursing." This overarching theme encompassed four sub-themes: "enhancing empathetic communication," "enhancing ethical sensitivity," "respecting the dignity of clients," and "listening to the voice of clients' feelings." The experiences gained through the reflective method within the clinical education setting, particularly in specialized clinical environments such as psychiatric wards and during initial encounters with clients in these departments, can provide valuable insights into students' attitudes and perspectives towards these clients and their families. These rich experiences can be effectively utilized to cultivate and strengthen communication and professional ethics among medical science students.

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.

Elucidating the Lived Experiences of Operating Room Nurses Regarding Moral Intelligence: A Hermeneutic Phenomenological Study
Masoomeh Salehi, Behzad Imani, Shirdel Zandi,
Volume 17, Issue 0 (12-2024)
Abstract
The diversity of work environments, regulations, and prevailing atmospheres uniquely influence individuals' moral intelligence. Given the significant role of operating room nurses in patient care and the importance of moral intelligence in enhancing the quality of these services, this study aimed to elucidate the experiences of operating room nurses regarding moral intelligence at Hamadan University of Medical Sciences. A hermeneutic phenomenological study was conducted in hospitals affiliated with Hamadan University of Medical Sciences, Iran, from May to October 2023. Twelve operating room nurses were purposefully selected. Data was collected through in-depth semi-structured interviews and analyzed using van Manen's method. The study's rigor was ensured through four criteria: credibility, dependability, confirmability, and transferability. Three main themes related to moral intelligence were identified by examining the experiences of operating room nurses. These themes include: moral sensitivity (inner guidance, recognizing the rightness or wrongness of actions, having a work ethic), the ability to make sound decisions (ability to make sound judgments, moral courage), and ethical behavior towards patient interests (providing ethical care, preserving patient dignity, ability to work as a team). Operating room nurses with high moral intelligence are sensitive to the rightness or wrongness of actions, guided by inner ideals and professional commitment to doing what is right. They make sound judgments when faced with challenges and defend them courageously, making sound decisions. By providing ethical care, working as a team, and protecting human dignity, they demonstrate ethical behavior towards patient interests.

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.
 

Investigating Ethical Considerations in the Use of Artificial Intelligence in the Field of Health: A Narrative Review
Reza Salehinia, Marzieh Nasiri Sangari, Hossein Abbasian, Sajjad Salehian,
Volume 17, Issue 0 (12-2024)
Abstract
Artificial intelligence (AI) represents a significant human advancement. The proliferation of AI technologies within the healthcare sector has led to substantial improvements in health outcomes and medical indicators. However, the application of AI in healthcare is accompanied by numerous ethical challenges. This study aimed to investigate the ethical considerations associated with the use of AI in the healthcare domain. This narrative review included articles published between February 2019 and November 2024. A comprehensive literature search was conducted across internal databases, including Magiran and SID, as well as external scientific databases such as PubMed, Web of Science, Medline, ScienceDirect, and Google Scholar. Keywords used for the search included "Ethics," "Artificial Intelligence," and "Health" in both Persian and English. After applying inclusion criteria and conducting quality assessments, nine studies were deemed eligible for inclusion in this review. The findings of previous studies demonstrate that the utilization of AI in healthcare has yielded significant benefits, including more accurate disease diagnoses, improved clinical predictions, more efficient hospital management, optimized resource allocation, enhanced patient care, streamlined clinical workflows, and advancements in medical research. These technologies have contributed to increased efficiency and quality within healthcare services. However, significant ethical challenges remain, including data privacy and security concerns, algorithmic bias, transparency issues, the need for robust clinical validation, and the importance of ensuring professional responsibility. Adherence to principles such as transparency, fairness, privacy protection, and equitable access is crucial for the responsible development and deployment of AI in healthcare. Ultimately, achieving a balance between technological advancements and human values is paramount for the sustainable and ethical utilization of AI in this domain. The findings of this review underscore the profound impact of AI on improving quality of life and enhancing services across various sectors, particularly healthcare, by providing innovative solutions. However, the optimal utilization of AI in healthcare necessitates a meticulous consideration of ethical implications, rigorous monitoring of AI systems, and proactive efforts to address the existing challenges.

Investigating the Factors Influencing Moral Courage in Nurses: A Systematic Review
Morteza Javanmardi , Seyede Elahe Karimipour , Zahra Bakhshizadeh , Mohammad Hossein Taklif, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Moral courage, encompassing the ability to act ethically in the face of adversity and uphold ethical principles, is crucial for nurses. This systematic review aimed to investigate the factors influencing moral courage among nurses. A comprehensive literature search was conducted using keywords such as "moral courage," "ethics," "nurses," and "courage" in major databases, including PubMed/Medline, Web of Science Core Collection, Scopus, Google Scholar, Irandoc, SID, and Magiran. The search included publications in both English and Persian with no time limitations. After excluding duplicates and screening the initial 2577 studies, 21 studies met the inclusion criteria. The review adhered to the PRISMA guidelines for reporting systematic reviews, ensuring ethical considerations were maintained throughout the selection, extraction, and analysis processes. The review revealed that moral courage in nurses is influenced by a multifaceted array of factors. Individual factors such as age, gender, work experience, and type of employment (e.g., permanent vs. temporary) were found to influence moral courage. Higher education, particularly possessing a master's degree or higher, and participation in medical ethics training were significantly associated with increased moral courage. Ethical sensitivity, defined as the ability to recognize and appreciate ethical dilemmas, was a significant facilitator of moral courage. A supportive work environment, characterized by factors such as strong ethical leadership, open communication, and adequate resources, was found to positively influence moral courage. Conversely, ethical distress experienced in challenging clinical situations can negatively impact moral courage. This review demonstrates that moral courage among nurses is influenced by a complex interplay of individual, professional, and environmental factors. Enhancing moral courage requires a multi-pronged approach, including strengthening nursing education with a robust emphasis on ethics training, fostering a supportive and ethically sound work environment, and implementing strategies to mitigate ethical distress. These interventions can significantly contribute to improved clinical practice and enhanced patient care.

Investigating the Relationship Between Moral Intelligence and Clinical Competence of Nurses and Nursing Students: A Systematic Review
Zahra Abdollahi, Marzieh Barahooei Noori, Mohammad Hossein Khani, Mohammad Hossein Taklif, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Moral intelligence encompasses an individual's ability to discern right from wrong, possess ethical values, and demonstrate ethical behavior in practice. Clinical competence, a crucial aspect of nursing practice, encompasses a combination of knowledge, skills, and attitudes, including adherence to ethical principles. This systematic review aimed to investigate the relationship between moral intelligence and clinical competence among nurses and nursing students. A comprehensive literature search was conducted using keywords related to "moral intelligence," "clinical competence," "nurses," and "nursing students" in major international databases, including Web of Science Core Collection, PubMed/Medline, Scopus, and Google Scholar, as well as national databases such as Irandoc, SID, and Magiran. The search included publications in Persian and English with no time limitations. After removing duplicates and screening the initial 150 identified studies, five studies met the inclusion criteria. Ethical considerations, including minimizing bias in the selection, extraction, and analysis of evidence, were adhered to throughout the review process. The abstract adheres to PRISMA guidelines for reporting systematic reviews. The review revealed a significant positive correlation between moral intelligence and clinical competence across various dimensions. Studies demonstrated that higher levels of moral intelligence were associated with improved clinical competence, including ethical reasoning and clinical self-efficacy. Factors such as age, work experience, educational status, and individual rank were found to influence this relationship. Additionally, some studies indicated that moral intelligence could predict clinical competence scores, while others demonstrated that it could be a significant predictor of clinical competence alongside other factors such as Grade Point Average (GPA). This systematic review provides evidence for a significant positive relationship between moral intelligence and clinical competence among nurses and nursing students. Enhancing moral intelligence through targeted educational interventions can contribute to improved clinical competence and ultimately enhance the quality of patient care. Future research should focus on developing and evaluating educational programs designed to enhance moral intelligence in nursing education and practice.

Investigating the Effects of Spiritual Care on Death Anxiety: A Systematic Review
Mohammad Hossein Khani, Zahra Abdollahi, Marzieh Barahooei Noori , Mohammad Hossein Taklif, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Death anxiety, characterized by persistent fear of death, is a significant psychological burden. Spiritual care, encompassing compassionate listening, fostering trust, and addressing spiritual and existential concerns, has the potential to alleviate this anxiety. This systematic review aimed to investigate the impact of spiritual care interventions on death anxiety in various patient populations. A comprehensive literature search was conducted using keywords such as "spiritual care," "death anxiety," "spirituality," and "patients" in major databases, including Web of Science Core Collection, PubMed/Medline, Scopus, Irandoc, SID, Magiran, and Google Scholar. The search included publications in English and Persian with no time limitations. After screening and removing duplicates, eight studies met the inclusion criteria. Ethical considerations, including minimizing bias in the selection, extraction, and analysis of evidence, were adhered to throughout the review process. The review followed the PRISMA guidelines for reporting systematic reviews. The findings suggest a potential positive impact of spiritual care on reducing death anxiety. Studies conducted among patients with chronic kidney disease, multiple sclerosis, and stroke demonstrated that spiritual care interventions, including individual counseling and group support, can effectively alleviate death anxiety and improve overall well-being. However, some studies, particularly those involving patients with cardiac problems and gastrointestinal cancer, did not show a significant reduction in death anxiety. Furthermore, research conducted during the COVID-19 pandemic highlighted the potential effectiveness of tele-nursing interventions for providing spiritual care and alleviating death anxiety in older adults. This review provides evidence suggesting that spiritual care interventions may be effective in reducing death anxiety in certain patient populations. Further research is warranted to investigate the effectiveness of different spiritual care modalities across diverse patient groups, including those with chronic illnesses, terminal diseases, and those facing end-of-life care.

A Review of the Ethical Challenges Surrounding Abortion and Related Perspectives in Islamic Societies
Mohammad Chahkandi, Yasaman Sadeghi, Vajihe Tanoumand ,
Volume 17, Issue 0 (12-2024)
Abstract
Induced abortion remains a significant global health concern, with an estimated 73 million procedures performed annually. While legal and medical frameworks vary across countries, many Islamic societies grapple with ethical dilemmas surrounding abortion. This review examines the ethical challenges surrounding abortion within the context of Islamic perspectives. A comprehensive literature search was conducted using the keywords "abortion," "Islam," and "ethics" in combination with Boolean operators (AND, OR) within PubMed, SID, Google Scholar, and other relevant databases. The search was conducted by three independent researchers. Inclusion criteria included articles published between 2014 and 2024 with the keywords appearing in the title, abstract, or keywords, and full-text availability. After removing duplicates, 11 articles met the inclusion criteria. The decision to undergo elective abortion is influenced by various factors, including the desire for pregnancy, maternal and fetal health status, family dynamics, social stigma, and legal and religious regulations. While Islam generally prohibits abortion, ongoing debates arise from challenges related to access to safe abortion methods and the protection of women's rights. Despite the religious prohibition of abortion, restrictions on access to safe abortion services do not eliminate the practice but rather drive women towards unsafe methods, leading to significant physical and psychological harm, particularly among vulnerable populations. Moreover, limitations on prenatal screenings can result in the birth of infants with genetic defects. These factors raise important questions about the effectiveness and ethical implications of restrictive abortion policies in Islamic societies. Ensuring access to safe and legal abortion services, along with comprehensive sexual and reproductive health education, is crucial for improving maternal health outcomes and upholding women's rights within these contexts.

Factors Affecting Compassion Fatigue in Critical Care Nurses: A Systematic Review
Hedayat Jafari, Fatemeh Ahmadi, Mobina Abedinpour,
Volume 17, Issue 0 (12-2024)
Abstract
Compassion fatigue refers to the physical and emotional exhaustion experienced by healthcare professionals due to prolonged exposure to job-related stress and the emotional demands of caring for others. Compassionate care is vital for achieving better patient outcomes, but various factors during healthcare delivery can compromise it. This study examines the factors influencing compassion fatigue among critical care nurses. This systematic review was conducted by searching databases including SID, Magiran, Irandoc, Iranmedex, Civilica, Science Direct, Web of Science, Embase, PubMed, Scopus, ProQuest, and Google Scholar. Keywords used in the search included “compassion fatigue,” “critical care,” “intensive care,” “nurses,” “compassion satisfaction,” and “burnout.” After removing duplicates, studies were screened based on inclusion and exclusion criteria, and their quality was assessed using the Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Ultimately, 23 studies met the criteria and were included in the systematic review (qualitative synthesis). The studies included in this review were conducted between 2012 and 2024, with a total of 5,820 participants. The review found that both workplace structural factors and demographic characteristics of nurses, such as age, sex, marital status, nationality, educational level, resilience, length of shifts, experience in critical care settings, place of work, position within the unit, and nurse-to-patient ratios, are causes and predictors of compassion fatigue. Leadership and administrative support in clinical settings, as well as the coping strategies employed by nurses, were identified as factors that mitigate the impact of compassion fatigue among critical care nurses. This systematic review highlights the profound impact of compassion fatigue on nurses and emphasizes the roles of workplace environment and demographic factors in its development. The findings underscore the importance of supportive leadership and effective coping strategies in reducing compassion fatigue and enhancing compassion satisfaction among critical care nurses. By addressing these factors, healthcare organizations can reduce burnout, improve nurse well-being, and enhance patient care and clinical outcomes.
 

Barriers to Equitable Healthcare Access Among People Living with HIV
Heshmatolah Heydari,
Volume 17, Issue 0 (12-2024)
Abstract
Acquired Immunodeficiency Syndrome (AIDS) is a disease that 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 in 2024, with an incidence rate of 1.3 million and a mortality rate of 630,000 globally. In Iran, the prevalence and incidence rates of HIV were reported as 54,000 and 2,400 people, respectively, with a mortality rate of 3,200 annually. Access to healthcare is considered one of the key goals of a health system. The Universal Declaration of Human Rights recognizes the right to health services as a common standard. 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 was conducted using a conventional content analysis approach between April and September 2024 in Iran. Participants included people living with HIV and healthcare providers, who were recruited through purposive sampling. Data were collected through 10 face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. From the data analysis, 406 initial codes were extracted. These codes were then grouped 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 their rights, and non-adherence to treatment regimens)
2.Factors related to the healthcare system (with subcategories: discrimination in accessing healthcare services, contemptuous attitudes of healthcare providers, incompetency of healthcare providers, fear of infection by the virus, disclosure of patient information, negligence by medical centers in identifying infected individuals, and failure to conduct premarital testing)
3.Cultural factors (with subcategories: non-acceptance of infected individuals in society, stigma, and discrimination in marriage and childbearing).
The right to access healthcare services, confidentiality of information, the right to marry, financial protection, and active participation in society should be prioritized for people living with HIV.

The Relationship Between Ethical Culture and Job Commitment of Nurses Working in Educational and Medical Centers of Hamadan University of Medical Sciences
Mehran Saadatmand, Abolfazl Ghani Honar,
Volume 17, Issue 0 (12-2024)
Abstract
Promoting an ethical culture is crucial for ensuring job commitment and competent clinical care among nurses. Ethical culture encompasses shared understandings and perceptions that guide ethical conduct within an organization. Job commitment reflects an individual's psychological and emotional attachment to their job. This study aimed to investigate the relationship between ethical culture and job commitment among nurses working in educational and medical centers affiliated with Hamadan University of Medical Sciences. This descriptive correlational study included 170 nurses selected from teaching hospitals in Hamadan using the Morgan table and based on inclusion criteria. Data were collected using demographic questionnaires, the Gobel et al. Ethical Culture Questionnaire, and the Schaufeli Job Commitment Questionnaire. Data analysis was performed using SPSS version 22 software. A significant and positive correlation was found between ethical culture and nurses' job commitment (r=0.42, p<0.05). Ethical culture was significantly higher among nurses with more work experience and female nurses compared to their counterparts. Additionally, job commitment was significantly higher among male nurses and those with formal employment status. The findings demonstrate a strong positive correlation between ethical culture and job commitment among nurses. Enhancing ethical culture within healthcare settings through effective leadership, clear ethical guidelines, and open communication channels can significantly improve job satisfaction and, ultimately, patient care. Further research is needed to explore the specific factors that contribute to ethical culture within different healthcare contexts.

Ethical Challenges of Artificial Intelligence in Academic Writing and Dissemination
Amirmohammad Azarakhsh, Mohammadreza Dinmohammadi, Kian Nouroozi Tabrizi, Kowsar Nouri,
Volume 17, Issue 0 (12-2024)
Abstract
In recent years, artificial intelligence (AI) has significantly impacted the publication of research articles, transforming the landscape of academic writing and dissemination. However, the integration of AI in this process presents significant ethical challenges that require careful consideration. This review study utilized a comprehensive search strategy, employing keywords such as "artificial intelligence," "publication ethics," "ethical challenges," "academic integrity," and "research dissemination" to identify relevant articles in scientific databases including PubMed, Scopus, CINAHL, and Google Scholar. The search included articles published between 2010 and 2024 in both English and Persian. Research articles, systematic reviews, and case reports that included the specified keywords in their titles and abstracts were selected. A total of 150 articles were screened, and 50 relevant studies were included for detailed analysis. The analysis identified several ethical challenges associated with the use of AI in academic publishing. Concerns regarding academic integrity are paramount, as AI-generated content can blur the lines between original research and automated writing, raising concerns about authorship and plagiarism. Furthermore, the reliance on AI tools for data analysis and manuscript preparation can raise questions about the accuracy and validity of research findings. additionally, the potential for bias embedded within AI algorithms is a significant concern, as it can influence the selection of research topics, the framing of research questions, and even the peer review process. The lack of transparency in AI-driven editorial processes can further undermine trust in academic publishing. This review underscores the urgent need for robust ethical frameworks and regulations to guide the responsible use of AI in academic publishing. Increased awareness and training among researchers and editors regarding the ethical implications of AI are crucial. Interdisciplinary collaborations are essential to address these challenges effectively and ensure the integrity and trustworthiness of academic research in the AI era.
 

Assessment of the Level of Adherence to Ethical Principles in Research by Researchers at Iranian Medical Sciences Universities (Eight Regions)
Batool Zeidabadi, Khadijeh Ahmadzadeh, Zeinab Khademi, Reza Sadeghi, Farnoosh Ghomi,
Volume 17, Issue 0 (12-2024)
Abstract
Research ethics is a fundamental component of the scientific process and is crucial for ensuring the integrity and reliability of research outcomes. Researchers must recognize that the results of their studies can impact individuals and societies. Therefore, accountability and transparency in conducting research are of particular importance. Adherence to ethical principles not only enhances the scientific credibility of researchers but also contributes to the advancement of science and technology. This study aimed to assess the level of adherence to research ethical principles among researchers at Iranian Medical Sciences Universities. This descriptive-analytic, cross-sectional study focused on researchers from Iranian universities of medical sciences. The data collection tool was a research ethics compliance questionnaire, which was distributed to researchers at medical universities in Region Eight. The questionnaire contained 40 items across 9 dimensions: respect for subjects' moral rights, free thinking, professional responsibility, social responsibility, accuracy, emotional impartiality, honesty, Originality, and legitimacy. Data were analyzed using SPSS version 24 software. In addition to descriptive statistics, Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests were also applied. A total of 230 researchers participated in the study, 193 of whom were faculty members. The results indicated that the average score for adherence to ethical principles in research was 3.174, reflecting a high level of adherence. The results also revealed that the dimensions of legitimacy and accuracy had the highest average scores (21.7 and 22.5, respectively). Significant differences were observed in adherence to ethical principles based on educational degree, academic rank, age, and work experience (p < 0.05). Spearman's correlation indicated a significant inverse relationship between adherence to ethical principles and educational degree, meaning that higher educational levels were associated with lower adherence to ethical principles in research. Overall, the findings of this study show that most researchers in the eight regions of Iranian medical sciences universities adhere to ethical principles in research at a high level.

Commitment to Care, Commitment to Education: An Exploration of the Ethical Dimensions of Patient Education in Healthcare
Azar Darvishpour, Fatemeh Mansouri, Shiva Mahdavi Fashtami,
Volume 17, Issue 0 (12-2024)
Abstract
Patient education is a fundamental component of healthcare that enhances patient outcomes, satisfaction, and self-management. Healthcare professionals have a responsibility to deliver high-quality patient education that is personalized to meet the unique needs and circumstances of each patient. Adhering to ethical principles—ensuring the provision of accurate, unbiased information while respecting patient autonomy and decision-making capacity—is crucial in this process. This study aimed to explore the ethical dimensions of patient education. This study employed a systematic review approach. A comprehensive search was conducted in the PubMed, Scopus, Web of Science, and Google Scholar databases using the keywords ethics, patient education, and ethical adherence for the period 2014–2024. Inclusion criteria encompassed studies that focused on the ethical aspects of patient education and adherence. Data were analyzed using qualitative content analysis. Out of 216 identified articles, 20 met the inclusion criteria. Three key categories emerged from the data analysis: (1) Commitment to Care, encompassing client-centered education and patient support with emotional reassurance; (2) Commitment to Education, including structured educational programs and communication skills of healthcare professionals; and (3) Adherence to Ethical Principles, which involved respect for patient autonomy and confidentiality. The study underscores the significance of healthcare professionals' dual commitment to both care and education in delivering effective patient education. Awareness of the ethical dimensions of patient education is essential for ensuring that educational interventions are patient-centered and aligned with ethical standards. Future research should explore the interplay between patient-centered care, autonomy, and healthcare professionals’ communication skills in relation to patient education outcomes.

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