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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.

Telehealth: Ethical and Legal Challenges in the Healthcare System
Hooman Heydary, Shakila Belkafeh, Mohammadreza Dinmohammadi,
Volume 17, Issue 0 (12-2024)
Abstract
Telehealth has emerged as a rapidly expanding method for delivering healthcare services, especially during the COVID-19 pandemic. This approach has opened new avenues for accessing medical care and contributed to reducing healthcare costs. However, the growth of telehealth has introduced significant legal and ethical challenges that warrant thorough investigation. This review study employed keywords such as "telemedicine," "telehealth," "ethical challenges," "legal challenges," and "healthcare system" to search scientific databases including PubMed, Scopus, CINAHL, and Google Scholar. Articles published in English and Persian between 2010 and 2024 were reviewed. Eligible sources included research articles, systematic reviews, and case reports focusing on legal and ethical issues related to telehealth. Following an initial screening, articles were assessed based on quality and scientific credibility, and the selected works were analyzed for the final synthesis. Telehealth presents several critical challenges that must be addressed to ensure safe and equitable care delivery. One of the foremost concerns is patient privacy and data protection; the exchange of sensitive health information necessitates robust security protocols and adherence to data protection regulations to uphold patient confidentiality and trust. Another key issue is informed consent, which must be adapted to the virtual context to ensure patients are adequately informed of both the benefits and potential risks associated with telehealth services. While telehealth enhances healthcare accessibility, it may also deepen existing health disparities due to unequal access to digital technologies. Therefore, investments in communication infrastructure and digital literacy are essential to promote inclusivity and equal access to care. Although telehealth offers substantial benefits—including improved access, convenience, and enhanced coordination of care—its legal and ethical implications must not be overlooked. To fully realize its potential, stakeholders must collaborate in developing comprehensive regulations and ethical frameworks. Addressing these challenges is imperative to advancing telehealth in a manner that ensures patient safety, protects rights, and promotes health equity.

Investigating the Ethical Challenges of Nurses in End-of-Life Care at Home for Elderly Patients: A Review Study
Nayereh Baghcheghi, Zahra Maddah,
Volume 17, Issue 0 (12-2024)
Abstract
With the increasing elderly population and the growing demand for home healthcare and end-of-life care services, nurses are facing expanded duties and responsibilities. This intensification of responsibilities can expose them to significant ethical challenges. This study aimed to investigate the ethical issues nurses encounter in providing end-of-life care at home for elderly patients. This review study involved a comprehensive search of databases including PubMed (Medline), Google Scholar, ISI Scopus, ProQuest, Science Direct, SID, IranDoc, IranMedex, and Magiran. The keywords used were: nursing ethics, ethical challenges, end-of-life care, and home care, along with their Persian equivalents. The search covered literature published between 2000 and 2024. The review identified several prominent ethical challenges faced by nurses in home-based end-of-life care, including: lack of attention to patients’ rights and independence, disrespect for the dignity of elderly patients, inadequate empathetic care, poor communication, and unsafe home environments for nurses. These challenges may lead to moral distress, as well as psychological and emotional consequences for both the care providers and the elderly patients. Given the serious ethical challenges nurses face in end-of-life home care for the elderly, it is essential for them to be well-versed in ethical principles relevant to this context. Enhancing awareness and competence in ethical practices can help nurses uphold patient rights, promote autonomy, and provide high-quality, compassionate care through effective communication and support.

Attitudes Towards Euthanasia Among Intensive Care Nurses
Maryam Ghaffari, Reza Shabanloei, Mozhgan Behshid,
Volume 17, Issue 0 (12-2024)
Abstract
Euthanasia, often referred to as mercy killing or an "easy death," remains a deeply controversial issue, particularly in Islamic countries where it is both ethically and legally prohibited. Nurses working in intensive care units (ICUs) are more likely than other healthcare professionals to encounter situations related to end-of-life care, given the critical condition of the patients they serve. Consequently, their attitudes toward euthanasia hold significant ethical and professional implications. This descriptive-analytical study was conducted to explore the attitudes of ICU nurses toward euthanasia in a context where it is culturally and legally forbidden. A total of 194 nurses from eight hospitals affiliated with Tabriz University of Medical Sciences participated. Data collection instruments included a demographic questionnaire and Holloway’s Attitudes Toward Euthanasia Scale. Data were analyzed using descriptive statistics, t-tests, and ANOVA. The mean attitude score towards euthanasia was 71.95 ± 4.99 out of a possible 120. Overall, 74% of participants scored below 75, reflecting a generally negative attitude toward euthanasia, while 26% scored above 75, indicating a more favorable view. No statistically significant association was found between attitudes toward euthanasia and any demographic variables (p ≥ 0.05). Despite the legal and religious restrictions against euthanasia in Iran, a portion of ICU nurses demonstrated a positive attitude toward the practice. Given the potential impact of these attitudes on patient care, nursing managers and educational authorities should address even minimal levels of support for euthanasia. Targeted training and ethical guidance are essential to ensure that patient care remains aligned with legal and moral standards, particularly in ethically sensitive clinical situations.
 

The Effect of Spiritual Intelligence Training on Nurses' Spiritual Care Competency in Patient Care: A Review Study
Mina Kafash Mohammadjani, Mandana Kazemi, Fatemeh Mahboob Bashari,
Volume 17, Issue 0 (12-2024)
Abstract
Spiritual intelligence, defined as the capacity to effectively utilize religious and spiritual resources, plays a crucial role in providing high-quality nursing care. This study aimed to investigate the effect of spiritual intelligence training on nurses' competency in caring for patients. This review study utilized a comprehensive search strategy, including Persian and English keywords (Spirituality, Spiritual Intelligence, Spiritual Care, and Nursing) within the PubMed, Scopus, Google Scholar, and SID databases, covering the period from 2017 to 2023. A total of 21 full-text articles (in English and Persian) were selected and analyzed. The findings revealed that 45% of the nurses assessed exhibited below-average levels of spiritual care competency. Most studies demonstrated a significant positive correlation between spiritual intelligence and nurses' competence in providing spiritual care. Spiritual intelligence fostered the development of nurses' beliefs, personality traits, and a strong desire for personal and professional growth, ultimately enhancing the quality of nursing care. Furthermore, male gender, place of residence, and religious adherence emerged as predictors of nurses' spiritual care competency. Studies consistently highlighted the increased importance of spiritual dimensions during illness and hospitalization, emphasizing the critical need for nurses to provide comprehensive spiritual care.Based on this review, it is evident that ethical challenges exist within nursing care, and some nurses may not adequately address the spiritual needs of their patients. Therefore, promoting spirituality in nursing care through spiritual intelligence training is essential to enhance the quality of nursing practice.
 

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.
 

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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