Iranian Journal of Medical Ethics and History of Medicine

Improvement of staffs’ productivity through job ethic promotion is the most important challenges in new millennium. Therefore, this research aimed to determine the relationship between job ethics and staffs’ productivity in Tehran University of Medical Sciences. This research was a descriptive-analytical cross-sectional study conducted in 2016-2017. The research population was all of the staff of Tehran University of Medical Sciences. The sample size calculated 375 by Cochran formula according to staff of the hospitals and university schools. The research tool was Cullen and Victor’s job ethnics and Hersey and Goldsmith’s staff productivity questionnaires. The data was analyzed by SPSS software version 22, and used average and standard deviation for descriptive results and parametric tests, for example Pearson and Multivariate Linear regression. There was significant correlation between staff’s productivity and their job ethics and its dimensions. Also, organizational justice had the more and righteousness had the less correlation with staff’s productivity. Moreover, the staff's gender had significant correlation with their productivity, but the age and educational degrees of the staff had negative significant correlation with their productivity. Ultimately, 86% of staff’s productivity variations were impressed by their job ethics and its dimensions. To increase productivity of staff, establishment of safe organizational climate, development of personal ethics, and consideration of ethical issues by managers and supervisors is suggested.

Today, the role of spiritual leaders is to stimulate employees by employing a spiritual perspective and creating cultural backgrounds based on human values to raise capable employees. On the other hand, professional ethics is one of the variables that has a significant impact on individual and group activities and outcomes of the organization. The purpose of this study was to investigate the relationship between spiritual leadership and professional ethics with organizational performance and quality of work life with the intermediate role of organizational learning among employees of Imam Reza Hospital in Urmia. The design of this research was a descriptive-correlational cross-sectional design model of structural equations. The statistical population of this research included 759 employees, 240 of them were selected by random sampling method. For data collection, standard questionnaires were used. Pearson Coefficient and Structural Equation Model Finding were used to analyze and examine the assumptions and the relation between the variants. The results show that there is a significant relationship between spiritual leadership variables and Professional Ethics with organizational performance and quality of life of employees (P<0.01, r=0.42, r=0.51), (P<0.01, r=0.36, r=0.75). Furthermore, the results showed that the intermediate role of organizational learning in the association between spiritual leadership and professional ethics with organizational performance and quality of work life (β = 0.17, β = 0.18, β = 0.16, β = 0.17) ) is confirmed. According to the findings, it can be concluded that paying attention to spiritual leadership and professional ethics can improve the organizational performance and quality of work life, as well as enhance organizational learning among the staff of Imam Reza Hospital.

Nurses need to be familiar with the ethical issues of nursing and its sensitivity to all communications and interventions with patients. This sensitivity as a basis for nursing ethics should be considered from the beginning of nursing education. This study aimed to investigate the moral sensitivity of nursing students of Bushehr University of Medical Sciences. This descriptive cross-sectional study was conducted to determine the ethical sensitivity of 73 nursing students using standard questionnaire of ethical sensitivity of nurses in decision-making. Its validity and reliability were confirmed in previous studies (α=0.8). Dimensions of the questionnaire were: amount of respect for patient independence, level of knowledge about the relationship with the patient, level of professional knowledge, experience of difficulties and ethical conflicts, and the use of ethical concepts in ethical decision-making, honesty and benevolence. 0-50 were considered as low moral sensitivity, 50-75 as moderate, and 75-100 as high. All nursing students of the third and eighth semester were enrolled in the census in 2016. The average students' moral sensitivity was moderate (68.15±13.99). The highest average was for "honesty and benevolence", and the least for "professional knowledge" and "the use of ethical concepts in moral decision-making". The average moral sensitivity of the eighth semester students was higher than the third semester. There was a significantly relationship between students' moral sensitivity and academic term (p=0.000). Low ethical sensitivity in nurses leads to inappropriate decision-making; therefore, appropriate educational programs should be considered to increase the moral sensitivity of nurses and nursing students from the beginning of education.
 

The aim of this study was to determine the role of organizational health and job satisfaction in Work ethics of university staff. The research method was descriptive-correlational and the statistical population of the study consisted of all the staff of the University of Guilan. In this study, 134 participants were selected by stratified random sampling method. The research tools consisted of three questionnaires, work ethics, organizational health and job satisfaction. In order to analyze the data, Pearson correlation and regression analysis were used. The results showed that there is a positive and significant relationship between organizational health and Work ethics (P<0.01). There is a positive and significant relationship between job satisfaction and work ethics (P<0.01). Also, regression analysis showed that organizational health and job satisfaction could explain 39% of the variance of work ethics (P<0.01). The findings of this study indicate the importance of organizational health and job satisfaction in explaining the work ethics of university staff.

Ethical approach is one of the most important features of medical staffs expected to be used. One of the most important diseases that have been allocated to high moral challenges is HIV/AIDS. Nurses should provide standard care to these patients in their professional careers. In this descriptive study, 136 nurses working in the internal and surgical wards of one of the hospitals in Shiraz were selected through a cross-sectional questionnaire in 2015.Frequency of compliance with ethical values of nurses toward HIV/AIDS patients within various aspects showed that in total 40.4% of nurses in the observance of moral values has unsatisfactory performance, 33.1% relatively good performance and 26.5% has optimal performance. (P-value: 0.018)The mean score of different dimensions to separate parts of questionnaire showed no significant difference in dealing with AIDS patients among nurses according to different ages, sex and working years. The mean score of the separation of education in the respect of client/patient and keep his human dignity significantly differ between Diploma, B.S and M.S. Findings showed poor compliance with ethical code among nurses toward HIV/AIDS patients. Due to importance of ethical approach towards patients especially this vulnerable group of patients, regular educational program in relation to AIDS patients, in order to improve the quality of services, is recommended.

Moral sensitivity is one of the most important factors in improving the quality of nursing cares and nurses' performance. This research aimed to determine the relationship between moral sensitivity and self- efficacy in operating room nurses affiliated to educational- therapeutic centers in Ardabil University of medical sciences. This descriptive-correlation study was carried out on a sample of 144 nurses of operating room by census method in 2017. Data were collected by using moral sensitivity standard questionnaire and clinical performance self- efficacy. Data were analyzed using statistical tests: Pearson correlation coefficient, independent t- test and one way ANOVA by SPSS15 software. The mean of nurses' age was 30±6.07 years old. The majority of nurses were female (%54) and majority of them were in operating room discipline (%59). The mean and standard deviation of moral sensitivity score was 87±11.00 and the total self-efficacy was 129±13.00. Pearson correlation coefficient showed a significant statistical correlation between self-efficacy score and moral sensitivity of nurses (P<0.0001, r=0.882). The results of this study showed that moral sensitivity and self-efficiency of operating room nurses is high. Furthermore, it seems that high moral sensitivity increases self-efficacy. However, moral sensitivity and self-efficacy of nurses can be improved by holding ethical and professional workshops.

Spiritual health (SH) is a supernatural force and endeavor to achieve perfection and peace of mind in life.When it is endangered, a person experiences loss of meaning in life. In nursing, caring services and SH are related to each other. It is necessary to promote the SH of nurses so that patients will receive better care. The study aim was the effect of spiritual education on SH of nursing students. In this quasi-experimental study, 76 of undergraduate nursing students were selected using random simple sampling method and divided into experimental group (EG) and control group (CG) (n= 38) with random allocation method. Educational intervention was done for the EG for a period of 4 weeks, a 60-minute session per week, but no intervention was performed for the CG. Four weeks after the intervention, the post-test was taken in 2 groups. Data were collected using the SH scale by Paloutzian and Ellison. Independent t-test didn’t indicate any difference before the intervention in the mean score of SH in 2 groups (t=-0.49, p=0.62), while in the post-test, the independent t-test indicated the mean score of SH was higher in the EG than in the CG (t=-2.14, p<0.03). After the intervention, there was a significant increase in the SH (t=-4.39, p<0.001) in the EG. The paired t-test indicated no difference in the SH in the CG compared to the pre and post-test (t=-0.25, p<0.79). Spritual education influenced SH of nursing students. It is recommended that spiritual education be considered as one of the strategies for promoting SH in students.
 

Considering the increasing prevalence of the malignant diseases and their great effects on the different aspects of the patients’ life and even their family, the disclosure of its diagnosis and trust telling to the patients have been changed to one of the main medical ethics challenges. This study aimed for the evaluation of patient’s tendency and their family to disclosure of malignant disease. This study was a cross-sectional research. It has been done with a questionnaire on the 270 people. The sample consisted of three groups: 100 patients without cancer disease, 100 patients’ family members, and 70 patients with cancer disease, who referred to Mustafa Khomeini Hospital. The data were analyzed through SPSS-16 software in this study, 74% of the patients with cancer and 85% of patients without cancer and 50% of patients’ families had tendency to know the diagnosis of malignant disease. In the case of prognosis, 39% of cancer patients and 75% of without cancer patients, were agreed to complete knowledge, and 42% of cancer patients and 22% of without cancer patients, agreed on relative knowledge. Regarding the result of this study and respecting the individuals' rights, it seems better for the patients with malignant disease to be informed of their diagnosis and prognosis by the health care workers. Furthermore, it would be better to implement strategies for improvement of patient-physician relationship through physicians' communication skills with patients.

Patient Advocacy is one of the vital duties of nurses. The purpose of this study was to determine the relationship between spiritual intelligence and patient advocacy in educational hospitals in Khorramabad during 2017. This was a correlational descriptive-analytic study that was performed on 250 nurses working in educational hospitals in Khorramabad in 2017. The criteria for entering this study included a minimum degree of nursing and one year of clinical work experience. Participants in this study were selected by random sampling method. Data collection tools consisted of Hank’s advocacy Questionnaire and King's spiritual intelligence. Data were analyzed using descriptive statistics (mean, standard deviation) and inferential (correlation coefficients and regression coefficients) using SPSS v.21 software. Sixty seven percent (164 persons) were female and 37.5% (79 persons) were male. Sixty three percent of participants had a work experience of less than 5 years. The findings of this study showed the mean score of spiritual intelligence of nurses was 80.88 ± 11.19. The average score for patient advocacy was 155.73 ± 21.41. Pearson correlation coefficient showed that there was a significant correlation between spiritual intelligence score and Advocacy and its components (p = 0.624). The mean score of spiritual intelligence in nurses was high in the King questionnaire. The average score for patient advocacy was Hanks' questionnaire in the medium range. The present study showed that there was a significant positive correlation between spiritual intelligence and patient advocacy. As spiritual intelligence is acquired, spiritual intelligence can be promoted through classes and workshops, thereby increasing the patient advocacy and increasing the safety of patients.
 

One of the most effective factors on organizational behavior is the Nurses’ job satisfaction. Spiritual wellbeing of nurses is an inseparable personal element that influences their job satisfaction. The aim of this study was assessing association between Nurses' spiritual well-being and job satisfaction in Educational-Therapeutic center of Tabriz Shohada. The study population was nurses of Shohada hospital. In this study, 155 participants were selected by stratified Simple random sampling method. The research tools consisted of two questionnaires including spiritual well-being scale (SWBS) and job satisfaction (MSQ). In order to analyze the data, descriptive (frequency, percent, mean, standard deviation) and inferential (independent t, Pearson, Spearman, ANOVA Tukey test) were used. The results showed that there is a positive and significant relationship between nurses' spiritual well-being and their job satisfaction (P<0.05). Also, mean score of nurses' job satisfaction was 61.89 (12.63) and mean score of spiritual well-being was 89.85 (13.64) and both were above average (P<0.05). Type of employment, age, and sex had significant relationship with job satisfaction (P<0.05). According to the findings of this study, it is recommended that the relevant stakeholders and authorities increase their nurses' job satisfaction, pay special attention to the issue of spiritual health and improvement of it, because increasing spiritual health increases nurses’ job satisfaction and ultimately lead to better Care services will be better for patients.

Trust is one of the most important issues in patient-physician relationship and affects the treatment acceptance and followup from the patient and optimal outcome. Patient trust to emergency physician is different from other physicians in many ways because of patient’s urgent situation and lack of choice in physicians. This paper explores the reasoning for (dis)trust in emergency physicians in Imam khomeini hospital. A qualitative study in Imam khomeyni hospital was done including 5 recorded focused groups (with 3-6 patients in each group) and 8 in-depth interviews with patients. Patient trust’s issues were divided into 2 major groups: 1- issues that depend on emergency physicians (including professionalism; practical skills and physician’s personal factors) 2-issues independent to emergency physicians (including patient’s previous beliefs; environmental and hospital’s factors and patient’s personal factors). Many factors about emergency physicians like personal factors that are extracted from this study were similar to other physicians. In other hand, it seems that patient trust in emergency physicians is affected by environmental factors especially hospital related factors and it is better to consider it as an integrated foundation and not only trust between persons.

Since 1984, criminal law more than any other period has been specified under the framework of human rights and consequently limited based on its principal. It was followed by the emergence of a new approach called “quality of law principle”. In criminal law, which was presented by European Court of Human Rights for the first time then in the content of verdicts issued by this international judicial institute and reconsideration of criminal law legality principle, it has developed and become more consistent with social justice and manners. According to this principle, the qualitative law is a law which is consistent with quality elements of law based on human rights and moral principles. It is interesting to note that lack of each requirement voids the related law and according to Court’s case law, the existence of such law would not be different from lack of law. In present paper, through the investigation of physician liability and focus on article 495 of Islamic Penal Code as the key to legislation in this regard, and given the requirements of quality of law principle, it has been concluded that the above mentioned provision and all other articles related to this context are not consistent with elements of “the Quality of Law”, thus with failure to meet the minimum criteria of justice, social morality and human rights, the law fails to have the required quality and consequently, it is recommended to legislate based on the criteria of Quality of Law.

Empathy is considered an essential prerequisite for a nurse to effectively care for a patient. Also, spirituality is an important component in nurse-patient relationships. The aim of this study was to determine the relationship between empathy and spiritual attitude among nursing students. In this descriptive and correlation study, the samples consisted of 272 nursing students that were studying in 3 Medical Sciences Universities in Tehran, 2017. Samples were selected through convenience sampling method. Data were collected by demographics’ data form, validated and reliable scales of empathy and spiritual attitude. Data were analyzed by descriptive and analytical (Pearson Coefficient, Independent T test, and ANOVA) statistics. The students had a mean empathy score of 106.982 ± 14.65 that this was more than median scores of scale (60). Furthermore, they had a spiritual attitude score of 115.79 ± 15.8 that this was more than median scores of scale (86). Findings indicated that a significant relationship between empathy and spiritual attitude among nursing students (r=.265, p=.0001). Gender, educational level, interest in nursing, work status, and the average score of the previous term had significant relationships with empathy (P < 0.05). Interest in nursing and work status had significant relationships with spiritual attitude (P < 0.05).Research findings support the hypothesis of association between empathy and spiritual attitude. Since empathy has a significant relationship with spiritual attitude, it seems that nursing students’ empathy will increase by promoting their spiritual attitude.

Pharmacists, as a member of the health team face a lot of ethical challenges in performing their professional duties. This study was aimed to evaluate status, challenges and improvement strategies of pharmacy professional ethics in drugstores. It was a descriptive-analytic study carried out in 2015-2016. Data was collected using a standardized questionnaire related to principles of pharmacy professional ethics’ code from the viewpoint of qualified faculty members and students of Tabriz faculty of pharmacy. The overall score obtained for each principles of professional ethics code indicated moderate and high level status for each of the principles. However, there are some shortcomings in counseling to patients, consulting and interacting with physician, delivery of non-OTC drugs without any prescription, and accepting professional responsibility among the pharmacists. In addition, 71.5% of the professors and 75.5% of the students believed that inadequate income of pharmacists, the economic problems of drugstores, defects in the insurance systems, lack of proper culture for pharmacist's position, insufficient training of professional ethics at universities, priority of physician in Iran health system and giving gifts by some pharmaceutical companies are the main factors influencing professional ethics in pharmacies. Thus, comprehensive management is essential for improving professional ethics in pharmacies. In this regard, promoting professional ethics education, paying attention to economic problems of pharmacists and pharmacies, improving the performance of insurance organizations, developing culture to promote the position of pharmacists and serious supervision of health system officials on drugstores and pharmaceutical companies are necessary.

Development of new methods of treatments for infertility has given rise to a serious question as to the access to such methods. Determination of the ones who can access the mentioned treatments and the limits of this access, depends to the definition of infertility. The Law of the method for Embryo Donation to Infertile Couples according to Iranian legislature considers the infertile couple who “cannot reproduce in accordance with credible medical certificate” as eligible to receive the donated embryo. However, applicants for modern infertility treatment methods have gone beyond infertile couples and include those couples who wish, based on credible medical evidence, to avoid having unhealthy children, especially by using donation methods or surrogacy. Accordingly, having supported a preventive approach to ARTs, a new concept of infertility will appear on the horizon. Expanding this concept to couples who are considered fertile from a common medical perspective but give birth to seriously unhealthy children shall inevitably lead us to revise the common legal concept of infertility. Therefore, by resorting to ethical reasoning, laws, and regulations of various legal systems and Fiqhi opinions we can develop another interpretation of Embryo Donation Law and argue for the access of the “perceived as infertile” couples to the infertility treatment with the help of third parties.

Science considers using technologies for treatment of infertility as the important cause of multifetal pregnancies. Fetal reduction is a clinical procedure developed for reducing the number of fetuses in multifetal pregnancies in order to avoid their common complications. Three aims may be offered for fetal reduction: (1) pregnancy preservation, and prevention of and decreasing risks of multifetal pregnancy to the mother and the remaining fetuses (high-end multifetal reduction); (2) eliminating fetuses bearing certain kind of illnesses (selective reduction); and (3) just preventing multiple birth where no considerable risk threatens the mother or the fetuses (elective reduction). Moral evaluation on fetal reduction techniques varies depending on which of the mentioned aims is followed. However, in many cases this is “medical necessity” that morally justifies the reduction. Nevertheless, given the difficulty of reaching a decision on this issue, risks involved in fetal reduction procedure, and its psychological implications for the mother and the father, it is seriously recommended to avoid such an action by methods that prevent multifetal pregnancy.