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The Effect of An Intervention Based on the Knowledge-to-Action Model on Moral Distress in Critical Care Nurses
Mohammadmahdi Pazhavand, Maasoumeh Barkhordari-Sharifabad, Khadijeh Nasiriani,
Volume 18, Issue 1 (3-2025)
Abstract
Identifying an effective coping strategy for moral distress, as an important and common phenomenon among intensive care unit nurses, seems essential. The knowledge-to-action model aims to identify effective methods for implementing evidence into clinical practice. The present study sought to determine the effect of an intervention based on the knowledge-to-action model on moral distress among nurses working in intensive care units. This was an experimental study, and the statistical population included nurses working in the intensive care units of Namazi Hospital in Shiraz, Iran. A total of 100 eligible nurses were selected through convenience sampling and then randomly assigned to intervention and control groups. For the intervention group, the knowledge-to-action model was implemented. Data were collected using the Hamric Moral Distress Scale before and one month after the intervention. Both groups completed the questionnaire at these time points. Data were analyzed using descriptive and inferential statistics with SPSS version 19. The findings showed that the two groups were similar in terms of demographic characteristics and mean moral distress scores before the intervention. After the intervention, the mean scores of moral distress in the intervention group were significantly reduced in the frequency dimension (2.12±0.34) and severity dimension (2.32±0.46) compared to the control group (frequency: 2.51±0.43; severity: 2.57±0.55) (p<0.001). The results indicated that implementing the knowledge-to-action model reduces moral distress in intensive care unit nurses. Therefore, it is recommended that nursing managers adopt this model to improve the quality of care.

The Necessity of Spiritual Health Education in Iranian Universities of Medical Sciences: A Qualitative Study
Akram Heidari, Morteza Heidari, Baqer Larijani, Professor Ali Mohammad Mosadeqrad,
Volume 18, Issue 1 (3-2025)
Abstract
Spiritual health refers to having purpose and meaning in life and a sense of belonging to something beyond the self, which strengthens inner peace, satisfaction, and happiness. This qualitative study was conducted in 2024 using an interpretive phenomenological approach. Through semi-structured interviews with 47 policymakers, managers, faculty members, staff, and students, a total of 183 benefits of spiritual health education in universities of medical sciences were identified. These benefits were categorized into six groups: benefits for faculty members, students, staff, patients, society, and the university. For faculty members, spirituality education leads to enhanced ethical awareness, increased motivation, job satisfaction, professional commitment, and improved quality of education. Students, by strengthening spirituality, gain greater communication and empathy skills, experience reduced stress and anxiety, and demonstrate improved professional competencies. Healthcare staff benefit from reduced medical errors, increased resilience, improved social relationships, and enhanced quality of care. Patients receiving spiritual care experience lower levels of stress and depression, improved mental health and quality of life, and a more rapid course of treatment and recovery. At the societal level, spiritual health education contributes to more positive social behaviors and the development of a healthier community. Furthermore, universities implementing such education can design more comprehensive curricula, promote interdisciplinary research, strengthen professional ethics, and train holistically oriented healthcare professionals, thereby increasing their credibility and productivity. Spiritual health education in Iranian universities of medical sciences, by exerting positive effects on faculty members, students, staff, patients, society, and the university itself, results in the improvement of psychological and professional well-being, the enhancement of educational quality, and the increased productivity and credibility of the higher education health system of the country.

The Relationship Between Moral Injury and Moral Courage in Nurses Working in Intensive Care Units
Samaneh Fallah-Karimi, Zahra Khalilzadeh-Farsangi, Azizollah Arbabisarjou, Fatemeh Etemadinia,
Volume 18, Issue 1 (3-2025)
Abstract
Nurses working in intensive care units are frequently exposed to complex ethical issues and difficult decision-making, placing them at high risk for moral injury. Such injury can negatively affect their professional performance and mental health. Accordingly, this study aimed to explore the relationship between moral injury and moral courage among nurses working in intensive care units. This descriptive cross-sectional study was conducted in 2024. The study population consisted of 150 nurses working in intensive care units. Data were collected through Sekerka’s Moral Courage Questionnaire and the Moral Injury Symptom Scale for Health Professionals. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient, and the independent samples t-test via SPSS software version 22. The findings revealed a significant inverse relationship between moral injury and moral courage (r = -0.64, p < 0.001). Moreover, moral courage levels were higher among registered nurses compared to nurses in the compulsory service program. Besides, a direct relationship was observed between age and moral courage, suggesting that moral courage increases with age. The results of this study highlight the importance of designing and implementing effective educational programs to reduce moral injury and promote moral courage among this group of nurses.

A Critique of Blackshaw’s Ethical Argument Against Procreation
Amir Rastin Toroghi,
Volume 18, Issue 1 (3-2025)
Abstract
Recent decades have witnessed a decline in birth rates and a growing trend toward voluntary childlessness, phenomena reflected in emerging ethical theories such as antinatalism. This study critically analyzed one of the most prominent arguments in this domain—Bruce Blackshaw’s “Applying Pascal’s Wager to Procreation.” Inspired by Pascal’s Wager and McMahan’s Asymmetry Principle, Blackshaw argues that since a child may one day lose faith and face eternal torture, procreation is morally impermissible, regardless of the low probability of such an outcome. He concludes that moral responsibility requires individuals to avoid reproduction altogether, either through celibacy or sterilization. This study critiqued Blackshaw’s argument from three perspectives: (1) its implausible implications, such as generalizing to all moral decisions and disruption of everyday life; (2) foundational critiques by moral philosophers who reject asymmetry principle; and (3) incompatibility with theological foundations, particularly within the Islamic tradition, such as the neglect of key considerations including the moral responsibility of children, the educational role of parents, and the diverse interpretations of eternal damnation. From an Islamic perspective, procreation is not a hazard but rather part of the prophetic tradition, human nature, and the wise design of creation. Birth is seen as a gateway to development, choice, and proximity to God.

Is the Use of Video Recording Important in the Intensive Care Unit?
Parsa Farmahin Farahany, Zahra Torkashvand,
Volume 18, Issue 1 (3-2025)
Abstract
 One of the key ethical-legal concerns in the medical profession is patients’ trust in the quality of care and adherence to professional standards. This viewpoint explored the ethical-legal dimensions of using surveillance cameras in Intensive Care Units (ICUs), focusing on a specific legal-ethical case. In this scenario, the patients’ family caregivers express doubt about the quality of care and request access to recorded footage. From an ethical-legal perspective, documenting events by the medical team—provided that privacy, data protection regulations, and visual monitoring standards are respected—can help safeguard patients’ rights, clarify staff performance, and prevent legal misunderstandings. While acknowledging the potential benefits, this study also outlined legal considerations, such as patient notification, access limitations, and data management protocols. The key conclusion is that the use of cameras in ICUs, if aligned with legal and institutional requirements, can enhance trust, demonstrate ethical compliance, and reduce legal complaints.

A Critique of the Jurisprudential-Ethical Foundations of Applying the Term “Death” to the Vegetative State
Sayyed Mohammad Taghi Hosseini Vardaniani, Dr Ahmad Salami, Sayyed Morteza Hosseini, Jannat Mashayekhi,
Volume 18, Issue 1 (3-2025)
Abstract
The vegetative state is a condition in contemporary medicine that raises numerous ethical, jurisprudential, and legal challenges. The most fundamental question when confronting this condition concerns whether individuals in such a state are considered alive or deceased, as subsequent rulings and implications are typically contingent upon the answer to this question. Some contemporary Islamic jurists, drawing upon the jurisprudential division of life into “stable life” and “unstable life”, have deemed individuals in a vegetative state to be deceased, given their lack of volition and consciousness. This study argues that the concept of “unstable life” does not apply to these individuals, particularly in cases of persistent and chronic vegetative states where the possibility of regaining consciousness, however remote, exists. Furthermore, the continued function of the brainstem and the non-fulfillment of the medical and legal criteria for brain death in many systems affirm that the designation of “deceased” is incorrect. From an Islamic perspective, the definitive separation of the soul from the body, which is the condition for the occurrence of death, cannot be ascertained in the vegetative state. Ultimately, in circumstances of doubt regarding the life or death of a person in a vegetative state, this uncertainty constitutes a “case-specific doubt”, and by applying the legal principle of “presumption of continued life”, the individual must be deemed alive and all the corresponding legal and religious consequences of life must be accorded to them.

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