Iranian Journal of Medical Ethics and History of Medicine

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.
 

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.

Reflecting on the Qara – Khitai of Kerman (from 619 to 704 A.H. / 1223 to 1305 A.D.), we can see that the rule of the dynasty, some women of Qara – Khitai, with expertise and competence into political, economic, scientific and cultural even reached into the kingdom of Kerman. Among these women the one that can be mentioned is -Qutlugh Terken (Terken Khatun), who was directly and indirectly involved in Kerman government for more than 40 years. So, the main question of this article is to assess measures of Qutlugh Terkan for promotion of Kerman's medical condition and further investigation of patients' rights. One of the findings of the present study was that Terken Khatun, build and equipped hospitals in Kerman with best facilities about eight hundred years ago, she also constructed an advanced school to train a new generation of intellectuals including physicians.

Patients’ satisfaction of treatment centers is one of the most important indicators for the quality of care and treatment services. Taking care of patients’ satisfaction has essential role in managing programs of health services. The aim of study was to evaluate patients' satisfaction with the quality of services provided in Shahid Beheshti Hospital in Qorveh in 2015. The research method was cross-sectional and descriptive-analytic. The statistical population of the study consisted of 384 patients selected in one stage cluster sampling from different parts of hospital. Patient satisfaction was evaluated by means of questionnaire that its validity and reliability was confirmed. Information was analyzed by statistical software SPSS 20 and t-test. The results showed that most of satisfaction was related to the emergency department and the lowest levels of satisfaction was related to ICU. Overall satisfaction from health services of Shahid Beheshti hospital was 72%. In this study, the satisfaction and habitat of patient had meaningful relationship, but other factors had not significant relationship with patient statisfaction. In recent years, patient satisfaction had an acceptable level due to dramatic improvements in health system. Nevertheless, the problems and weaknesses in the health care field also should be concerned and resolved and we have to improve the quality of services.
 

Patient rights is one of the essential rights that should be considered by the medical staff, checking and comparing the attitudes of first and last year medical students to inform the ethical points of service delivery is important. The aim of this study was to compare and evaluate of first and last year medical students' attitude about respecting patients' rights in hospitals of Bushehr University of Medical Sciences. The present study was a descriptive, cross-sectional study carried out by using a questionnaire derived from Patient Right Charter approved by the Ministry of Health. The study population included all the first and last year of medical students of Bushehr University of Medical Sciences. The sample size was 113 and the sampling method was census. By using independent t-test and Pearson correlation, data analysis was performed by SPSS19 software. The attitude of first year students' was 76.36 ± 13.90 and among seniors was 71.63 ± 8.08, which was statistically significant (p<0.05). %52 of first and %84 of last year medical students had respectively and relatively favorable attitude regarding patients' rights. There was not statistically significant relationship between students' attitude and demographic factors. First year students had a better attitude among patient rights than the last year students. Therefore, planning to improve the students' attitude of observing patients' rights during the years of study is recommended.
 

In this research, an intercultural comparison between medical students from Iran and England was made to investigate the potential impact of culture on empathy and the relationships between empathy and child birth order in the family. The population consisted of medical students of medical universities from three cities: Tehran (Iran), London and Sheffield (England). The sample consisted of 182 students from two countries (88 Iranian, 94 English) which was selected by convenience sampling method. Data was collected by scale of empathy- student version and researcher made demographic questionnaire. Data was analyzed by using student’s t- test, MANOVA and Scheffe post hoc test. Results showed that the physician empathy of Iranian medical students is significantly higher than English students (P <0.01). Also the results showed that birth order of students has a meaningful correlation with their empathy (F=2.96,P<0.05). The results of multivariate analysis of variance showed that in the empathy variable, empathic care and self-care is more than English students rather than the patient of Iranian students, but they do not differ in the component of adopting the view. The result of this study reveals the importance of cultural differences and family factors such as birth order on personality factors for instance the physician ability to empathize with patients.
 

The most important factor in interpersonal relationships is trust. Trust in the physician-patient relationship is key and essential. Understanding the factors that affect trust is a prerequisite for trust. These factors vary in different societies. So we need to identify these factors and provide a single criterion for measuring them. Therefore, because we need a tool to measure these different factors in the context of culture and society, the purpose of this study is to determine the factors that influence public confidence in physicians to provide the necessary evidence for making appropriate instruments in Iran. The first step was to investigate the factors affecting patients' confidence in physicians during a library study. Then, during interviews and numerous discussion sessions, nineteen factors influencing public confidence in physicians were provided. Then, to determine the content validity, twenty experts evaluated the transparency, relevance and importance of the factors. Content validity ratio (CVR) and content validity index (CVI) were measured. CVR value for each of nineteen factors was 0.42, therefore content validity of the tool was significant with P.value 0.05. CVI value was 0.944 and content validity of the tool was confirmed. Factors affecting public confidence in physicians in Iran include 19 factors extracted during this study and can be used as factors for assessment of public confidence in physicians. Factors affecting public confidence in physicians in Iran include 19 factors extracted during this study.

Physician- patient communication is essential for good medical practice and leads to patient satisfaction and subsequent following of prescribed therapeutics and health promotion. There is limited study on this subject in Iran. The purpose of this study was to evaluate patients' satisfaction of the physician-patient communication and factors influencing it to provide useful information for decision-makers within the health services. This research was an applied field cross-sectional study among hospitals in Tehran. Satisfaction was assessed by 22 questions after obtaining consent from the patients. The level of patient's satisfaction with physician's communication among 1200 patients in order of priority was: medium 63.4%, high 15.1%, low 14.4%, very high 4.7%, and very low 2.5%. Mean patients’ satisfaction was 76.35±13.99, maximum and minimum satisfaction was 110 and 30, respectively. There was a significant relationship between patient satisfaction and patients’ gender, age, marital status, occupation, physicians’ age, sex and timely presence of the physician in the clinic and good deal of communication between patient and physician’s receptionist. Overall patient satisfaction with the patient -physician communication is medium that is not desirable. Factors such as gender, age, material status, and occupation of patients and age and sex of physician, timely presence of the physician in the clinic and a good deal of communication between patient and physician receptionist had a positive correlation with patient's satisfaction. According to important role of communications’ skills in patients’ satisfaction, it is necessary to put more emphasis on training and assessment of communication skills of physicians and health care personnel.
 

Communication with patients is an important issue in nursing meaning that to realize the truth from their viewpoints. This study was performed to compare levels of nurses’ empathy with patients at drug abuse treatment centers (DATCs) and the internal ward of hospital. The present research was a cross-sectional and descriptive-analytic study conducted at two environments of the internal ward and DATCs. A total of 60 subjects comprised research participants and were listed in the study through census method. A two-part scale was used including personal information and Jefferson scale of empathy with verified validity and reliability. Data were analyzed using SPSS16 software. The scores of nurses' empathy with patients recorded in the internal ward and at DATCs were 67.84±6.32 and 79.73±9.21 (out of 100), respectively (P=0.001). Male nurses (76.80±9.88), married nurses (75.93±9.98), ages of >40 years (79.1±11.12), masters’ degrees (75.5±3.78), job experiences of >10 years (83.53±8.53) and overtime hours of <50 h (80.61±9.9) attained the highest empathy scores with significant differences (P<0.05). The scores of nurses’ empathy with drug-dependent patients at DATCs were higher than those of internal wards indicating that the care of addicted patients in a specialized ward leads to increased empathy. Considering the relationship between empathic communication, educational levels and occupational experience of nurses, it is essential to consider training empathy skills to nursing students from the first semester and to provide in-service training to nurses working at hospitals and centers by nurses of higher educational qualifications and experiences.

Patient safety is one of the basic principles of health care and its evaluation and promotion are one of the main goals of the health system development plan in Iran. Therefore, the present study was designed to determine the status of patient safety culture in nursing staff of three hospitals, A and B, Shahrekord and C Borojen hospitals. This was a descriptive-analytical study performed from September to February 2018 and 359 eligible nurses were evaluated based on a multi-stage sampling method based on Patient Safety Culture Questionnaire. The collected data were analyzed by descriptive and inferential statistics using SPSS 20 software. The mean age of participants was 23.33 ± 7.79 years. The overall score of patient safety culture was 123.23 ± 16.15 for nurses, with the lowest score being 8.40 ± 1.86 for communication channels as well as feedback and informing others about errors 8.72±2.23 reported. Also, there was no statistically significant difference between different dimensions of patient safety culture and overall score in three hospitals (p> 0.05). Leadership is a key element in prioritizing patient safety. How to respond to mistakes determines the hospital safety culture. To promote a good hospital safety culture, the fear of being blamed for mistakes must be eliminated and the atmosphere of open communication and continuous learning must be implemented in the hospital.

The mutual trust in a social relationship is essential to adjusting that relationship under ethics and law. The functionality of legal and ethical rules can be trusted to create a good, orderly and just relationship when the parties can trust each other under the protection of such rules. The first legal documents in Iran required the practitioner to obtain the respect and trust of the society in himself and his colleagues, and then made clear his obligation under it. In subsequent reforms, such obligation stood as they were, but the values of “trust” and “respect” were not mentioned. It seems that “trust” and “respect” of physicians in a society is the good will of these professionals which supports the efficiency of the treatment on one hand, and the conscious cooperation of the patient on the other. This matter is dependent on the physician’s effort in respecting the patient’s boundary and staying true to the physicians own technical and professional obligations. This article emphasizes the necessity this inseparable relationship, and the analysis of legal obligation in the light of such higher ethical values.
 

Over the past years in the literature of medical ethics about the doctor-patient relationship, patient's rights have been greatly considered, but the other side of this relationship is not concerned, and the physician’s obligations have been highlighted. The two meanings are understood from the concept of   physicians’ rights; their rights in conflict with the patient rights’ and the right to self improvement. We want to review the causes of this neglect and its complications. The reasons for not paying attention to the physician’s rights include: traditional beliefs about the power imbalance in doctor-patient relationship, lack of emphasis in the four principles of medical ethics, lack of supportive structures, customer-orientation in medicine, and hyper medical professionalism. Continuing this neglect creates complications that include: physicians’ work-life imbalance, symbolic violence in their society, burnout of physicians, forgetting the principle of gratitude and ultimately, the lack of respect for patients' rights. Consequently, the discourse of medical ethics fails to achieve its primary goals.

A study on the adaptability of the patient's admission process with ethical standards has a significant role in reducing the misconduct of the medical staff and increasing the satisfaction of patients. Hence, by the study of the patient's admission process in the Neurosurgery ICU and the identification of its personnel faults; we are going to provide a platform for excellent service to patients. This study is a qualitative study. It had done with the In-depth interviewing with 28 staff of the Neurosurgery ICU of Loghman Hospital during the winter of 1396 (December2017- March 2018). The data is collected and analyzed with triple coding: open, selective, and axial. "The lack of ethical sensitivity to nursing profession and its importance" is a general tag for seven categories of functional status of ICU staff: the use of staff with insufficient professional competence, the impact of staff tastes in professional relationships, irrational expectations, lack of communication skills, the inability to admission new patients and work in other health centers. Accordingly, "the lack of moral sensitivity to the profession and its importance" in the ICU staff is a central phenomenon that results from neglect of the importance of developing transparent processes for various activities in the ICU, as well as the lack of professional training. This will make the ICU staff ignore the implementation of the defined standards, and subsequently  the decline in the quality of health care services in ICU.
 

Increased patient satisfaction can promote patient’s compliance with prescribed treatments and improve patients’ health. The aim of this study was to determine the patients’ satisfaction with nurses in surgical departments of Imam, Razi, and Golestan hospitals of Ahvaz city in 2018. In this descriptive-analytic study, patients over 18 years of age with at least 3 days of hospitalization were studied. Data including age, sex, marriage status, level of education, type of illness, hospitalization time, number of hospital admissions, and health status were collected through a demographic form. Patients’ satisfaction with nurses was obtained by the satisfaction questionnaire of nursing services. Chi-square, one-way analysis of variance, Kruskal-Wallis analysis, Mann-Whitney test, and Spearman correlation coefficient were used to analyze by SPSS software. Patients’ satisfaction in Imam, Razi and Golestan hospitals were 78.25±12.09, 68.30±11.24, and 58.09±17.42, respectively. Highest level of patients’ satisfaction was with Razi hospital nurses (P-value<0.05).There were no significant difference between patients of different hospitals regarding age, marriage status, place of residence, hospitalization history, and education level (P-value>0.05).With increasing age, having a history of admission, an increase in the duration of hospitalization, the patients’ satisfaction score decreased significantly (P-value<0.05), but there was no significant difference between the patients’ satisfaction by marriage status, place of residence and level of education (P-value>0.05). It is suggested that effective strategies for increasing patients’ satisfaction be applied through more care and attention of more sensitive people. Also, increasing awareness of  the community about the duties of patients, nurses, and medical staff is recommended.

In human communication, the relationship between the patient and the physician is one of the most challenging issues. This relationship is of critical importance in the medical ethics and forms the base of medical measures. Relationship between the physician and the patient brings about mutual trust between them to the extent that it overshadows physician’s skills. A physician needs to have the art of communication with the patients as well as his information in medical sciences. Damaging this communication leads to lack of efficiency, trust and satisfaction in the treatment of the patient. The authors of this article seek to analyze the major issues of medical ethics in the medical texts based on Mathnawi. Rumi has also made special mention of physicians' responsibilities and ethical duties in the stories of pulmonology, physiology, herbal therapy, routine treatment, and etc. In The story of “King and Handmaiden”, Confidentiality, Compassion, Kindness, and the expertise of saint against Handmaiden are issues that they are discussing in medical ethics. At the end of the story, audiences unbelievably are evaluating the performance of saint as opposed to the spirit of Hippocratic oath. In the story of “the old man and the physician”; deficiency of the communication between physician and patient is very definite. Not building trust and emotional communication in the relationship between the physician and the patient, specifically at the very first time which has happened without semiology has provided the context in which the patient distrust his physician and is not pleased with the treatment process. In the story of “Man who was desperately ill”, the physician has hidden the secret and also he has not given a clear and enough explanation for the prescription, therefore the patient's life is endangered.
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One of the most challenging aspects of treatment is when patient seriously refuses the desired by treating physician. On the other hand, refusing treatment is a condition of the patient's right to be aware, but does such a right also imposes a moral obligation on the treating physician or not? This study discusses the diagnosis of Systemic Lupus Erythematosis disease. This article attempts to provide an overview of the ethical considerations for obtaining informed consent for a patient who refuses treatment. In this report, according to the patient's age, it can be concluded that although the patient has the capacity to make decisions, but because her age is below the legal age and does not have the authority to decide, her refusal to receive treatment cannot be accepted and it is necessary to make a decision based on the supreme interests of the patient with the opinion of a qualified legal guardian in this regard, taking into account the scientific aspects.

Privacy is a basic principle of humanity and one of the most important fundamental rights of every human, that adherence to it is required particularly in health care organizations. The purpose of this study was to evaluate privacy level of elderly patients in educational and medical centers of Ahvaz Jundishapur University of Medical Sciences. This cross-sectional study was performed on 230 elderly patients hospitalized in internal and surgical wards of educational and medical centers of Ahvaz Jundishapur University of medical sciences. Data were collected by a researcher-made questionnaire. The questionnaire was prepared in two dimensions of psychological with 11 questions and physical with 18 questions. Validity of the questionnaire was evaluated by experts and professors. Results showed that 62.2% (143 people) of the patients were female and the rest were male. In terms of adherence to privacy, 47.13% of women and 51.75% of men evaluated it as high and 13.79% of women and 20.28% of men evaluated it as poor. The level of privacy in terms of gender of the patient, nurse, and the physician in charge were statistically different (P-value<0.05). However, there was no significant difference between adherence to privacy and age and occupation of patient before retirement, marital status of nurse, and physician in charge (P-value> 0.05). Training of nurses, physicians, personnel, and health care providers to enhance privacy of elderly patients and reinforce supervisory performance of managers and authorities is necessary.