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Viewpoint of Attending and Medical Residents of Shiraz University of Medical Sciences About Disclosure of a Colleague Medical Error
Omid Asemani, Zahra Javadi, Seddigheh Ebrahimi,
Volume 13, Issue 0 (3-2020)
Abstract

Regarding how to make decisions on the revelation of medical errors done by colleagues, investigation of physicians' points of view particularly those in educational settings could help the improvement of circumstances to which we encounter medical errors and thus respecting patient's rights. This cross-sectional descriptive study was conducted through a researcher-made questionnaire after performing face and content validaty and determination of internal and external reliability. The viewpoint of 40 attending physicians and 112 medical residents from different specialties about their inclination to disclose errors, the results of disclosure, the factors influencing on nondisclosure, and the factors decreasing medical errors were asked. Data were analyzed using SPSS v.21. Mean scores of 15.2±1.3 for attending and 12.56±2.05 for residents regarding the dimension of "inclination to disclose others' medical error"; and mean scores of 7.55±0.677 for attending and 9.09±2.01 for residents in terms of "inclination to NOT disclose" were differed significantly (p<0.001). Participants declared the head of medical department/ward as the best authority for managing and dealing with medical errors as the best approach for disclosure of the errors through attendance of the senior physician accompanied by the physician who has made the error. Urban general physicians, nurses, and first-year residents were reported with the most frequency of the errors. The data can be used for the promotion of the patient's rights and the perspective of the medical team when encountering errors done by a colleague, rightfully, and protectively. Building cultural, legal, and social contexts will be the mission of the educational-medical settings aimed at making possible a scientific and skillful error disclosure.


Cultural Considerations in Physician-Patient Relationships, With an Emphasis on Electronic Health Record
Maryam Zahedi, Sedigheh Mohammadesmaeil, Mohsen Banihashemi, Mansour Sharifi,
Volume 13, Issue 0 (3-2020)
Abstract
Good and healthy communication between physician and patient is cornerstone of a complete medical care that has long been considered in sociology. From the classical point of view, the physician-patient relationship as a unique relationship encompasses a wide range of cultural and social influences. Electronic health record not only has facilitated the treatment and diagnosis process, but also has promoted the health care system by organizing patient records; however, it alters the physician-patient relationship process culturally and it will create new ethical challenges. Based on current findings and analyses Opinions of health experts about the cultural and communication dimensions of this technology, the electronic health record, despite its effectiveness, easy and convenient diagnosis, awareness of other physicians' diagnosis, earlier and better treatment, has cultural obstacles such as security, reduction of emotional and face-to-face actions, and fear of social stigma. Having a suitable cultural context and information and awareness can affect development of health technology. The results of this study, which have identified the role of culture on physician-patient relationships in context of using electronic health record, shows that building trust in patients and changing cultural conditions through education and improving system security can increase the efficiency of this system in health care processes.

Assessing the Compliance of Medical Affairs with Religious Standards from the Viewpoint of Patients and Interns in Teaching Hospitals Affiliated to Ahvaz University of Medical Sciences In 2020
Sasan Moogahi, Farkhondeh Jamshidi, Negar Parvizi, Ali Mohammadi Sepahvandi,
Volume 14, Issue 0 (3-2021)
Abstract
In medical centers, compliance of personal and social behaviors with ethics and religious standards is very important and requires constant evaluations. Therefore, the present study was conducted to determine the compliance of medical affairs with the standards of the Holy Sharia from the perspective of patients and interns in the teaching hospitals of Jundishapur University of Medical Sciences in Ahvaz in 2020. This was a descriptive cross-sectional study and the statistical population consisted of 204 interns and 385 patients referred to the teaching hospitals of Jundishapur University of Medical Sciences in Ahvaz. Sampling was done randomly. Data were collected by data collection form and questionnaire from patients and interns which was collected by the researcher including 17 questions. Data were analyzed by SPSS version20 software and descriptive and inferential statistics. From the interns' point of view, there was a significant difference (P <0.05) between the compliance of medical affairs with the standards of holy sharia in different hospitals and gender, but there was no significant difference in different ages and marital status (P> 0.05). From the patients' point of view; There was no significant difference (P >0.05) between the compliance of medical affairs with the standards of the Holy Sharia based on gender, age, education, marital status, and hospital. From interns and patients point of view, compliance with Holy Sharia standards were 45.1% and 40.5%, respectively. According to the results of the present study, physical space and more medical staff in both genders are required to fully comply medical affairs with the standards of the Holy Sharia in all the examined hospitals.

The Relationship between Perceived Stress and Coping Strategies of the family members of Patients with Coronavirus Admitted to the Intensive Care Units of Ardabil Medical centers
Dariush Azimi,
Volume 14, Issue 0 (3-2021)
Abstract
The widespread and increasing number of deaths due to the Corona virus has caused many psychological injuries, including stress. Therefore, the aim of this study was to study the relationship between perceived stress and coping strategies of the family members of patients with Corona virus admitted to the Intensive Care Unit (ICU) of Ardabil medical centers. The present study is a descriptive-analytical study. Sampling was done by available method among the companions of patients with Corona virus infection admitted to the ICU (between May and September 2020). The number of research samples according to the results of a pilot study was estimated at 462 people. Available sampling method was used for sampling. Data collected included patient demographics, Cohen's Perceived Stress Questionnaire, and the Blinges-Moss Coping Styles Questionnaire. The collected data were analyzed using independent t-test, Mann-Whitney, Spearman and Chi-square tests and one-way analysis of variance by SPSS software version 24. The results showed that the mean and standard deviation of perceived stress were 44.80 ± 5.92 and emotion-oriented and problem-oriented coping styles were 19.08 ± 3.02 and 32.35 ± 5.54, respectively. Spearman correlation coefficient test showed a significant relationship between perceived stress with problem-oriented coping style (r = 0.321) and emotion-oriented coping style (r = 0.113) (p <0.05). This study showed that the companions of coronary patients admitted to the intensive care unit use more emotional coping methods, which results in increased emotional behaviors. Therefore, in order to help the psychological health of coronary patients, it is possible to strengthen the application of problem-oriented coping style by designing and implementing educational and supportive-care programs.

Knowledge of Nursing and Midwifery Students about Patient Rights
Hadi Jalilvand, Mojtaba Abdi, Matineh Pourrahimi, Alireza Jalilvand , Dorsa Tanharo, Negin Vali, Hamed Abbasi Joshaty , Yaghoob Hassan , Somaye Norouzi , Mohaddeseh Alizadeh, Sahar Aghaee,
Volume 14, Issue 0 (3-2021)
Abstract
Human is spiritual dimensions that has legal status in health and disease. The purpose of this study was to evaluate the knowledge of nursing and midwifery students about patient rights in Iran Universities of Medical Sciences teaching hospitals’ in 2017. This study was a descriptive cross-sectional study in 2017 with convenience sampling method. Data was collected by a three-part questionnaire including demographic information, Knowledge about the Patient Rights Charter, and strategies for student information to deal with patient rights. Mann-Whitney and Spearman tests were used for data analysis. A total of 1219 undergraduate students participated in this study. The mean score of students' awareness of the Patient Rights Charter was 13.54±4.45 out of 29 points. 1007 students (82.61%) reported that education about patient right was sufficient. Direct correlation was between patient knowledge awareness score with pre-internship training (r = 0.461) and learning from instructor information (r = 0.512) and there was a negative correlation between self-education (r = -0.151) and other methods of information acquisition (r = -0.067). Given that most students did not consider the educational content taught in the field of patient rights to be effective, it can be concluded that these methods were ineffective and failed to convey the correct information. Therefore, revising of the Patient Rights Curriculum for Nursing and Midwifery students is recommended

With or Without Hijab This Is Not the Problem.
Fariba Asghari,
Volume 15, Issue 1 (3-2022)
Abstract
Many debates and news regarding not providing healthcare services to female patients based on wearing hijab were raised following the woman, life, freedom movement in Iran. In this editorial, the author first has an overview of the cases in which the doctor is ethically allowed to choose her patient, then recommend not to refuse patients based on wearing hijab, putting forward this argument that it can enhance social polarization and make discrimination in access to health care based on hijab a matter of concern to the society which in turn can cause distrust in the medical profession especially in Iran’s current situation. In addition, this editorial emphasizes that the Council of Medicine as the patient advocate should prevent the government limiting the access of women without hijab to health care services.

Identification and Analysis of Organizational-Professional Factors Affecting the Trust Between the Patient and the Physician
Mahshid Safaei, Maghsoud Farasatkhah, Ehsan Shamsi Gooshki,
Volume 15, Issue 1 (3-2022)
Abstract
In the health system, professional problems and organizational obstacles cause patient fatigue, physician exhaustion, and ultimately interpersonal issues between the patient and the physician, including lack of mutual understanding and erosion of trust. Therefore, trust, as the central core of social capital, plays a significant role in the quality of interpersonal and intergroup interactions. The trust between the patient and the doctor and its general expansion requires a set of organizational considerations and professional principles in the health system. The purpose of this qualitative research was to analyze organizational and professional factors affecting trust between the patient and the physician. The data were collected through semi-structured interviews in the health service centers located in Tehran. Using purposeful sampling and snowball, a total of 39 participants were interviewed until theoretical saturation was reached. Using the systematic approach of grounded theory (GT) and ATLAS.ti software, the data were categorized and analyzed in three stages of open, axial and selective coding. The findings show that the professional-organizational components effecting on trust between physicians and patients include three components of "adaptable professional management", "adaptable insurance" and "adaptable policy" and nine sub-components as described in the article. These components are the composing elements of the structure and infrastructure of professional development in health system, which can restore the relationship and interaction based on trust between the patient and the physician in health system. The other strategic researches are needed to develop strategies and executive policies to increase the trust between the patient and the physician.

Exploring Advance Directives and End-of-Life Preferences in Heart Failure Patients: A Systematic Review and Meta-Analysis
Aydin Feyzi, Amirali Soheili, Samira Chaibakhsh, Fidan Shabani, Shiva Khaleghparast,
Volume 17, Issue 0 (12-2024)
Abstract
Advance directives (ADs) are legal instruments that enable individuals to express their healthcare preferences in anticipation of a future loss of decision-making capacity. These directives are particularly important in the context of chronic conditions such as heart failure (HF), a disease marked by progressive functional decline and unpredictable medical crises. ADs help safeguard patient autonomy by ensuring that care aligns with personal values and preferences, especially at the end of life. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to examine the preferences of patients with heart failure regarding life-sustaining treatments and end-of-life decision-making. A comprehensive literature search was performed across PubMed, Scopus, and Web of Science databases, covering publications up to March 2024. Search terms included "advance directive," "advance care planning," "heart failure," and "end-of-life decision-making." Studies were included if they were original, peer-reviewed, full-text articles focusing on HF patients aged 18 and older. Non-peer-reviewed works and inaccessible full texts were excluded. A total of 25 eligible studies were identified and appraised using the NIH quality assessment tool. Extracted data included demographic characteristics, preferences for treatment, surrogate decision-making, and educational interventions. Findings from the reviewed literature reveal consistently low levels of awareness and completion of ADs among HF patients. Completion rates varied significantly across studies, reflecting potential cultural and systemic influences. Preferences for surrogate decision-makers overwhelmingly favored family members over healthcare professionals. A notable finding from Jawahri et al. (2016) indicated that patients who received video-based education were significantly less inclined to choose cardiopulmonary resuscitation (CPR) or mechanical ventilation compared to those receiving only verbal information. Additional qualitative insights, such as those from Formiga et al. (2004), showed that patients prioritized maintaining dignity, independence, and meaningful relationships over merely extending life. These patterns highlight the necessity of aligning care with patients’ broader goals and values. Across the 25 studies included, a total of 4,091 heart failure patients were analyzed, with a mean age of 68.22 years. Meta-analytic findings demonstrated diverse preferences regarding life-sustaining interventions: approximately 53.73% of patients favored such treatments, while 45.37% declined CPR. These statistics underscore a substantial variability in end-of-life preferences, further reinforcing the need for individualized care planning. In conclusion, patients with heart failure display heterogeneous preferences concerning end-of-life care, shaped by cultural context, personal values, and the type of information provided. Despite the established importance of ADs, significant deficits in awareness, understanding, and documentation persist. These findings point to a critical need for tailored educational interventions, improved provider-patient communication, and culturally sensitive approaches to advance care planning. Future research should focus on designing and integrating standardized AD facilitation tools into routine clinical practice to support truly patient-centered care.

COVID-19: An Opportunity to Restore Lost Trust? A Narrative Review of Trust Trends Before and After the Pandemic
Hanieh Karimi, Ali Farahmand Asil, Saeedeh Saeedi Tehrani,
Volume 17, Issue 0 (12-2024)
Abstract
Trust between doctors and patients is a cornerstone of improved health outcomes and quality medical care. However, this trust has eroded in recent decades due to various factors. The global crisis of the COVID-19 pandemic presents a unique opportunity to examine and analyze changes in public trust towards the healthcare system. This narrative review explores the state of public trust in healthcare before and after the COVID-19 pandemic, analyzing the factors influencing this trust and proposing strategies for its maintenance and rebuilding. A narrative review was conducted, with information gathered from searches in reputable national and international scientific databases like PubMed, ScienceDirect, Springer, and Scopus. Relevant articles from Iranian databases such as Magiran and IranMedex were also included. The review focused on the components of trust, factors affecting it, and challenges faced by the healthcare system during the pandemic. The review revealed significant changes in the components of trust in doctor-patient relationships due to the COVID-19 pandemic. Prior to the pandemic, public trust in physicians had been declining due to factors such as perceived inequities in treatment, medical errors, and unprofessional behavior by some healthcare professionals. For example, surveys indicate a decline in public trust in healthcare professionals in the United States, dropping from 73% in 1966 to 34% in 2012. The COVID-19 pandemic significantly exacerbated this decline, with many people distrusting governmental institutions, pharmaceutical companies, and media outlets perceived to be providing misleading information. A study in Poland found that 31% of respondents viewed the pandemic as an exaggerated threat, while 3% considered it entirely fictional. However, the dedicated service and transparent communication of some institutions and healthcare personnel during the COVID-19 crisis partially restored public trust. This led to the emergence of a concept known as "dual trust," where people not only trust individual physicians but also pay closer attention to the overall performance of the healthcare system and governments. Dual trust has implications not only for the quality of healthcare services but also for the success of prevention and treatment programs. The COVID-19 crisis has had a profound impact on public trust in the healthcare system. To maintain and rebuild this trust, effective measures are essential. These measures should focus on enhancing service quality, fostering scientifically informed citizens, ensuring transparent communication, and promoting positive interactions between doctors and patients.

Ethical Challenges of Truth-Telling for Terminally Ill Patient
Neda Yavari ,
Volume 17, Issue 0 (12-2024)
Abstract
Communicating the truth about a terminally ill patient’s diagnosis and prognosis is a profound ethical challenge in healthcare. While patients have the right to know the details of their medical condition, grounded in the ethical principle of autonomy, healthcare providers often grapple with concerns about causing distress or hopelessness. These concerns sometimes lead to paternalistic approaches where information is either manipulated or withheld from patients in end-of-life stages. Research on the timing, method, and extent of information sharing with terminally ill patients has yet to reach a consensus. The challenge is further complicated by cultural differences regarding death, as well as varying family and social dynamics. This article explores the views and experiences of both healthcare providers and patients regarding the ethical challenges associated with truth-telling in end-of-life care. This qualitative study involved semi-structured, in-depth interviews with 27 healthcare providers, 20 patients, and 15 caregivers. Participants were selected through purposive sampling, and interviews were conducted until data saturation was achieved. The data were analyzed using conventional content analysis. The findings were organized into four key themes:
1.Diverse methods of truth-telling employed by healthcare providers, influenced by personal values, institutional policies, and cultural contexts.
2.Patients’ and families’ preferences for receiving information, which frequently conflicted with healthcare providers’ practices.
3.The impact of timing, manner, and setting of truth-telling on the emotional health of both patients and their families.
4.The necessity for a patient-centered approach that acknowledges the unique circumstances, values, and preferences of patients and their families.
This research highlights the ethical complexities involved in truth-telling for terminally ill patients. While respecting patient autonomy is fundamental, the manner and timing of delivering the truth are crucial to maintaining trust in the physician-patient relationship and safeguarding the patient’s mental health. Further research should focus on developing effective communication strategies and support systems for healthcare providers engaged in end-of-life care. Educational programs should prioritize improving communication skills, cultural sensitivity, and ethical decision-making to enhance best practices and alleviate the emotional challenges faced by healthcare professionals in this sensitive area.

The Importance of Patient Autonomy in Home Care: A Systematic Review
Mohammadreza Jalilfar, Hedayat Jafari, Fatemeh Roudi, Seyed Tohid Hoseini, Soodabeh Eslami, Seyed Mohammad Mirshafiei,
Volume 17, Issue 0 (12-2024)
Abstract
With the increasing need for home nursing care, patient autonomy emerges as a crucial ethical principle in delivering care services. Therefore, this study aimed to investigate the importance of autonomy and individual independence in home-based patient care. In this systematic review, articles from PubMed, Scopus, ScienceDirect, Magiran databases, and Google Scholar search engine, published within the last 10 years, were used to search for articles related to autonomy and independence in home nursing care. The keywords used in the search were: "patient autonomy", "home nursing care", "nursing ethics" and "autonomy in nursing home care".  After reviewing and filtering the articles based on the study's objectives, 20 articles related to autonomy in home nursing care were included in this systematic review. The findings of these studies indicated that various factors can influence patient autonomy at home-care, including: · Individual factors: age, gender, physical and mental health status of the patient; · Family factors: family support, family relationships, family culture; · Social factors: social support, access to social resources; · Organizational factors: care policies, organizational structure, organizational culture.  Considering these findings and their comparisons, it can be concluded that to promote patient autonomy at home, all the mentioned factors should be considered. Some of the suggested solutions to promote patient autonomy are: · Educating the patient and family about patient autonomy; · Strengthening family support for the patient; · Providing social support services to the patient; · Developing care policies that support patient autonomy; · Improving organizational structure and culture.  Patient autonomy is one of the essential ethical principles in home nursing care. Considering the factors affecting patient's autonomy, comprehensive solutions should be considered to promote it. Patient and family education, strengthening family support, providing social support services  and improving organizational structure and culture are among the effective solutions in this field.

Financial Relationships and Conflicts of Interest Between Physicians and Patients: Guideline to Professional Ethics for Medical Practitioners, Medical Council of Islamic Republic of Iran
Saeed Biroudian,
Volume 17, Issue 0 (12-2024)
Abstract
Conflicts of interest, particularly financial ones, pose a significant ethical challenge in the medical field. They can compromise clinical decision-making, erode patient trust, and ultimately diminish the quality of healthcare. This study reviewed ethical documents and guidelines published by the Medical Council of the Islamic Republic of Iran, including the Charter of Rights for the Medical Community. A comprehensive review of relevant scientific literature on conflicts of interest in healthcare was also conducted. The analysis revealed that financial relationships between physicians and external entities, such as pharmaceutical companies, can create conflicts of interest that negatively impact patient care. These conflicts can erode patient trust and lead to suboptimal clinical decisions. The Medical Council's ethical guidelines address these concerns by emphasizing the importance of transparency regarding financial ties and relationships. They advocate for the disclosure of such relationships to patients and the implementation of educational programs to enhance physician awareness of ethical principles and conflict-of-interest management strategies. Adherence to the ethical guidelines established by the Medical Council of Iran is crucial for effectively managing conflicts of interest in the physician-patient relationship. By prioritizing transparency, disclosure, and ongoing education, healthcare professionals can mitigate potential conflicts and maintain the highest standards of ethical conduct in patient care.

Exploring the Concept of Patient Advocacy
Reza Negarandeh ,
Volume 17, Issue 0 (12-2024)
Abstract
Patient advocacy is a cornerstone of ethical healthcare practice, encompassing actions that protect patient rights, uphold their autonomy, and ensure they receive high-quality care. Nurses are often seen as being in the best position to play this vital role. This conference abstract aims to provide a comprehensive understanding of patient advocacy and identify strategies for enhancing advocacy practices in healthcare settings. In this comprehensive review, scientific literature, including peer-reviewed articles, professional guidelines, and relevant policies, was retrieved and reviewed. Data extracted from the literature were synthesized using quantitative content analysis to identify different forms of patient advocacy, including clinical advocacy and systemic or workplace advocacy, as well as strategies to improve the necessary skills for each. Clinical advocacy involves ensuring patient safety, supporting informed decision-making, and advocating for appropriate pain management. Improving clinical advocacy requires a multifaceted approach that prioritizes building trust and rapport with patients to foster effective communication and shared decision-making. Encouraging patient participation in their care, supporting self-management strategies, fostering effective communication within the healthcare team, and staying informed about relevant ethical, legal, and policy developments are essential components. Workplace or systemic advocacy, on the other hand, focuses on addressing broader issues within the healthcare system that impact patient care. Improving systemic advocacy involves identifying and analyzing systemic issues, such as healthcare disparities, resource limitations, and policy barriers, through data collection, stakeholder engagement, and thorough analysis. Strategies to address these issues include policy advocacy, improved resource allocation, and quality improvement initiatives. Building strong partnerships with other healthcare professionals, community organizations, and policymakers is key. Additionally, promoting education and awareness within both the healthcare workforce and the public is crucial. Leveraging technology to enhance data collection, communication, and mobilization efforts can further support systemic advocacy initiatives. By implementing these strategies, healthcare professionals can effectively advocate for systemic change, improve the quality of care for all patients, and create a more equitable healthcare system. Patient advocacy is a dynamic and multifaceted role that requires continuous learning and adaptation. By embracing the principles outlined in this synthesis, nurses can effectively champion patient rights, improve the quality of care, and contribute to a more equitable healthcare system.

Survey on Measuring Patients' General Trust in Doctors
Fatemeh Sadat Asgarian, Ali Saber, Sare Bagheri,
Volume 17, Issue 0 (12-2024)
Abstract
Trust is one of the most important aspects of human relationships, providing the foundation for participation and cooperation among individuals. It is also one of the most valuable social assets within the healthcare system. If trust is disrupted, it can impose significant costs on the system. The purpose of this study is to measure the level of patients' trust in doctors and its impact on the treatment process at Shahid Beheshti Hospital, Kashan. In this study, 325 patients referred to the emergency department of Shahid Beheshti Hospital in Kashan were selected. After applying the inclusion and exclusion criteria, 310 participants remained in the study. The General Trust Instrument was used for this research. This questionnaire consists of 33 questions covering six dimensions: patient-centered care (6 questions), macro-level patient care policies (6 questions), provider expertise (4 questions), quality of care (9 questions), communication and information provision (6 questions), and quality of collaboration between providers (2 questions). Scores ranged from 0 to 100, categorized as follows: 0–20 indicates very low trust, 20–40 low trust, 40–60 moderate trust, 60–80 high trust, and 80–100 very high trust in healthcare. Out of the 310 participants, 157 (50.6%) were male, and 153 (49.4%) were female. The mean age of the patients was 56.6 ± 20.6 years. Among the patients, 178 (57.4%) had acute illnesses, while 132 (42.6%) had chronic illnesses. The mean and standard deviation of the total score for the General Trust Questionnaire was 95.59 ± 13.8. This study demonstrated that the general trust score of patients in the doctors at this center is high. In delivering healthcare, interventions alone are insufficient; improving the quality of services is essential to enhance patient trust and satisfaction.

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.

Cutting the Financial Relationship Between Doctor and Patient: A Key Solution to Health Ethics Challenges
Mohsen Rezaei Adaryani,
Volume 17, Issue 0 (12-2024)
Abstract
The relationship between healthcare providers and patients is often marred by financial issues, which present significant ethical challenges. These financial interactions can be categorized into direct and indirect communications, both of which give rise to various ethical dilemmas. In direct financial communication, issues such as under-the-table payments, fee splitting, self-referral, inappropriate referrals, induced demand, and unnecessary surgeries or hospitalizations are prevalent. These practices compromise the ethical standards of medical care. On the other hand, indirect financial communication occurs when a small portion of the healthcare cost is paid by the patient, while the majority is covered by intermediary institutions like insurance companies or the Ministry of Health. The family physician system, with accurate patient referrals and cost management, supports this model. Under such a system, service tariffs align with actual costs, creating "real" tariffs, and reducing opportunities for many ethical challenges to arise. The current health system provides practical examples of the disconnection of financial relationships, notably through policies such as the Accident Insurance Law (Article 92 of the Fourth Development Plan) and the family physician system within the Imam’s Relief Committee. Health centers involved in treating injured patients and staffed with experienced personnel have observed and reported significant improvements following the implementation of the Accident Insurance Law, highlighting the positive impact of financial disconnection on healthcare ethics. This study demonstrates that cutting financial ties between doctors and patients, through indirect financial communication models and accurate referral systems, is an effective solution to addressing a wide range of ethical challenges in healthcare.

The Effect of Using Student Reflective Narratives to Observe Dignity and Respect for Patients’ Rights in Clinical Education
Hoda Ahmari Tehran, Ahmad Mashkoori, Tayebeh Ilaghinezad, Maryam Tajadini,
Volume 17, Issue 0 (12-2024)
Abstract
Research shows that stress in medical students leads to burnout and a loss of respect for patients’ rights. These declines in mood and an increase in malpractice are particularly evident during the internship period. On the other hand, literature highlights the importance of reflective practice in education. This study investigates the effect of using student reflective narratives on observing dignity and respect for patients’ rights in clinical education. A mixed-methods study based on reflective learning theories (Gibbs' Reflective Model) was conducted over 12 months with 48 intern students. In a quasi-experimental design, 38 medical students were randomly assigned to either an intervention or a control group. Only students in the intervention group were allowed to engage in conversations with patients and inquire whether they had properly respected the patients’ rights and dignity. The students then reflected on their performances. In the first week, a pretest was conducted in both groups. The intervention group received reflective education and participated in reflection writing during the second and third weeks. In the final week, a post-test was conducted for both groups. To explore students’ perceptions of the effectiveness of reflecting on their performance, a qualitative content analysis was carried out, including 12 semi-structured interviews and 144 reflection notes. The mean scores of students’ performance regarding respect for patients in the intervention group improved significantly in the post-test (12.32 ± 1.21) compared to the pretest (9.85 ± 1.39) (p < 0.05). An independent t-test indicated that the difference in post-test scores between the two groups was significant (p = 0.01). From the interviews, four main themes emerged: improving empathy and understanding patients’ feelings, paying attention to patients’ humanistic dimensions, respecting patients’ autonomy and rights, and promoting interpersonal communication skills. This study demonstrated the positive emotional effects of reflective narrative writing interventions on medical students in observing dignity and respecting patients' rights. It is recommended to incorporate reflective narratives into medical education programs to enhance these qualities.

Assessment of Compliance with the Patients’ Rights Charter by Healthcare Staff from the Perspective of Hospitalized Patients in Shahid Rahnemoon Hospital, Yazd
Tahereh Shafaghat, Elahe Rahmani Samani, Elnaz Haiery, Atiyeh Dehghan Niri, Zahra Raisi,
Volume 17, Issue 0 (12-2024)
Abstract
An efficient healthcare system relies on active participation and a strong relationship between healthcare providers and recipients. Observing the Patients’ Rights Charter is an essential aspect of delivering high-quality healthcare services. However, the existence, formulation, and dissemination of the charter do not ensure its implementation and compliance. Therefore, evaluating adherence to the charter is critical. This study aimed to assess compliance with the Patients’ Rights Charter at Shahid Rahnemoon Hospital, Yazd. This applied, descriptive-analytical study was conducted cross-sectionally at Shahid Rahnemoon Hospital, Yazd, in 2024. The study population included all hospitalized patients in the hospital. Cluster random sampling was used, and a standardized questionnaire developed by Parsapour et al. measured adherence to the Patients’ Rights Charter. Data analysis was performed using the Mann-Whitney and Kruskal-Wallis tests via SPSS software version 26. The findings revealed that patients perceived an average level of adherence to the Patients’ Rights Charter in Shahid Rahnemoon Hospital (mean ± SD: 53.99 ± 11.10). The highest compliance was observed in the domain of respect for patients and protection of privacy (mean ± SD: 78.12 ± 2.65), whereas the lowest compliance was reported for the existence of a complaint resolution system (mean ± SD: 2.97 ± 1.74). Patient satisfaction, a vital indicator of healthcare quality, is closely linked to the observance of patients’ rights. To improve compliance, it is recommended to:
1. Raise staff awareness about the importance of adhering to patients’ rights.
2. Educate patients about their rights through staff training and media campaigns.
3. Develop plans by hospital management to address areas of non-compliance.
4. Foster greater collaboration between staff and patients.
5. Follow up on violations of patients’ rights and implement legal measures to ensure compliance.
6. Regularly monitor adherence to patients’ rights to enhance patient satisfaction and staff commitment to ethical practices.

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.

Attitudes of Medical Students Toward Patient-Centered Care at Iran University of Medical Sciences in 2023-2024
Amirmahdi Taromiha, Saeedeh Saeedi Tehrani, Soodabeh Hoveidamanesh, Mahshad Noroozi,
Volume 17, Issue 1 (3-2024)
Abstract
Patient-centered care, which prioritizes patients' needs, values, and preferences, is a cornerstone of modern healthcare delivery.  This study aimed to evaluate the attitudes of medical students at Iran University of Medical Sciences toward providing patient-centered care. This cross-sectional study included medical students in all academic degrees at Iran University of Medical Sciences. Data were collected through the Patient-Practitioner Orientation Scale (PPOS) distributed online. The collected data were analyzed using SPSS version 26. Of the 389 participants, 48.6% were male and 51.4% were female, with a mean age of 24.02±2.435 years. Moreover, 41.09% of the participants were in the clerkship stage, 40.9% were in the internship stage, and 14.7% had at least one parent who was a physician. The most preferred specialties were cardiology, surgery, and ophthalmology, respectively. The mean scores for the overall PPOS, sharing subscale, and caring subscale were 3.61± 0.50, 3.39± 0.64, and 3.83± 0.56, respectively, indicating a predominantly physician-centered attitude among students. There was a significant relationship between the mean scores of the three parts and gender (P-value<0.001), with female students demonstrating more patient-centered attitudes. Academic degree was significantly associated only with the mean score of the sharing subscale. The findings suggest that most medical students at Iran University of Medical Sciences exhibit a physician-centered attitude toward the physician-patient relationship. The results highlight the need for educational programs to promote patient-centered attitudes and enhance patient participation in diagnostic and treatment processes among medical students.

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