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Ethical Decision-Making in Pediatric Nursing: Managing Critical and Serious Conditions
Azam Khorshidian,
Volume 17, Issue 0 (12-2024)
Abstract

Nurses are committed to protecting the rights of their patients. However, significant challenges often arise in their communication with physicians and patients. In some situations, nurses feel that patient autonomy is not respected, and sufficient, appropriate information is not provided to patients and their families. These challenges are particularly pronounced in pediatric nursing, as children often cannot fully express their needs. Pediatric nurses must be especially sensitive to the vulnerability of children and their families, actively supporting their welfare and best interests. When a child is suffering from a serious illness or nearing the end of life, the ethical challenges become even more complex. Some of these challenges include:
- How should healthcare decisions be made for these children?
- Who should make these decisions?
- How is the best interest of these children determined?
- Who can best advocate for children's rights?
- When treatment involves life-sustaining therapies (LST), is preserving life more important than ensuring quality of life?
- Who has the authority to transition from therapeutic or life-sustaining interventions to palliative care?

To address these challenges, nursing associations in various countries have developed ethical charters. However, no universal consensus or definitive solutions exist for navigating these complex clinical situations. Consulting experts across different fields and developing comprehensive professional ethics codes can serve as valuable guidance for pediatric nurses making ethical decisions in cases of serious illness.
 


Promoting Ethical Motivation in Health Care Organizations: Ethical Accreditation of Healthcare Service Facilities: A Review Study
Seyed Ali Enjoo ,
Volume 17, Issue 0 (12-2024)
Abstract
Organizational ethics in healthcare literature encompasses a set of complex and interrelated topics. It is regarded as the frontier of medical ethics or the next stage in the evolution of bioethics. To effectively address organizational ethical issues within healthcare organizations, it is crucial to understand both the similarities and differences between competing concepts. Moreover, the presence of financial and contractual concerns often makes it challenging to motivate managers to enhance the ethical climate of their organizations. This study aims to develop a deeper and more comprehensive understanding of organizational ethics in the healthcare system. This review study involved a comprehensive search of the literature on healthcare system ethics, utilizing the following databases: PubMed, Scopus, Web of Science, and CINAHL. Additionally, grey literature from published books on Healthcare Organization Ethics and websites of organizations such as JCAHO and VBN were also included. The search strategy employed a combination of keywords such as 'health ethics,' 'organizational ethics,' 'health organizations,' 'ethical decision-making,' 'manager motivation,' and 'CEO incentives.' Only English-language sources with accessible full-texts were considered. All search results were reviewed, and duplicates were removed. This study offers a comprehensive overview of the existing literature on organizational ethics in healthcare, providing a detailed map of key texts in the field.
 

Modern Care and Ethical Challenges: Emerging Needs and Considerations
Aliasghar Pishdad , Soolmaz Moosavi,
Volume 17, Issue 0 (12-2024)
Abstract
Scientific advancements and emerging technologies in healthcare - such as Artificial Intelligence (AI), the Internet of Things (IoT), and telemedicine -have created unprecedented opportunities to enhance the quality of care. These innovations enable physicians and patients to achieve faster and more accurate methods in diagnosis, treatment, and monitoring. However, they also introduce new ethical challenges that require careful analysis and appropriate solutions. This study was conducted as a Scoping Review aimed at exploring and elucidating various dimensions of modern care. The methodological framework proposed by Arksey and O'Malley, along with its enhancements by Levac et al., was employed. The main steps included:
1. Research Questions
  • The review focused on the following key questions:
  • What is modern care, and what are its main dimensions?
  • What factors and evidence influence the design and delivery of modern care?
  • What are the major challenges associated with modern care?
  • What are the potential strategies to address these challenges?
2. Search Strategy Development
Reputable scientific databases including PubMed, Scopus, Web of Science, and Google Scholar were searched using relevant keywords such as “modern care,” “contemporary healthcare,” “innovative care,” and “advanced patient care.” Boolean operators were applied to refine the search strategy.
3. Study Selection
Inclusion and exclusion criteria were as follows:
  • Inclusion: Articles related to modern care, published within the last 10 years, in English or Persian, addressing challenges, strategies, or innovative care approaches.
  • Exclusion: Studies focused solely on traditional care or lacking full-text access.
  • Initial selection was based on titles and abstracts, followed by full-text screening
4. Data Extraction and Analysis
Key data were extracted using standardized forms, including study characteristics (year, location), definitions of modern care, focus areas, and main findings. A qualitative approach was used for data analysis, and core themes were identified. Findings were categorized into three major areas:
  • Types of Advanced Technologies and Applications in Care
  • Ethical Challenges in Modern Technology Use
  • Proposed Strategies for Addressing Ethical Challenges
1. Artificial Intelligence (AI)
  • AI algorithms assist in analyzing complex data, pattern recognition, and treatment outcome prediction. Their applications are significant in medical imaging, genetic data analysis, and patient outcome forecasting.
2. Internet of Things (IoT) in Healthcare
  • IoT enables real-time monitoring through connected devices, useful in remote monitoring and chronic disease management.
3. Telemedicine
  • Telemedicine provides patients in remote areas or at home with access to healthcare services, reducing the need for in-person visits and enhancing patient comfort.
Ethical Challenges in Modern Care
  1. Privacy and Data Security
    • Modern technologies, especially AI and IoT, require the collection and analysis of vast amounts of sensitive patient data, posing significant privacy risks and opportunities for unauthorized access.
    • Solution: Employ advanced security systems, data encryption, and adherence to privacy regulations such as GDPR.
  2. Automated Decision-Making by AI
    • AI systems may suggest or even make treatment decisions, sometimes without human oversight. This could result in ethically inappropriate decisions that overlook human and emotional aspects.
    • Solution: Ensure that AI-based decisions are supervised by medical professionals and account for human factors.
  3. Accountability and Responsibility
    • Determining responsibility in case of errors or failures in automated systems is complex. Is the medical team liable, or the technology provider?
    • Solution: Develop clear guidelines and legal frameworks outlining responsibilities and oversight mechanisms.
  4. Equity in Access to Advanced Services
    • Advanced care may not be accessible to all, especially in low-income areas or developing countries, leading to healthcare and social inequalities.
    • Solution: Plan for equitable access and provide support to underserved communities.
  5. Use of Genetic Data and Personalized Medicine
    • Although personalized medicine based on genetic profiling improves outcomes, it also raises concerns about genetic discrimination and privacy breaches.
    • Solution: Establish strict laws and ethical standards for handling genetic data.
  6. Changing Roles of Physicians and Patient Trust
    • Automation may diminish the central role of physicians, potentially undermining patient trust.
    • Solution: Reinforce the human element in care and ensure physicians maintain their role as primary decision-makers.
Proposed Strategies to Address Ethical Challenges
  1. Education and Empowerment of Medical Teams and Patients
    • Familiarity with new technologies and their ethical implications helps care teams make informed decisions. Patients should also be aware of their rights and data privacy issues.
  2. Development of Comprehensive Regulations
    • Clear and enforceable legal frameworks that uphold ethical standards and protect patient privacy are crucial.
  3. International Collaboration and Knowledge Sharing
    • Global standard development and sharing of best practices can enhance ethical use of medical technologies.
  4. Establishment of Ethics Committees and Oversight Bodies
    • Ethics committees in healthcare and research institutions can assess and manage emerging ethical concerns. Close monitoring of technology use is essential.
  5. Assessment of Long-Term Impacts
    • Longitudinal studies are needed to understand the long-term consequences of modern technologies, supporting better decision-making.
Modern healthcare technologies offer vast potential for improving quality of life. However, they also introduce new ethical challenges. Addressing these requires integrating ethical principles with scientific innovation and strategic planning. This article underscores the importance of comprehensive legislation, education, and maintaining the human role in medical processes to reduce these challenges and strengthen patient trust in modern care.

The Role of Ethics in Emergency Care for the Elderly
Soolmaz Moosavi ,
Volume 17, Issue 0 (12-2024)
Abstract
The elderly population is rapidly increasing, and as a result, the demand for emergency services for this age group is also growing. Due to their specific physical and mental conditions, the elderly are exposed to numerous ethical issues and challenges when receiving emergency services. These issues are significant because their physical and mental conditions can prevent them from making decisions independently and achieving informed consent. The aim of this article is to examine the ethical challenges associated with the care of the elderly in the emergency department and to provide suggestions for improving this care. This educational narrative review article examines and analyzes ethical challenges in elderly care in the emergency department using reliable sources and articles between 2005 and 2024. Keywords included "medical ethics," "elderly care," and "emergency," and sources were extracted from reliable scientific databases such as PubMed, Scopus, and Google Scholar. Ethical challenges in elderly care in the emergency department include maintaining the independence of the elderly, obtaining informed consent, ensuring privacy and confidentiality, decision-making at the end of life, observing justice and fairness, maintaining honesty, providing psychological and emotional support, offering compassion and empathy, upholding professional principles of education and awareness, communicating effectively with the family, managing pain, and ensuring patient comfort. Although developed countries have long faced the issue of aging, in recent years, the growth rate of aging in developing countries has accelerated. These countries face major challenges in elderly care due to inadequate infrastructure and rapid demographic changes. Ethical challenges in caring for elderly patients in emergency rooms are among the most important issues that healthcare teams face. These challenges are exacerbated by the physical and mental sensitivity of the elderly, the complexities of treatment, and the need for rapid decision-making. Adherence to ethical principles, along with ongoing education of caregivers, can improve the quality of care for the elderly in emergency situations and prevent physical and mental harm. Therefore, in addition to knowledge and skills, caring for the elderly requires adherence to ethical principles and humane behavior. By following these principles, a sense of trust and peace can be fostered in the elderly. Some suggested solutions include educating and raising awareness among healthcare teams, strengthening communication with family and legal representatives, using ethical standards, encouraging the elderly to prepare a medical will, and utilizing psychological and physical assessments.
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.

Factors Affecting Compassion Fatigue in Critical Care Nurses: A Systematic Review
Hedayat Jafari, Fatemeh Ahmadi, Mobina Abedinpour,
Volume 17, Issue 0 (12-2024)
Abstract
Compassion fatigue refers to the physical and emotional exhaustion experienced by healthcare professionals due to prolonged exposure to job-related stress and the emotional demands of caring for others. Compassionate care is vital for achieving better patient outcomes, but various factors during healthcare delivery can compromise it. This study examines the factors influencing compassion fatigue among critical care nurses. This systematic review was conducted by searching databases including SID, Magiran, Irandoc, Iranmedex, Civilica, Science Direct, Web of Science, Embase, PubMed, Scopus, ProQuest, and Google Scholar. Keywords used in the search included “compassion fatigue,” “critical care,” “intensive care,” “nurses,” “compassion satisfaction,” and “burnout.” After removing duplicates, studies were screened based on inclusion and exclusion criteria, and their quality was assessed using the Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Ultimately, 23 studies met the criteria and were included in the systematic review (qualitative synthesis). The studies included in this review were conducted between 2012 and 2024, with a total of 5,820 participants. The review found that both workplace structural factors and demographic characteristics of nurses, such as age, sex, marital status, nationality, educational level, resilience, length of shifts, experience in critical care settings, place of work, position within the unit, and nurse-to-patient ratios, are causes and predictors of compassion fatigue. Leadership and administrative support in clinical settings, as well as the coping strategies employed by nurses, were identified as factors that mitigate the impact of compassion fatigue among critical care nurses. This systematic review highlights the profound impact of compassion fatigue on nurses and emphasizes the roles of workplace environment and demographic factors in its development. The findings underscore the importance of supportive leadership and effective coping strategies in reducing compassion fatigue and enhancing compassion satisfaction among critical care nurses. By addressing these factors, healthcare organizations can reduce burnout, improve nurse well-being, and enhance patient care and clinical outcomes.
 

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.

The Necessity of Social Solidarity and Sustainability Principles in Health System Programs
Mehran Seif-Farshad,
Volume 17, Issue 0 (12-2024)
Abstract
Health care services, in addition to being recognized as fundamental rights in various global human rights declarations, play a crucial role in advancing the development of human societies. The four principles of biomedical ethics introduced by Beauchamp and Childress—autonomy, non-maleficence, beneficence, and justice—are pivotal for ethical analysis and decision-making. However, certain other dimensions, which may not be explicitly addressed within these principles, are essential for policymaking at both macro and micro levels in health care. Two such important principles are social solidarity and sustainability, both of which hold a prominent position in health systems planning. The principle of social solidarity refers to the ways in which unity, cohesion, and collaboration are fostered within a community. A socially cohesive society embraces cultural diversity, respects human rights and the rule of law, and demonstrates a shared commitment to social order and collective responsibility. Social solidarity can significantly reduce health risks by creating a strong societal framework where cooperative efforts foster conditions for well-being, minimizing disability and disease. On the other hand, a health care system is fundamentally responsible for establishing and maintaining a sustainable and high-quality care environment. Sustainability in health services is achieved when ethical obligations—such as maximizing possible benefits, balancing risks against benefits, ensuring fairness (including for future generations), and respecting public rights—are prioritized. Continuity of health care ensures better coordination and improved delivery of services. Disruptions in health policies or intermittent provision of health services can severely undermine public trust. A conceptual understanding of sustainability and continuity in public health ethics is crucial, as these principles ensure that health policies, programs, and services enable access to the highest attainable standard of health, free from economic, social, or political instability. However, sustainability should not imply stagnation; services must remain responsive to the evolving needs of populations and societies. Ignoring these two principles in health policymaking and program design can seriously erode public trust and ultimately harm individual and Health system planning, should be changed to Health care programs.

The Relationship Between Ethical Culture and Job Commitment of Nurses Working in Educational and Medical Centers of Hamadan University of Medical Sciences
Mehran Saadatmand, Abolfazl Ghani Honar,
Volume 17, Issue 0 (12-2024)
Abstract
Promoting an ethical culture is crucial for ensuring job commitment and competent clinical care among nurses. Ethical culture encompasses shared understandings and perceptions that guide ethical conduct within an organization. Job commitment reflects an individual's psychological and emotional attachment to their job. This study aimed to investigate the relationship between ethical culture and job commitment among nurses working in educational and medical centers affiliated with Hamadan University of Medical Sciences. This descriptive correlational study included 170 nurses selected from teaching hospitals in Hamadan using the Morgan table and based on inclusion criteria. Data were collected using demographic questionnaires, the Gobel et al. Ethical Culture Questionnaire, and the Schaufeli Job Commitment Questionnaire. Data analysis was performed using SPSS version 22 software. A significant and positive correlation was found between ethical culture and nurses' job commitment (r=0.42, p<0.05). Ethical culture was significantly higher among nurses with more work experience and female nurses compared to their counterparts. Additionally, job commitment was significantly higher among male nurses and those with formal employment status. The findings demonstrate a strong positive correlation between ethical culture and job commitment among nurses. Enhancing ethical culture within healthcare settings through effective leadership, clear ethical guidelines, and open communication channels can significantly improve job satisfaction and, ultimately, patient care. Further research is needed to explore the specific factors that contribute to ethical culture within different healthcare contexts.

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

The Impact of Professional Ethics Training on the Spiritual Care Competence of Emergency Nurses
Milad Kazemi Najm, Tahereh Toulabi, Abbas Abbaszadeh, Rasoul Mohammadi, Nasrin Imanifar,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses, as the largest group of healthcare workers globally, are responsible for providing holistic care to patients. Holistic care encompasses physical, mental, social, and spiritual dimensions. This study aimed to determine the effect of professional ethics training on the spiritual care competence of emergency nurses. This two-group field trial study with a pre-test and post-test design was conducted with 84 nurses working in the emergency departments of Lorestan University of Medical Sciences. Participants were selected through stratified random sampling. The intervention group participated in four workshops. The study tool was the Spiritual Care Competency Questionnaire. Data analysis was performed using SPSS, employing descriptive statistics (mean, median, and percentage) and inferential statistical tests, including repeated measures ANOVA, independent t-tests, and Fisher’s exact test.
The study included two groups: intervention (n = 42) and control (n = 42). Most participants in both groups were women. A significant difference was observed in the average total spiritual care competence scores and its dimensions (excluding the self-knowledge subscale) over different time points in the intervention group (P < 0.001). However, for the self-knowledge subscale, no significant difference was found in the average scores between the control and intervention groups at different time points. The results of this study demonstrated that professional ethics training improves nurses' spiritual care competence. By conducting workshops, training programs, and in-service courses on professional ethics and spiritual care, the quality of nursing care can be enhanced, ultimately improving patient safety. It is recommended that healthcare policymakers and nursing managers prioritize professional ethics as the foundation of all nursing practices. Employing innovative and engaging methods, such as the scenario-based approach used in this study, can further support the development of professional ethics in nursing.

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

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

Ethical Considerations in Healthcare Policy-Making and National Planning: A Qualitative Study
Peyman Parvizrad,
Volume 17, Issue 0 (12-2024)
Abstract
Healthcare policy-making and national planning are complex processes that require the integration of ethical principles to ensure fairness, effectiveness, and public trust. This qualitative study explores the key ethical considerations that should guide the development and implementation of healthcare policies and plans. A qualitative research design was utilized, incorporating semi-structured interviews with key stakeholders in the healthcare sector, including policymakers, healthcare providers, and patient representatives. A total of 15 interviews were conducted until data saturation was achieved. The interviews were transcribed verbatim and analyzed using thematic analysis. Thematic analysis identified seven key ethical considerations in healthcare policy-making and planning: (1) Equity and Justice – ensuring equitable access to healthcare regardless of socioeconomic status, race, or other demographic factors; (2) Autonomy and Informed Consent – respecting individual autonomy and ensuring informed decision-making in healthcare interventions; (3) Beneficence – prioritizing actions that maximize benefits and minimize harm; (4) Non-Maleficence – preventing harm to patients and communities; (5) Confidentiality and Privacy – safeguarding patient information and ensuring data protection; (6) Resource Allocation – making fair and justifiable decisions regarding the distribution of limited healthcare resources; and (7) Transparency and Accountability – promoting openness in policy decisions and ensuring accountability for outcomes. Ethical considerations play a critical role in shaping healthcare policies and national planning efforts. By integrating ethical principles into decision-making, policymakers and healthcare providers can foster policies that enhance public well-being, equity, and trust in the healthcare system. A structured ethical framework can help ensure that healthcare policies align with societal values and promote justice in health service delivery.

Home-Based Care Ethical Issues and Solutions: A Review Study
Shima Yadegar Tirandaz, Azam Shirinabadi Farahani,
Volume 17, Issue 0 (12-2024)
Abstract
In recent decades, care delivery has shifted from hospital settings to community and home-based care due to factors such as an aging population, cost control, patient preferences, and advancements in technology. While home care offers advantages like patient independence and care aligned with individual values, it also presents unique ethical challenges. These challenges arise from the home environment, which may not be designed for medical care, as well as potential conflicts between the values of patients and care providers. This study aims to explore the ethical issues in home-based care and propose solutions. This review was conducted by analyzing original articles from PubMed, Scopus, WOS, and Google Scholar, using the keywords "Home-Based Care" and "Ethical Issues" until November 2024. A total of 10 studies relevant to the study’s focus were included. The studies identified several ethical challenges in home-based care, including: respecting patient autonomy, establishing trust, managing patient resistance to care, balancing autonomy with benevolence, the risk of harm, justice concerns, limited resources, managing patient expectations, decision-making capacity, disagreements on treatment, access to healthcare providers, caregiver roles, maintaining professional relationships, providing truthful information, conflicts between families and patients, self-medication, medication access, sudden changes in condition, care coordination issues, inadequate treatment due to resource limitations, insufficient psychosocial support, life-saving decisions, communication problems, ineffective care, and cultural conflicts. To address these challenges, the following solutions were proposed: respecting patient values, beliefs, and preferences; supporting patient rights in family conflicts; promoting independence; building trust through respectful communication, empathy, and encouragement; ensuring patient dignity; maintaining healthcare workers' moral obligations; avoiding coercion; adhering to legal and ethical principles; facilitating patient participation; reducing caregiver burden; providing adequate resources; and educating and guiding patients and families. Ethical challenges are inherent in home-based care. If not properly identified and managed, these issues can negatively impact the quality of care. Home care organizations and providers must implement ethical strategies to uphold patients' independence and dignity within their home environment.
 

Ethical Challenges of Nurses in Caring for Patients with Chronic Mental Illness
Alireza Zare, Mohammad Hossein Taklif, Alireza Javid, Zahra Amadeh, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses, as key members of the healthcare team, face complex ethical issues when caring for patients with chronic mental illnesses. These challenges include maintaining confidentiality, obtaining informed consent from patients with limited cognitive abilities, managing conflicts between patient rights and safety requirements, and addressing social stigma. Inadequate attention to these challenges may lead to reduced care quality and psychological stress for nurses. A better understanding of these challenges and the provision of appropriate solutions is essential. This study was conducted through a simple review approach. A comprehensive search was first conducted in PubMed, Scopus, PsycINFO, and Google Scholar databases. Combined keywords such as "ethical challenges," "nursing," "chronic mental illness patients," and "ethical care" were used. Inclusion criteria included studies published in English and Persian from 2010 to 2023, including research, review, and qualitative articles related to the topic. A total of 150 articles were identified, and after evaluating their quality and relevance, 30 articles were selected for final analysis. Data were analyzed using thematic and comparative analysis methods. The findings revealed that nurses face multiple challenges, including maintaining confidentiality when interacting with families, obtaining informed consent from patients with cognitive disorders, and managing ethical conflicts between patient safety and individual freedom. Additionally, a lack of specialized ethical training, the absence of clear protocols, and the pressure from the social stigma of patients were identified as key challenges. The ethical challenges faced by nurses in caring for patients with chronic mental illness require special attention from relevant organizations. Providing continuous education, developing ethical guidelines, and creating psychological and legal support can help mitigate these challenges. Further studies on practical, experience-based solutions to address these issues are recommended.

Nursing Ethics in the Care of Elderly Patients: A Review of Challenges and Solutions
Alireza Zare, Mohammad Hossein Taklif, Alireza Javid, Zahra Amadeh, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
As the global elderly population continues to rise, nursing care for this demographic faces increasing ethical challenges. The elderly are particularly vulnerable, requiring specialized care that addresses their physical, psychological, and social needs. However, these needs often present ethical dilemmas, including issues related to autonomy, informed consent, fairness in resource allocation, and managing conflicts between patients and their families. This systematic review aims to identify the ethical challenges nurses face in caring for elderly patients and to propose solutions that enhance the quality of care. A comprehensive search was conducted across several reputable databases, including PubMed, Scopus, CINAHL, and Google Scholar, using keywords such as "nursing ethics", "elderly", "ethical challenges", and "ethical care". Articles published between 2010 and 2023 in English and Persian were considered for inclusion. After an initial screening, 40 eligible articles were selected for final analysis, and thematic analysis was used to interpret the data. The findings reveal several key ethical challenges for nurses in elderly care, including respecting patient autonomy, navigating decision-making processes in cases of cognitive decline, ensuring confidentiality, and managing family pressures. Additional difficulties include resource shortages, high workload, and limited access to ethics training. Proposed solutions to address these challenges include continuous ethics education, the development of comprehensive ethics protocols, and the formation of interdisciplinary teams to facilitate more informed decision-making. Addressing ethical challenges in elderly care requires robust planning and action from health systems. By establishing clear ethical guidelines, promoting ongoing education, and fostering a supportive work environment, the quality of care for elderly patients can be significantly improved. Further research should evaluate the effectiveness of these strategies in mitigating ethical issues within nursing practice.

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.

Moral Sensitivity Among Nurses in Cardiac Critical Care Units of Selected Hospitals Affiliated with Isfahan University of Medical Sciences in 2024
Safoura Dorri, Seyed Ali Rasooli, Hamideh Hakimi,
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity, defined as the ability to recognize and assess the ethical complexities of clinical situations and make appropriate ethical decisions, is a crucial skill for nurses. Despite its importance, various studies report varying levels of moral sensitivity among nurses, suggesting a gap in this competency. Nurses’ continuous exposure to ethical dilemmas can lead to adverse outcomes, including psychological and moral distress, decreased job satisfaction, and compromised care quality. As moral sensitivity can differ across healthcare settings and may change over time, studies assessing its levels across different periods are essential. This study aims to assess the level of moral sensitivity among nurses in hospitals affiliated with Isfahan University of Medical Sciences in 2024. This cross-sectional descriptive study was conducted with 200 nurses working in cardiac intensive care units (CICUs) of four large hospitals affiliated with Isfahan University of Medical Sciences. Participants were selected using a random sampling method. Data were collected using a demographic information form and the Lutzen Moral Sensitivity Questionnaire. Data analysis was performed using SPSS version 26, employing descriptive statistics such as means and standard deviations. The findings revealed that the average moral sensitivity score among the nurses was moderate (60.17±13.04). When analyzing the different dimensions of moral sensitivity, the highest score was observed in the dimension of "honesty and benevolence" (15.30 ± 4.48), while the lowest score was found in the dimension of "professional knowledge" (3.25 ± 1.88). The mean scores for the remaining dimensions were as follows: "respect for patient autonomy" (7.44 ± 2.13), "awareness of how to communicate with patients" (15.18 ± 3.41), "experiencing ethical problems and dilemmas" (7.74 ± 2.03), and "applying ethical concepts in ethical decision-making" (11.95 ± 3.35). The study revealed that nurses demonstrated a moderate level of moral sensitivity, with the lowest scores in the dimension of professional knowledge. This suggests that nurses may not be sufficiently involving patients in their treatment and care decisions. Given these findings, it is critical for healthcare policymakers and nursing managers to implement continuous assessment and feedback systems to accurately evaluate nurses' moral sensitivity and professional knowledge. By identifying the weaknesses and educational needs of nurses, targeted training programs can be developed, ultimately enhancing nurses' moral sensitivity and improving the quality of care.
 

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.

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