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Investigating Patient Rights and Associated Demographic and Hospital Factors Using Approach of Two-Level Linear Regression Models In the Hospitals of Tehran University of Medical Sciences
Khadije Mohammadi, Abbas Rahimi Froshani,
Volume 13, Issue 0 (3-2020)
Abstract
One of the main issues in hospitals is evaluation of efficiency and effectiveness. For this purpose, several indicators are presented, which are known as functional indicators. If the performance of hospitals depends on the patient's demographic characteristics, overlooking effect of hospital indicators, as an effective factor at a higher level on the patient rights, may lead to inaccurate conclusions about these relationships. In such cases, where the data are intrinsically multilevel, the use of multi-level statistical models for this type of data is useful. Samples were collected from eight hospitals of Tehran University of Medical Sciences during 2013 in a two stage cluster. Data on patient rights and demographic information were collected from 375 patients by a questionnaire. The patient's rights rate was measured by multivariate statistical analysis and factor analysis. Two-level linear regression models were used to examine the relationship between patients' rights and some demographic information. The first level was demographic factors and the second level was hospital factors. The results showed that rate of considering patients' rights in hospitals were in moderate level. About 16% of the variance of the dependent variable of patient's rights, which was significant, is due to variations at the higher level of the hospital and other variations at the individual level. Furthermore, variables of bed occupancy, complaint rate, and hospital escape rate at the higher level (Hospital) have a significant impact on the patient's rights.

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.

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.

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.

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.

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.

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.

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