Iranian Journal of Medical Ethics and History of Medicine

Medical errors in pediatrics if different from adults. This study aimed to investigate type and frequency of medical errors and the related contributing factors from pediatric residents' point of view. This descriptive and cross sectional study was done in 2016. After determining validity (face and content) and reliability the final questionnaire with 17 questions categorized in six parts was used for data collection. Data were analyzed descriptively using SPSS v.22. ''Errors of diagnosis or delay in diagnosis' (8.6)', ''choosing appropriate dose (8.3) and medication (8.2)'' had the highest average weights. Fellows of pediatrics (12.6) and pediatrics’ professors (12.1) with the highest average weights had the most dominant role in diagnosis and prevention of errors. The most and the least average weights of the errors was reported for urban general physicians and pediatrics’ professors, respectively. Errors could occur at 2-8 AM more likely. Junior residents were the ones with the most chance of doing errors. Medical errors were mostly reported to occur in the group of children (70.6%) than neonates (29.4%). Reconstruction and strengthening educational and supervision role of pediatric fellowships and attending with the aim of in time diagnosis and then prevention of medical errors could be considered as a must in teaching hospitals. Holding purposeful educational courses and control of contributing factors like workload, exhaustion, inexperience, etc. are among duties of educational and executive managers.
 

According to the important role of family factors in people quality of work and the importance of correct emotional relationship of medical staff in patients' satisfaction and spirits, the aim of the present study was to investigate the relationship between perceived intimacy from the main family and work-family conflict with empathy and addiction to work in the medical staff. This study was a description of correlation type. The statistical population of this study included all the medical staff of medical centers in Bojnourd city in the 2018-19 year. Among them 250 person were selected by available sampling method. For data collection we used main family health Questionnaire, work-family conflict questionnaire, Lamonica empathy scale, and work addiction questionnaire. To analyze the data of this study, Pearson correlation coefficient and regression analysis were used. In order to analyze the data, SPSS software (version 25) was used. The results of Pearson correlation showed that perceived intimacy from the main family had a positive and significant correlation with empathy and negative correlation with addiction to work. Also, the results indicated that there is a significant correlation between work-family conflicts with empathy, but there was not a significant correlation between work-family conflicts and addiction to work. The results of the present study indicate the role of family system and its internal conflicts on empathy with patients and work addiction in hospital staff, which emphasizes the need to pay more attention to the improvement of quality of family life of health care staff.

Obtaining informed consent is for protection of patients' rights. The aim of informed consent is not decreasing physicians' responsibility.Informed consent assists the patient in making a decision concerning their care, improve their satisfaction, and decrease legal litigations. This study examined patients' attitude toward the quality of informed consent and its challenges in educational -clinical settings. Current qualitative research was simple content analysis. Semi-structured interviews were conducted with 15 hospitalized patients who were selected by purposeful sampling method considering type and severity of the disease, gender, age, and satisfaction or dissatisfaction from the management. The data was analyzed using MAXQDA 2007 software. Primary codes and categories were extracted then the findings were presented based on the main. Five themes were extracted from the data: "meaning, importance and status of consent in medicine", "consequences of obtaining consent", "the role of patient and therapist in the process of informed consent", "challenges of making informed consents" and "facilitators in the process of informed consent"; all could define and compile the main theme “doctor, patient, and procedural elements, three pillars of informed consent”. Inadequate explanation to the patient, signing the form prior to read it, lack of trust to the practitioner, disregarding patients' psychologic needs and stress and obtaining the consent by someone other than the physician was among the main reported challenges of informed consent. Correction and standardization of obtaining informed consent's culture requires knowledge about current situation followed by training, enforcement, supervision, encouragement, and punishment.  Collaboration of health care team needs comprehension of necessity and importance of this issue and its consequences.

It is a widely held belief that "health care" is an old concept. As one of the most important institutions dealing with this issue, the hospital has been treating human beings throughout human civilization. But historical studies show that, in the pre-modern era, the hospital was not for the treatment of patients. Its function was as a nursing home for the poor and patients. In this article, we attempt to examine the reasons for this in two ways. We first examine the socioeconomic conditions that led to this function for hospitals in the middle ages. We then show that the treatment of patients at that time was based on humorism and classification medicine, which was not only considered the hospital as a place of treatment but also considered it as a barrier to treatment. Therefore, the hospital served as a hospice for the elderly and disabled, and veterans.
 

Muslims learned how to build a hospital using the experiences of physicians from other nations, especially Iranians, by modeling at Jundishapur Hospital, and this way set up many hospitals. In addition to building a variety of hospitals, Muslims created efficient structures and organized them based on bosses, deputies, stewards, supervisors, nurses, and the like, who served in different parts of hospitals. In Islamic hospitals, male and female physicians with various specialties treated patients regardless of religion or race. Using a descriptive-analytical approach based on library information, this research seeks to answer the question of how the structure and organization of hospitals in Islamic civilization have been. Findings of the present research verify that hospitals in Islamic civilization had a well-organized and efficient structure, and various medical departments. Findings also indicate that the structure and organization of Islamic hospitals have evolved over time.

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.

Failure to follow professional ethics in midwifery will lead to harmful risks, including an increase in maternal and infant mortality. The aim of this study was to investigate the barriers to professional ethics in midwifery clinical care from midwives ’viewpoints in hospitals specializing in obstetrics and gynecology in North Khorasan province in 2018. This cross-sectional descriptive study was performed with the participation of 141 midwives working in specialized obstetrics and gynecology hospitals in North Khorasan province, using classified sampling. The data collection tool was a questionnaire consisting of two parts: demographic information and barriers to professional ethics, in three areas: environmental and managerial and personal care. Data were analyzed using SPSS software version 22 and descriptive and inferential statistics. From the perspective of midwives, all three categories of environmental factors (73.94%), personal care (64.66%) and management (64.97%) were among the barriers to professional ethics. The most important barriers to professional ethics in the managerial dimension are staff shortages (80%), in the environmental dimension, biological changes in the body during work shifts (85.2%) and in the personal dimension, dissatisfaction with basic needs, such as insufficient income or adequate rest in midwifery (80.9%), was. Given the importance of observing professional ethics and the issues and problems arising from non-compliance, it is suggested that managers and officials make the necessary planning by hospitals to remove the barriers mentioned by midwives.

In recent decades, on the one hand, we have faced atmospheric phenomena and environmental changes, and on the other hand, with the emergence of new diseases called emerging diseases. Managing emerging diseases requires an ethical approach to control and care for them. Ethical problems raising from new diagnostic and therapeutic advances in medical science have increased the need to address medical ethics. One of these emerging diseases of the present century, which is faced by almost the whole world and its problems, is coronavirus (COVID-19). The present study was conducted with the aim of assessing attention of medical staff towards ethical considerations in the care of patients with COVID-19. In this study, in addition to the use of articles published in English related to this disease from late 2019 to early 2020, as well as using national researches by different research groups, different dimensions of the disease is reviewed; Interviews were conducted with the COVID-19 recovered patients who were hospitalized in Shahid Sadoughi Hospital in Yazd Province from the beginning of February 2020 to the end of October 2020. Studies showed the need to put ethical considerations in the care of patients with COVID-19 by training health care providers about professional ethics and medical ethics in the pandemic of the virus in order to optimally manage the disease

The rapid spread of COVID-19, lack of standard treatment, time constraints, and lack of resources are challenges around the world. Considering the importance of ethics in providing care to patients with emerging diseases, this study was conducted to explain the ethical challenges in care and treatment for patients with COVID-19. The present study was conducted by qualitative content analysis during 2019. Participants were 22 infectious disease physicians and nurses of COVID-19 care wards with at least five years of experience in hospitals of Mazandaran province. Data were collected through semi-structured interviews based on the purpose and method of snowball after obtaining informed consent from participants and continued until data saturation. Data analysis was performed using Granheim Lundman method. Guba and Lincoln proposed criteria were used for the accuracy and robustness of the study. In the present study, five main themes and 18 sub-themes were extracted. Respect for patients' rights, maintaining patient independence, preventing the effects of stigma and discrimination against patients, lack of comprehensive support, and lack of support and accountability of the authorities were the main ethical challenges in caring for patients during the admission period. According to the findings of the study, solutions to address ethical challenges, protect patients' rights and provide quality care through informed and ethical decision-making to increase patient satisfaction and improve their health are recommended.