Iranian Journal of Medical Ethics and History of Medicine

Moral sensitivity is one of the most important factors in improving the quality of nursing cares and nurses' performance. This research aimed to determine the relationship between moral sensitivity and self- efficacy in operating room nurses affiliated to educational- therapeutic centers in Ardabil University of medical sciences. This descriptive-correlation study was carried out on a sample of 144 nurses of operating room by census method in 2017. Data were collected by using moral sensitivity standard questionnaire and clinical performance self- efficacy. Data were analyzed using statistical tests: Pearson correlation coefficient, independent t- test and one way ANOVA by SPSS15 software. The mean of nurses' age was 30±6.07 years old. The majority of nurses were female (%54) and majority of them were in operating room discipline (%59). The mean and standard deviation of moral sensitivity score was 87±11.00 and the total self-efficacy was 129±13.00. Pearson correlation coefficient showed a significant statistical correlation between self-efficacy score and moral sensitivity of nurses (P<0.0001, r=0.882). The results of this study showed that moral sensitivity and self-efficiency of operating room nurses is high. Furthermore, it seems that high moral sensitivity increases self-efficacy. However, moral sensitivity and self-efficacy of nurses can be improved by holding ethical and professional workshops.

Science considers using technologies for treatment of infertility as the important cause of multifetal pregnancies. Fetal reduction is a clinical procedure developed for reducing the number of fetuses in multifetal pregnancies in order to avoid their common complications. Three aims may be offered for fetal reduction: (1) pregnancy preservation, and prevention of and decreasing risks of multifetal pregnancy to the mother and the remaining fetuses (high-end multifetal reduction); (2) eliminating fetuses bearing certain kind of illnesses (selective reduction); and (3) just preventing multiple birth where no considerable risk threatens the mother or the fetuses (elective reduction). Moral evaluation on fetal reduction techniques varies depending on which of the mentioned aims is followed. However, in many cases this is “medical necessity” that morally justifies the reduction. Nevertheless, given the difficulty of reaching a decision on this issue, risks involved in fetal reduction procedure, and its psychological implications for the mother and the father, it is seriously recommended to avoid such an action by methods that prevent multifetal pregnancy.

Moral intelligence as a dimension of intelligence can provide a framework for the proper functioning of human. This function can be effective in the clinical environment such as dentistry. Therefore, the present study examined ethical intelligence of the first and sixth year dental students in the Tehran University of Medical Sciences. The present cross-sectional study was conducted in 2018 among 106 of the first and sixth year dental students. The students were selected by census sampeling and the Lennic & Kiel's Ethical Intelligence Questionnaire were used for data collection. The variables were analyzed by SPSS-Ver.22 software using descriptive and analytical statistical tests. Findings of the study indicate that there is no significant relationship between the ethical intelligence of the first and sixth year dental students. Also, in the first year students, only the indirect relationship between ethical intelligence and mother's education (P value = 0.026) and the level of household economic condition (P- value = 0.009) were found. In the sixth year students', only the direct relationship between ethical intelligence and the level of household economic condition was found (P -value = 0.015). This study showed that the ethical intelligence of dental students during education was not significantly improved, which indicates that the educational system not effecient on for promoting ethical intelligence of dental students.

Nurses need to be familiar with the ethical issues of nursing and its sensitivity to all communications and interventions with patients. This sensitivity as a basis for nursing ethics should be considered from the beginning of nursing education. This study aimed to investigate the moral sensitivity of nursing students of Bushehr University of Medical Sciences. This descriptive cross-sectional study was conducted to determine the ethical sensitivity of 73 nursing students using standard questionnaire of ethical sensitivity of nurses in decision-making. Its validity and reliability were confirmed in previous studies (α=0.8). Dimensions of the questionnaire were: amount of respect for patient independence, level of knowledge about the relationship with the patient, level of professional knowledge, experience of difficulties and ethical conflicts, and the use of ethical concepts in ethical decision-making, honesty and benevolence. 0-50 were considered as low moral sensitivity, 50-75 as moderate, and 75-100 as high. All nursing students of the third and eighth semester were enrolled in the census in 2016. The average students' moral sensitivity was moderate (68.15±13.99). The highest average was for "honesty and benevolence", and the least for "professional knowledge" and "the use of ethical concepts in moral decision-making". The average moral sensitivity of the eighth semester students was higher than the third semester. There was a significantly relationship between students' moral sensitivity and academic term (p=0.000). Low ethical sensitivity in nurses leads to inappropriate decision-making; therefore, appropriate educational programs should be considered to increase the moral sensitivity of nurses and nursing students from the beginning of education.
 

Today, health care providers are moving toward becoming professionals, so only academic knowledge and skills are not enough in complex medical environments, morality is an integral part of medical decision making and paying no attention to it may have adverse effects on quality of care. This Research investigated the moral intelligence and its relative demographic factors between medical and nursing students. In this descriptive cross-sectional study, 214 students were selected by census sampling. Data were collected by using Kiel & lennik questionnaire which its reliability is reported as r=0.94 and has been validated in previous studies. The mean age of students was 21.79±2.82 years. The moral intelligence mean scores in medical and nurse students were 76.44±7.10 and 74.07±8.26, respectively. There was no significant relation between demographic factors and moral intelligence scores but there was significant difference among nursing and medical (p=0.025) and the first and last year students (p=0.002). Trustworthy domain was significantly higher in medical students (p=0.003). Although the results indicate that the students' moral intelligence score is in good condition, this situation can be upgraded to be very good and excellent. The significant difference in the score of moral intelligence in first and last year students shows the effect of educational curriculum. There was significant difference in the scores of medical and nursing groups. So, the educational climate and curriculums can effect on moral intelligence development. Therefore, considering the proven effect of moral intelligence on the quality of professional performance, ethical dimensions, and professionalism in clinical education should be emphasized, evaluated, and monitored more than ever.

The human moral or, in other words, his human dignity has long been the subject of discussions among various thinkers. Almost all theories that have addressed this issue are in principle the dignity of man and the supremacy of his position in relation to all beings, but what makes a different perspective on this topic is the criterion of this dignity and excellence. Making essential decisions for the fetus, including preserving the fetus or abortion, is one of the main applications of the principle of human dignity and is directly is influenced by its human and ethical status. Two groups of theories have focused on the issue of the dignity of the fetus: secular theories and theories based on religions and schools. The secular ideas, have some attractions that human intuition accepts them to some extent, but none is free of criticism, and the critique of each theory is all remarkableness and worthwhile. Hence, this article, while it is reviewing some of the secular views and the views of religions and schools on the status of the embryo and addressing some criticisms of them, provides the dominant human-being theory of fetus based on Shi'a thought and introduces the valuable position of man from fetal times. Finding the root of human dignity by relying on human thought and without resorting to revelation inspiration is faced to serious challenges. Human embryos, due to the ability to become human, have been at the beginning of being a valuable place that increases the value of fetal age when it increases its age so that it is not worthy of human dignity with God's soul. But because its granting by the Lord on the basis of the religious teaching perception, the egg cell should not only be eliminated, but also should be taken care of and protected due to its potential to become human

Several definitions for medical futility has been proposed in the literature. Medical futility is defined as the condition in which an intervention, either for diagnosis, prevention, treatment, rehabilitation or other medical goals, has no benefit for the individual patient. This critical review aimed to increase the understanding of physicians and other healthcare providers on the issue of futility in complementary and alternative medicine (CAM). Our comprehensive search resulted in more than 1000 studies; unrelated studies were excluded by title and abstract screening, then 219 full-texts were read and finally, 118 studies were included. The conclusion concerning whether or not it is morally acceptable to provide a futile treatment in CAM, becomes a controversial issue based on different approaches. Using futile treatments is not acceptable according to the duty-based approach, and the principle of justice. In contrast, the case-based approach  and the principle of autonomy of the patient, hold that such treatments could be morally acceptable. Based on utilitarianism, only evidence-based treatments can be morally discussed, and those CAM therapies that have been shown to be futile, should be prohibited; thus health care providers must not offer them to patients since it would be a kind of deceit. We suggest that more comprehensive studies should be performed to clarify the boundary between placebo, nocebo, and futility.

One of the most common ethical issues in nursing profession is moral distress which causes discomfort and impedes nurses proper moral performance, despite having sufficient knowledge. Moral distress disturbs the relationship between nurse and patient which leads to the decreased quality of care. Caring behaviors greatly contribute to improving the quality of care and patient safety. The present study aimed to determine the correlation between moral distress and caring behaviors of nurses in intensive care units of Bandar Abbas hospitals in 2018. This was a descriptive correlational study that was performed on 173 nurses working in ICU and NICU departments of Bandar Abbas hospitals. The data collection tools were demographic information questionnaire, the moral distress scale of nurses of intensive care units, and nursing Caring Behaviors Inventory. Data were analyzed using IBM SPSS 20. Moral distress in nurses in the intensive care unit was in the middle range (1.75 ± 0.81 of 4 score). Also, the mean score of nurses' caring behavior was 5.28 ± 0.48 of 6 score which was considered as an acceptable level. There was a significant negative correlation between moral distress and caring behavior (r = -0.150, P = 0.049). Regarding the importance of moral distress, as well as the role of caring behaviors in improving the quality of care of nurses and satisfaction of patients, it seems necessary that nurses get more familiarized with this concept and attempts to provide solutions for coping and reducing moral distress and improving nurses' caring behaviors.
 

To consider ourselves as "lesser evil" and to consider ourselves "holier" are two different categories in evaluating moral action, that its motivation and success rate vary in each other. After reviewing the justification mechanisms in four real situations involving altruistic act, the present study seeks to examine the validity of the current models of the temporality of justification for moral disengagement in terms of inclusion. In addition to verify the common models for categorizing justifications in two situations as "less evil" and as "holier", this examination aims to clarify the moral behaviors of the moral actor and facilitate ethical judgment in a more analytical space. The participants of the study were 71 undergraduate and postgraduate students at Shiraz University selected in convenience method. In order to evaluate how respondents respond to situations which require altruistic action, four realistic situations of altruistic action were designed. The responses and justifications presented by those who didn’t cooperate with the altruistic plan were subjected to direct content analysis. In the face of the altruistic plans of those who refuse, their justifications were in accordance with some of the mechanisms mentioned in the background. However, there were two categories of justification that were not understandable with the categories in the literature. These two categories are named according to their core themes, self-oriented justification, and other-oriented justification. The results implied confirmation of Klein and Epleis’s distinction of motivation toward lesser evil and holier.
 

Undesirable experience as “moral distress” is one of the major issues faced by nurses when making moral decisions. The spiritual dimension is one of the dimensions that influences their moral distress; therefore, this study was conducted with the aim of determining the relationship between spiritual health and the moral distress of nurses working in the emergency departments. In this descriptive-analytic study, 140 nurses working in the emergency departments of the educational and medical centers of Hamedan participated by census sampling. Data were collected through a three-part questionnaire, including demographic information, Paloutzian and Ellison spiritual health questionnaires and Corly moral distress questionnaire. The data was analyzed by Chi-square test and Pearson correlation coefficients using SPSS software, version 16. The mean age of participants was 31.9 ± 7.31 years. The spiritual health score and moral distress of most nurses were moderate. A negative and significant correlation was observed between spiritual health and the severity of nurses' moral distress, (r = -0.200, p = 0.05), meaning that the higher the nurse's spiritual health score, the lower their moral distress. The results indicate that spiritual health is an effective parameter in reducing moral distress in nurses, so it is suggested to pay attention to spiritual’s dimension in promotion of nurses' health.

The aim of the present study was to determine the relationship between sensory processing sensitivity and cognitive-emotional self-regulation by mediating moral characters among students. The study participants were 293 students of different fields and levels of Shiraz University (Medical Sciences and the Ministry of Science) who were studying in the academic year 2018-2019. To measure the variables of study, three high personal sensitivity scales (sensory processing) of HSPS, ethical sources and CERQ-P cognitive adjustment scale were used and to evaluate the proposed research model, structural equation modeling (SEM) was applied by using AMOS software; intermediate relationships were also tested using the Bootstrap method. The results of the structural equation model showed that Cognitive aesthetic sensitivity directly (p <0.01, β = 0.67) and also through positive moral characters (p <0.01, β = 0.26), predict cognitive self-regulation, positive emotion. In other words, people who better understand the subtle differences in the environment try to change the amount and type of emotional experiences; they are also more successful at doing so. On the other hand, the ease of direct and positive stimulation (β = 0.31, β = 0.33) and the mediation of negative moral characters (0 = 0.01, β = 0.12) can predict cognitive-emotional and negative emotional self-regulation; in fact, people with low sensory thresholds are less likely to cope with stressful situations and misbehaviors, and use inconsistent emotional strategies. Finally, positive moral sources directly predict positive cognitive-emotional self-regulation (p <0.01, β = 0.30), and negative moral sources directly predict negative cognitive-emotional self-regulation (p <0.01, β = 0.38).

Moral courage is the ability to overcome fear and performing the right action based on moral beliefs despite the potential danger. Nurses, as moral agents, need moral courage to properly manage moral problems and make a professional commitment to patients. Therefore, the above study was conducted to investigate the moral courage of nurses and related factors. In this descriptive cross-sectional study conducted in 2019, the research population was all nurses working in Baqiyatallah Hospital. After explaining the objectives of the study and obtaining the consent of the research, 220 nurses were selected as available samples. The data collection tool was Sadooghiasl questionnaire. After completing the questionnaire, they completed 187 sample questionnaires. SPSS software was used to analyze the data. The results of the study showed that the mean score of nurses' moral courage was 413.37 with a standard deviation of 46.70. Thirty percent had moderate moral courage and 69.5% had high moral courage. The results of the independent T-test and ANOVA showed that there is a statistically significant relationship between the variable employment status and the moral courage of nurses. Considering the results of this study and the many ethical challenges that exist in the nursing profession, the issue of moral courage and related factors and providing solutions to improve it, should be at the forefront of the health organization and nursing managers.

The health system needs nursing managers with moral reasoning ability to increase the quality of care in the system by adopting an effective leadership style. The aim of this study was to investigate the relationship between moral reasoning ability and leadership style of nursing managers of medical centers affiliated to Jiroft University of Medical Sciences. The present study was a descriptive- correlation cross-sectional study that was conducted in 2020. The population of study was all employed nursing managers, among whom 124 participants with a bachelor's degree in nursing and higher were included in the study by census sampling method. Data collection tools were demographic questionnaires, “Cherisham moral reasoning” and “Hershey and Blanchard leadership style”. Descriptive and inferential statistics and SPSS software version 19 were used to analyze the data. The results of the study showed that the mean score of moral reasoning of nursing managers is (48.10 ±7.04) which is higher than the mean score of the test. Also, the dominant leadership style of managers was selling leadership style 59.68%. The highest average of ethical reasoning of nursing managers was related to participating leadership style (48.44±7.35). There was no significant relationship between moral reasoning ability and leadership style of nursing managers (P >0.05). According to the results of the study, it is recommended to strengthen nursing managers 'efforts to strengthen transformational leadership styles in their managerial behaviors in order to improve leadership effectiveness and increase nurses' job satisfaction and observe ethical decision making.

Moral sensitivity is one of the important criteria in the principles of professional ethics and psychology is the theme of some of its dimensions, thus the aim of this study was to explain meaning of moral sensitivity by emphasizing on its psychological dimensions from the perspective of operating room treatment staff. In this quantitative research, a semi-structured and in-depth interview was conducted with a total of 11 operating room treatment staff. Content analysis was carried out by Strauss and Corbin method. Output of the recent study includes three themes of environmental variables, individual and interpersonal events and problems, and the reciprocal rights of the patient and medical staff. Dimensions of moral sensitivity included degree of respect for the client's independence, level of awareness about how to communicate with the patient, level of professional knowledge, experience of moral problems and conflicts, use of ethical concepts in moral decisions, and honesty and benevolence. Our observations revealed difference between views of the staff from various dimensions of "moral sensitivity" with what is actually mentioned in the texts. To the extent that many of the interviewees perceived moral sensitivity as something that offends them personally.

Turnover and moral distress are considered as one of the challenges in health care systems. Nursing leaders are one of the factors influencing the thoughts and behaviors of nurses in organizational environments. The aim of this study was to determine the relationship between ethical leadership, moral distress and the turnover intention of nurses working in hospitals affiliated to Kerman University of Medical Sciences in 2019-2020. The research method was descriptive-correlation. A total of 130 participants were enrolled by stratified sampling method from 3 hospitals. Data were collected using demographic information questionnaires, Ethical Leadership in Nursing, moral distress, and turnover intention. Then data were analyzed using descriptive and inferential statistics by SPSS software version 16. The results showed that ethical leadership and all its components were at the desired level. Also, moral distress and intention to leave were moderate. There was a significant negative correlation between ethical leadership and all its dimensions with the turnover intention and moral distress. Also, there was a significant positive correlation between the variables of turnover intention and the moral distress. Therefore, considering the significant relationship between ethical leadership, moral distress, and the turnover, by adopting this type of leadership approach by nursing managers, moral distress and the turnover intention among nurses can be reduced.

Medicine is a profession in which emotional and moral intelligence play an effective role in improving the quality of medical care for patients, mental health, and increasing job satisfaction. The aim of the present study was to investigate emotional and moral intelligence among different physicians. This study was conducted as a descriptive study. The statistical population consisted of all physicians in Mashhad in 2019. Among them, 213 physicians were selected by convenience sampling method and completed questionnaires. The data collection tools were the Bar-On Emotional Quotient Inventory (EQ-i) and the Moral Intelligent Questionnaire. Data were analyzed by Analysis of Variance (ANOVA) and independent t-test. The results showed that among physicians, female physicians, married, over 60 years old, and with a work experience of 30 years and more had more emotional intelligence. The results also showed that physicians over 60 years and a work experience of 30 years and more had higher moral intelligence. Therefore, it can be concluded that educating and selecting medical students and physicians based on measuring emotional and moral intelligence can give them better ability to solve problems and be more resilient when exposing to crises and difficult situations

Since the release of COVID-19 epidemic in late December 2020, recommendations issued for personal protection by the World Health Organization and National Health Organizations around the world. The most prominent of which has the use of masks to prevent the spread of the virus. Despite the importance of this solution, many people still resist using the mask. Therefore, this study, by emphasizing the effect of individual beliefs and norms on consumer behavior, predicts the rate of wearing of mask by people with 4 factors: systemic thinking, individual-social responsibility, moral obligations and individualism. The statistical population of this research consists of citizens of Kashan city. A questionnaire has been used to collect data. The results of the mean tests indicate that women use masks more than men. Also, with increasing age and education, the use of masks has increased. The results of regression analysis test show that 4 predictors had predictive power. The rate of mask use has a positive and significant relationship with the variables of systems thinking, individual-social responsibility, moral obligations and a negative and significant relationship with individualism. Also, moral obligations (β=0.694; p-value<0.05) and systemic thinking (β=0.107; p-value<0.1) had the most and least effect on the criterion variable (mask wearing), respectively. According to the findings of this study, it seems necessary to create and develop a systemic thinking, pay attention to individual and social responsibilities, strengthen moral obligations and avoid individualism in relation to desirable collective behaviors to manage a pandemic crisis. As a result, implementing strategies to enhance these individual characteristics can help can help to strengthen and form desirable collective behaviors such as wearing a mask in the time of COVID-19.

The ethical climate in hospitals can influence nurses' ethical decisions. In other words, in the hospital where the nurse cannot use his moral courage, the patient's rights and interests are gradually ignored. Therefore, the aim of this study was to determine the relationship between perception of ethical climate and moral courage of nurses working in hospitals affiliated to Shahid Sadoughi University of Yazd in 2019. This was a descriptive-analytical study. A total of 204 nurses working in hospitals affiliated to Shahid Sadoughi University of Medical Sciences in Yazd were included in the study by census sampling. Data were collected using demographic questionnaire, Professional Moral Courage (PMC), and Hospital Ethical Climate Survey (HECS) and analyzed by SPSS 18 software. The results showed that the mean score of ethical climate (3.35 ± 0.62) of 5 and the mean score of moral courage was 56.37 ± 5.46 out of 75. There was no significant relationship between ethical climate and moral courage (P≥0.05). Of demographic characteristics, gender had a significant relationship with the mean score of ethical climate (<0.05), but other demographic characteristics did not have a significant relationship with ethical climate and moral courage (>0.05). Considering influence of environments supporting nurses’ moral courage on optimal care to patients, development of plans by managers to promote nurses’ moral courage can lead to beneficial effects.