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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.

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.
 

The Effect of Spiritual Intelligence Training on Nurses' Spiritual Care Competency in Patient Care: A Review Study
Mina Kafash Mohammadjani, Mandana Kazemi, Fatemeh Mahboob Bashari,
Volume 17, Issue 0 (12-2024)
Abstract
Spiritual intelligence, defined as the capacity to effectively utilize religious and spiritual resources, plays a crucial role in providing high-quality nursing care. This study aimed to investigate the effect of spiritual intelligence training on nurses' competency in caring for patients. This review study utilized a comprehensive search strategy, including Persian and English keywords (Spirituality, Spiritual Intelligence, Spiritual Care, and Nursing) within the PubMed, Scopus, Google Scholar, and SID databases, covering the period from 2017 to 2023. A total of 21 full-text articles (in English and Persian) were selected and analyzed. The findings revealed that 45% of the nurses assessed exhibited below-average levels of spiritual care competency. Most studies demonstrated a significant positive correlation between spiritual intelligence and nurses' competence in providing spiritual care. Spiritual intelligence fostered the development of nurses' beliefs, personality traits, and a strong desire for personal and professional growth, ultimately enhancing the quality of nursing care. Furthermore, male gender, place of residence, and religious adherence emerged as predictors of nurses' spiritual care competency. Studies consistently highlighted the increased importance of spiritual dimensions during illness and hospitalization, emphasizing the critical need for nurses to provide comprehensive spiritual care.Based on this review, it is evident that ethical challenges exist within nursing care, and some nurses may not adequately address the spiritual needs of their patients. Therefore, promoting spirituality in nursing care through spiritual intelligence training is essential to enhance the quality of nursing practice.
 

Strategies for the Promotion and Development of Socio-Cultural Indicators Affecting Professional Commitment in Nursing Students
Mandana Arash, Nadergholi Ghourchian, Parivash Jafari, Akhtar Jamali ,
Volume 17, Issue 0 (12-2024)
Abstract
Professional commitment is a key indicator of success in the nursing profession. Nursing schools play a critical role in fostering this commitment by instilling the values and responsibilities associated with the profession. Developing a culture of commitment and integrating it as a societal value is essential for cultivating professional behavior in students. This study aimed to identify strategies for enhancing and developing socio-cultural factors that influence professional commitment among nursing students. This applied research employed a qualitative approach. Twenty professional experts were selected through purposive sampling in 2021. Data were collected using semi-structured interviews, guided by the principle of theoretical saturation, and analyzed using content analysis. Six major components were identified as influential strategies: 1. Participation of communication media in the cultural and scientific advancement of the profession; 2. Attention to cultural differences between universities and healthcare centers; 3. Promotion of a culture of commitment in universities and clinical settings; 4. Attention to the alignment between individual culture and professional culture; 5. Attention to ensuring the profession benefits from social support; 6. Attention to the promotion of a culture of work and effort in society. These components were reflected in 20 specific indicators, including: raising awareness, instilling a sense of need, fostering concern among academic communities, educating nurses, resolving cultural conflicts, creating conducive educational environments, employing committed faculty, embedding commitment in the culture and as a duty, aligning individual and professional cultures, promoting social prestige and recognition of the profession, addressing local cultural aspects and gender roles, and enhancing flexibility and participation in social interactions.
The development of professional commitment in nursing students can be significantly enhanced through the promotion of ethical and professional principles and the establishment of a supportive socio-cultural environment. Embedding professional commitment within cultural frameworks contributes to students’ sense of responsibility and its sustainability in professional practice.
 

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.

Nurse's Ethical Challenges During Global Crises: War and Beyond
Fatemeh Roudi, Hedayat Jafari, Mohammadreza Jalilfar, Seyed Mohammad Mirshafiei, Seyed Tohid Hoseini, Soodabeh Eslami,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses are critical healthcare providers during global crises, particularly in situations of armed conflict and war, where they face unique and often overwhelming ethical challenges. These professionals are tasked with making immediate and difficult decisions under extreme conditions. This study aims to thoroughly examine the ethical challenges encountered by nurses during global crises, with a particular focus on armed conflicts and wars. This systematic review analyzed articles sourced from PubMed, Scopus, ScienceDirect, Magiran, and Google Scholar databases, using the following search terms: "nursing ethics," "war," "global crises," "ethical considerations in nursing during war," and "nursing ethics in armed conflicts." Following a thorough review and filtering process based on the study's objectives, seven articles were selected for inclusion. The findings highlight several ethical challenges faced by nurses during wartime. These challenges include: allocating limited resources under dire circumstances, providing care to both combatants and civilians without bias, maintaining patient confidentiality while cooperating with military authorities, and delivering care in hazardous and unpredictable environments. The ethical issues nurses encounter in global crises, particularly in war, include: 1) the tension between professional duty and political or military affiliations, 2) the ethical dilemma of allocating scarce resources in critical conditions, 3) the decision of which patients should be prioritized for treatment, and 4) the significant risks to life involved in providing care in conflict zones. Nursing care during global crises, especially in wartime, presents profound ethical dilemmas that demand rapid and sound decision-making. Adequate training in nursing ethics tailored to wartime conditions, as well as robust support for nurses in these high-pressure environments, are critical to addressing these challenges effectively.

Challenges of People Living with HIV in Equity Access to Health Care
Heshmatolah Heydari,
Volume 17, Issue 0 (12-2024)
Abstract
Acquired Immune Deficiency Syndrome (AIDS) occurs in the final stage of infection with the Human Immunodeficiency Virus (HIV). According to the World Health Organization (WHO), approximately 39.9 million people were living with HIV worldwide as of 2024, with reported global incidence and mortality rates of 1.3 million and 630,000, respectively. In Iran, the prevalence and incidence rates of HIV are reported at 54,000 and 2,400 cases, with an annual mortality rate of 3,200. Access to healthcare is considered a primary goal of the health system, and the Universal Declaration of Human Rights recognizes the right to access health services as a common standard. However, people living with HIV, as a vulnerable group, may face barriers to accessing healthcare services. This study aims to explore the challenges faced by people living with HIV in accessing equitable healthcare. This qualitative study utilized a conventional content analysis approach, conducted between April and September 2024 in Iran. Participants included people living with HIV and healthcare providers, recruited through purposive sampling. Data were collected via 10 face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. Data analysis revealed 406 initial codes, which were then categorized based on similarities and differences into three main categories: 1) Factors related to clients (with subcategories: fear of transmitting the disease to others, poverty, physical problems, unfamiliarity with self-rights, and non-adherence to treatment regimens). 2) Factors related to the healthcare system (with subcategories: discrimination in access to health services, contemptuous attitudes from healthcare providers, incompetency of healthcare providers, fear of virus transmission, disclosure of patient information, negligence of medical centers in identifying infected people, and failure to conduct premarital tests). 3) Cultural factors (with subcategories: non-acceptance of infected people in the general culture, stigma, and discrimination in marriage and childbearing). The rights to access health services, confidentiality of information, marriage, financial protection, and participation in society should be considered essential for people living with HIV. Addressing these issues is crucial for ensuring that individuals with HIV can live with dignity and equal access to healthcare.

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.

Pediatric Nurses' Adherence to Codes of Ethics: A Narrative Review
Naiire Salmani,
Volume 17, Issue 0 (12-2024)
Abstract
Codes of ethics serve as essential guides for nurses in all medical settings to implement ethical principles, and they are especially important in pediatric wards. Given the vulnerability of sick children, it is crucial for pediatric nurses to provide care grounded in ethical codes and guidelines. This study aimed to review pediatric nurses' adherence to these codes of ethics. This review study was conducted by searching for articles using keywords such as “nurse,” “care,” “codes of ethics,” and “children” (and their Persian equivalents) through databases including Google Scholar, PubMed, Scopus, and SID from 2013 to 2024. A total of 1537 articles were retrieved initially. After reviewing the full-text English or Persian articles, 23 were assessed for quality, and 10 were selected for analysis. Pediatric nurses' adherence to ethical codes encompasses several key principles, including respecting the patient's family, establishing trust-based relationships, maintaining the privacy of sick children, demonstrating patience, taking responsibility for errors in patient care, and ensuring non-discrimination between sick children and families. To effectively adhere to codes of ethics in pediatric care, nurses must provide ethical care that is both patient-centered and family-focused, using ethical principles as a foundation for their practice.

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